The sense or nonsense of mobile-bearing total knee prostheses
Wolterbeek, N.
Citation
Wolterbeek, N. (2011, November 10). The sense or nonsense of mobile-
bearing total knee prostheses. Retrieved fromhttps://hdl.handle.net/1887/18058
Version: Corrected Publisher’s Version
License: Licence agreement concerning inclusion of doctoral thesis in the Institutional Repository of the University of Leiden
Downloaded from: https://hdl.handle.net/1887/18058
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The sense or nonsense of
mobile-bearing total knee prostheses
ISBN 978-90-9026309-0
Final support was provided by:
Anna Fonds Leiden
Dutch Arthritis Association Stryker SA
J.E. Jurriaanse Stichting
Cover design: Gert Kraaij and Nienke Wolterbeek.
Copyright © 2011, Nienke Wolterbeek, Amsterdam.
All rights reserved. No part of this publication may be reproduced or transmitted in any form or by any means, electronic or mechanical, including photocopying, recording, or any information storage and retrieval system, without permission in writing from the copyright owner.
The sense or nonsense of
mobile-bearing total knee prostheses
Proefschrift
ter verkrijging van
de graad Doctor aan de Universiteit Leiden,
op gezag van Rector Magnificus prof. mr. P.F. van der Heijden, volgens besluit van het College voor Promoties
te verdedigen op donderdag 10 november 2011 klokke 13:45 uur
door
Nienke Wolterbeek
geboren te Amsterdam in 1981
Samenstelling promotiecommissie:
Promotor: Prof. dr. R.G.H.H. Nelissen
Co-promotores: Dr. ir. E.R. Valstar Dr. E.H. Garling
Overige leden: Prof. M. Taylor (University of Southampton, UK) Prof. dr. H.E.J. Veeger (Technische Universiteit, Delft) Dr. ir. J. Harlaar (VU Medisch Centrum, Amsterdam) Prof. dr. A. van Kampen (Radboud Universiteit, Nijmegen) Prof. dr. J.L. Bloem
Our purpose is to explain what may appear to be a paradox: that a condylar replacement prosthesis may best confer stability upon the living joint if it is itself completely unstable.
Goodfellow and O’Connor, The journal of Bone and Joint Surgery, 1978
Aan mijn ouders
Contents
1 General introduction 1
1.1 Development of total knee prostheses . . . 2
1.2 Theoretical considerations for mobile-bearing total knee prostheses . . 4
1.3 Clinical considerations for mobile-bearing total knee prostheses . . . . 6
1.4 Aim of this thesis . . . 7
1.5 Outline of this thesis . . . 7
2 Knee joint kinematics 9 2.1 Normal knee joint kinematics . . . 10
2.2 Knee prosthesis kinematics . . . 11
2.3 Motion of the mobile insert . . . 13
3 Co-contraction in RA patients with a mobile-bearing total knee prosthesis during a step-up task 15 3.1 Introduction . . . 17
3.2 Methods . . . 18
3.2.1 Subjects . . . 18
3.2.2 Experimental protocol . . . 20
3.2.3 Calibration of the EMG force processing . . . 21
3.2.4 Electromyography . . . 21
3.2.5 Kinematics and kinetics . . . 22
3.2.6 Data analysis . . . 22
3.2.7 Statistical analysis . . . 23
3.3 Results . . . 23
3.4 Discussion . . . 26
4 Integrated assessment techniques for linking kinematics, kinetics and muscle activation to early migration: A pilot study 31 4.1 Introduction . . . 33
4.2 Materials and Methods . . . 34
4.2.1 Subjects . . . 34
4.2.2 Tasks . . . 35
4.2.3 Fluoroscopy . . . 35
4.2.4 Electromyography . . . 36
4.2.5 External motion registration . . . 37
4.2.6 Force plate . . . 37
4.2.7 Synchronisation . . . 37
4.2.8 RSA . . . 39
4.3 Results . . . 40
4.3.1 RSA . . . 40
4.3.2 Fluoroscopy . . . 40
4.3.3 Electromyography . . . 41
4.3.4 External movement registration and force plate . . . 42
4.4 Discussion . . . 42
5 Insert mobility in a high congruent mobile-bearing total knee prosthesis 47 5.1 Introduction . . . 49
5.2 Methods . . . 50
5.2.1 Fluoroscopy . . . 52
5.2.2 Electromyography . . . 52
5.2.3 Statistical analysis . . . 53
5.3 Results . . . 54
5.3.1 Fluoroscopy . . . 54
5.3.2 Electromyography . . . 55
5.4 Discussion . . . 58
6 Mobile-bearing kinematics change over time 63 6.1 Introduction . . . 65
6.2 Methods . . . 66
6.2.1 Statistical analysis . . . 68
6.3 Results . . . 69
6.4 Discussion . . . 71
7 Kinematics and early migration in single-radius mobile- and fixed-bearing total knee prostheses 79 7.1 Introduction . . . 81
7.2 Methods . . . 82
7.2.1 RSA . . . 83
7.2.2 Fluoroscopy . . . 83
7.2.3 Statistical analysis . . . 84
7.3 Results . . . 85
7.3.1 RSA . . . 85
7.3.2 Fluoroscopy . . . 86
7.3.3 Axial rotation mobile insert . . . 88
7.3.4 Anterior-posterior translation . . . 88
7.4 Discussion . . . 89
8 No differences in in vivo kinematics between six different types of knee prostheses 93 8.1 Introduction . . . 95
8.2 Materials and Methods . . . 95
8.2.1 Fluoroscopy . . . 96
8.2.2 Statistical analysis . . . 98
8.3 Results . . . 98
8.3.1 Knee flexion angle . . . 98
8.3.2 Axial rotation . . . 99
8.3.3 Pivot point of rotation . . . 100
8.3.4 Anterior-posterior translation of the contact points . . . 100
8.4 Discussion . . . 101
9 Discussion and conclusion 105 9.1 Introduction . . . 106
9.2 Fluoroscopy . . . 107
9.3 Kinematics . . . 108
9.4 Muscle activations . . . 109
9.5 Patella . . . 109
9.6 Motion of the mobile insert . . . 110
9.7 Final Conclusions . . . 111
Bibliography 113
Summary 125
Samenvatting (Dutch summary) 127
List of publications 131
Curriculum Vitae 133
Acknowledgements 135
