Célia Planckaert1,2, Gabriel Larose2,3, Pierre Ranger4,5, Marc Lacelle2, Alexandre Fuentes2, Nicola Hagemeister6,7. 1. École de technologie supérieure, 1100 Rue Notre-Dame Ouest, Montreal, QC, H3C 1K3, Canada. 2. Laboratoire de recherche en imagerie et orthopédie (LIO), École de techonologie supérieure, Centre de recherche du CHUM, Tour Viger, 900 Rue Saint-Denis, Local R11.322, Montreal, QC, H2X 0A9, Canada. 3. Université de Montréal, 2900 Boulevard Edouard-Montpetit, Montreal, QC, H3T 1J4, Canada. 4. Hôpital Jean-Talon, 1385 Rue Jean-Talon E, Montreal, QC, H2E 1S6, Canada. 5. Hôpital Sacré-Coeur, Canada, 5400 Boul Gouin O, Montreal, QC, H4J 1C5, Canada. 6. École de technologie supérieure, 1100 Rue Notre-Dame Ouest, Montreal, QC, H3C 1K3, Canada. Nicola.hagemeister@etsmtl.ca. 7. Laboratoire de recherche en imagerie et orthopédie (LIO), École de techonologie supérieure, Centre de recherche du CHUM, Tour Viger, 900 Rue Saint-Denis, Local R11.322, Montreal, QC, H2X 0A9, Canada. Nicola.hagemeister@etsmtl.ca.
Abstract
INTRODUCTION: Up to 20% of total knee arthroplasty patients remain unsatisfied post-surgery, and a large proportion of them report anterior knee pain. This study aims to verify whether patients who experience anterior knee pain after total knee arthroplasty (TKA) will exhibit kinematic characteristics similar to those associated with patellofemoral syndrome, including in the frontal and transverse planes. MATERIALS AND METHODS: Using four different assessment methods [radiological, patient-reported outcome, musculoskeletal assessment with functional performance testing, and a 3D kinematic assessment during gait], the clinical and 3D knee kinematic profiles of three groups were compared: a painful and an asymptomatic TKA group and a healthy control group. All three groups underwent a three-dimensional kinematic knee assessment while walking on a treadmill. Prosthetic component rotation was assessed through a CT scan measurement performed by one experienced radiologist. Flexion/extension, ab/adduction, and tibial internal rotation curves were compared, and significant differences were highlighted through ANCOVA analysis performed on SPSS. RESULTS: A total of 62 knees were evaluated, 24 asymptomatic, 21 painful, and 17 control. A dynamic flexion contracture during gait was observed in the painful group, which was associated with a lack of flexibility of the thigh muscles. Moreover, painful TKA cases exhibited a valgus alignment (- 1.5°) during stance, which increases the Q angle and lateralizes the patella. Finally, CT scan evaluation of painful total knee arthroplasty patients revealed that their combined components rotation was in slight internal rotation (- 1.4°, SD 7.0°). CONCLUSIONS: Painful TKA patients presented three well-known characteristics that tend to increase patellofemoral forces and that could be the cause of the unexplained pain: a stiff knee gait, a valgus alignment when walking, and combined TKA components slightly internally rotated.
INTRODUCTION: Up to 20% of total knee arthroplasty patients remain unsatisfied post-surgery, and a large proportion of them report anterior knee pain. This study aims to verify whether patients who experience anterior knee pain after total knee arthroplasty (TKA) will exhibit kinematic characteristics similar to those associated with patellofemoral syndrome, including in the frontal and transverse planes. MATERIALS AND METHODS: Using four different assessment methods [radiological, patient-reported outcome, musculoskeletal assessment with functional performance testing, and a 3D kinematic assessment during gait], the clinical and 3D knee kinematic profiles of three groups were compared: a painful and an asymptomatic TKA group and a healthy control group. All three groups underwent a three-dimensional kinematic knee assessment while walking on a treadmill. Prosthetic component rotation was assessed through a CT scan measurement performed by one experienced radiologist. Flexion/extension, ab/adduction, and tibial internal rotation curves were compared, and significant differences were highlighted through ANCOVA analysis performed on SPSS. RESULTS: A total of 62 knees were evaluated, 24 asymptomatic, 21 painful, and 17 control. A dynamic flexion contracture during gait was observed in the painful group, which was associated with a lack of flexibility of the thigh muscles. Moreover, painful TKA cases exhibited a valgus alignment (- 1.5°) during stance, which increases the Q angle and lateralizes the patella. Finally, CT scan evaluation of painful total knee arthroplastypatients revealed that their combined components rotation was in slight internal rotation (- 1.4°, SD 7.0°). CONCLUSIONS: Painful TKA patients presented three well-known characteristics that tend to increase patellofemoral forces and that could be the cause of the unexplained pain: a stiff knee gait, a valgus alignment when walking, and combined TKA components slightly internally rotated.
Authors: Roman Popescu; Stefan Cristea; Valentin Oleksik; Adrian Marius Pascu; Emil George Haritinian Journal: J Appl Biomed Date: 2021-09-20 Impact factor: 1.797
Authors: Henrik C Bäcker; Chia H Wu; Matthias R G Schulz; Thomas Sanjay Weber-Spickschen; Carsten Perka; Sebastian Hardt Journal: Arch Orthop Trauma Surg Date: 2021-02-06 Impact factor: 3.067