Asymmetric polyethylene inserts promote favorable kinematics and better clinical outcome compared to symmetric inserts in a mobile bearing total knee arthroplasty
Purpose This study aims at comparing the effects of symmetric and asymmetric designs for the polyethylene insert currently available and also for mobile bearing total knee arthroplasty (TKA). The investigation was performed both clinically and biomechanically through finite element analysis. Methods...
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| Veröffentlicht in: | Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA sports traumatology, arthroscopy : official journal of the ESSKA, 2019-04, Vol.27 (4), p.1096-1105 |
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| creator | Castellarin, Gianluca Pianigiani, Silvia Innocenti, Bernardo |
| description | Purpose
This study aims at comparing the effects of symmetric and asymmetric designs for the polyethylene insert currently available and also for mobile bearing total knee arthroplasty (TKA). The investigation was performed both clinically and biomechanically through finite element analysis.
Methods
303 patients, with a mobile bearing TKA, were analyzed retrospectively. All patients received the same femoral and tibial components; for the insert, 151 patients received a symmetric design (SD) and 152 an asymmetric design (AD). Additionally, a 3D finite element model of a lower leg was developed, resurfaced with the same TKAs and analysed during gait and squat activities. TKA kinematics, and bone-stresses were investigated for the two insert solutions.
Results
After surgery, patients’ average flexion improved from 105°, with 5° of preoperative extension deficit, to 120° (AD-group) and 115° (SD-group) at the latest follow-up. There was no postoperative extension deficit. No pain affected the AD-group, while an antero-lateral pain was reported in some patients of the SD-group. Patients of the AD-group presented a better ability to perform certain physical routines. Biomechanically, the SD induced higher tibial-bone stresses than the AD. Both designs replicated similar kinematics, comparable to literature. However, SD rotates more on the tray, reducing the motion between femoral and polyethylene components, while AD permits greater insert rotation.
Conclusion
The biomechanical analysis justifies the clinical findings. TKA kinematics is similar for the two designs, although the asymmetric solution shows less bone stress, thus resulting as more suitable to be cemented, avoiding lift-off issues, inducing less pain. Clinically, and biomechanically, an asymmetric mobile bearing insert could be a valid alternative to symmetric mobile bearing insert.
Level of evidence
Case–control study retrospective comparative study, III. |
| doi_str_mv | 10.1007/s00167-018-5207-9 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_2118313238</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>2117632311</sourcerecordid><originalsourceid>FETCH-LOGICAL-c438t-8bfbb80dfa41e6e8d3381d3e3d0b5112f474b0bb927a97f8c02224846403baa53</originalsourceid><addsrcrecordid>eNp1kU1vFSEUhomxsdfWH-DGkLhxM_bwcWeYZdPUj6SJG7smwJyxtDMwAmMyf8dfKje3tYmJG2DxvO8BHkLeMvjIALqLDMDargGmmj2HrulfkB2TQjSdkN1LsoNe8obDvj0lr3O-B6hH2b8ipwIEtFzyHfl9mbd5xpK8o0ucNix324QBqQ8ZU8l0SXGOBelofsVk7IT0wQecTfEuUxMGarEUTNRNPnhnJhrX4uKMtC6LSTjQEunzjKdaH6ihc7S-Flo0yYcfFSw1_xAQqUnlLsVlMrls5-RkNFPGN4_7Gbn9dP396ktz8-3z16vLm8ZJoUqj7GitgmE0kmGLahBCsUGgGMDuGeOj7KQFa3vemb4blQPOuVSylSCsMXtxRj4ce-uTf66Yi559djhNJmBcs-aMKcEEF6qi7_9B7-OaQr3dgeraCjFWKXakXIo5Jxz1kvxs0qYZ6INAfRSoq0B9EKj7mnn32LzaGYe_iSdjFeBHIC-HT8P0PPr_rX8ASjyp1w</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>2117632311</pqid></control><display><type>article</type><title>Asymmetric polyethylene inserts promote favorable kinematics and better clinical outcome compared to symmetric inserts in a mobile bearing total knee arthroplasty</title><source>Springer Online Journals Complete</source><source>Wiley Online Library All Journals</source><creator>Castellarin, Gianluca ; Pianigiani, Silvia ; Innocenti, Bernardo</creator><creatorcontrib>Castellarin, Gianluca ; Pianigiani, Silvia ; Innocenti, Bernardo</creatorcontrib><description>Purpose
This study aims at comparing the effects of symmetric and asymmetric designs for the polyethylene insert currently available and also for mobile bearing total knee arthroplasty (TKA). The investigation was performed both clinically and biomechanically through finite element analysis.
Methods
303 patients, with a mobile bearing TKA, were analyzed retrospectively. All patients received the same femoral and tibial components; for the insert, 151 patients received a symmetric design (SD) and 152 an asymmetric design (AD). Additionally, a 3D finite element model of a lower leg was developed, resurfaced with the same TKAs and analysed during gait and squat activities. TKA kinematics, and bone-stresses were investigated for the two insert solutions.
Results
After surgery, patients’ average flexion improved from 105°, with 5° of preoperative extension deficit, to 120° (AD-group) and 115° (SD-group) at the latest follow-up. There was no postoperative extension deficit. No pain affected the AD-group, while an antero-lateral pain was reported in some patients of the SD-group. Patients of the AD-group presented a better ability to perform certain physical routines. Biomechanically, the SD induced higher tibial-bone stresses than the AD. Both designs replicated similar kinematics, comparable to literature. However, SD rotates more on the tray, reducing the motion between femoral and polyethylene components, while AD permits greater insert rotation.
Conclusion
The biomechanical analysis justifies the clinical findings. TKA kinematics is similar for the two designs, although the asymmetric solution shows less bone stress, thus resulting as more suitable to be cemented, avoiding lift-off issues, inducing less pain. Clinically, and biomechanically, an asymmetric mobile bearing insert could be a valid alternative to symmetric mobile bearing insert.
Level of evidence
Case–control study retrospective comparative study, III.</description><identifier>ISSN: 0942-2056</identifier><identifier>EISSN: 1433-7347</identifier><identifier>DOI: 10.1007/s00167-018-5207-9</identifier><identifier>PMID: 30306242</identifier><language>eng</language><publisher>Berlin/Heidelberg: Springer Berlin Heidelberg</publisher><subject>Arthroplasty (knee) ; Asymmetry ; Bearing ; Biomechanical engineering ; Biomechanics ; Biomedical materials ; Bone surgery ; Comparative studies ; Femur ; Finite element method ; Gait ; Inserts ; Joint surgery ; Kinematics ; Knee ; Medicine ; Medicine & Public Health ; Orthopedics ; Pain ; Patients ; Polyethylene ; Polyethylenes ; Stresses ; Surgical implants ; Three dimensional models ; Tibial components</subject><ispartof>Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA, 2019-04, Vol.27 (4), p.1096-1105</ispartof><rights>European Society of Sports Traumatology, Knee Surgery, Arthroscopy (ESSKA) 2018</rights><rights>Knee Surgery, Sports Traumatology, Arthroscopy is a copyright of Springer, (2018). All Rights Reserved.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c438t-8bfbb80dfa41e6e8d3381d3e3d0b5112f474b0bb927a97f8c02224846403baa53</citedby><cites>FETCH-LOGICAL-c438t-8bfbb80dfa41e6e8d3381d3e3d0b5112f474b0bb927a97f8c02224846403baa53</cites><orcidid>0000-0001-8992-8865</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://link.springer.com/content/pdf/10.1007/s00167-018-5207-9$$EPDF$$P50$$Gspringer$$H</linktopdf><linktohtml>$$Uhttps://link.springer.com/10.1007/s00167-018-5207-9$$EHTML$$P50$$Gspringer$$H</linktohtml><link.rule.ids>314,776,780,27901,27902,41464,42533,51294</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/30306242$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Castellarin, Gianluca</creatorcontrib><creatorcontrib>Pianigiani, Silvia</creatorcontrib><creatorcontrib>Innocenti, Bernardo</creatorcontrib><title>Asymmetric polyethylene inserts promote favorable kinematics and better clinical outcome compared to symmetric inserts in a mobile bearing total knee arthroplasty</title><title>Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA</title><addtitle>Knee Surg Sports Traumatol Arthrosc</addtitle><addtitle>Knee Surg Sports Traumatol Arthrosc</addtitle><description>Purpose
This study aims at comparing the effects of symmetric and asymmetric designs for the polyethylene insert currently available and also for mobile bearing total knee arthroplasty (TKA). The investigation was performed both clinically and biomechanically through finite element analysis.
Methods
303 patients, with a mobile bearing TKA, were analyzed retrospectively. All patients received the same femoral and tibial components; for the insert, 151 patients received a symmetric design (SD) and 152 an asymmetric design (AD). Additionally, a 3D finite element model of a lower leg was developed, resurfaced with the same TKAs and analysed during gait and squat activities. TKA kinematics, and bone-stresses were investigated for the two insert solutions.
Results
After surgery, patients’ average flexion improved from 105°, with 5° of preoperative extension deficit, to 120° (AD-group) and 115° (SD-group) at the latest follow-up. There was no postoperative extension deficit. No pain affected the AD-group, while an antero-lateral pain was reported in some patients of the SD-group. Patients of the AD-group presented a better ability to perform certain physical routines. Biomechanically, the SD induced higher tibial-bone stresses than the AD. Both designs replicated similar kinematics, comparable to literature. However, SD rotates more on the tray, reducing the motion between femoral and polyethylene components, while AD permits greater insert rotation.
Conclusion
The biomechanical analysis justifies the clinical findings. TKA kinematics is similar for the two designs, although the asymmetric solution shows less bone stress, thus resulting as more suitable to be cemented, avoiding lift-off issues, inducing less pain. Clinically, and biomechanically, an asymmetric mobile bearing insert could be a valid alternative to symmetric mobile bearing insert.
Level of evidence
Case–control study retrospective comparative study, III.</description><subject>Arthroplasty (knee)</subject><subject>Asymmetry</subject><subject>Bearing</subject><subject>Biomechanical engineering</subject><subject>Biomechanics</subject><subject>Biomedical materials</subject><subject>Bone surgery</subject><subject>Comparative studies</subject><subject>Femur</subject><subject>Finite element method</subject><subject>Gait</subject><subject>Inserts</subject><subject>Joint surgery</subject><subject>Kinematics</subject><subject>Knee</subject><subject>Medicine</subject><subject>Medicine & Public Health</subject><subject>Orthopedics</subject><subject>Pain</subject><subject>Patients</subject><subject>Polyethylene</subject><subject>Polyethylenes</subject><subject>Stresses</subject><subject>Surgical implants</subject><subject>Three dimensional models</subject><subject>Tibial components</subject><issn>0942-2056</issn><issn>1433-7347</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2019</creationdate><recordtype>article</recordtype><sourceid>BENPR</sourceid><recordid>eNp1kU1vFSEUhomxsdfWH-DGkLhxM_bwcWeYZdPUj6SJG7smwJyxtDMwAmMyf8dfKje3tYmJG2DxvO8BHkLeMvjIALqLDMDargGmmj2HrulfkB2TQjSdkN1LsoNe8obDvj0lr3O-B6hH2b8ipwIEtFzyHfl9mbd5xpK8o0ucNix324QBqQ8ZU8l0SXGOBelofsVk7IT0wQecTfEuUxMGarEUTNRNPnhnJhrX4uKMtC6LSTjQEunzjKdaH6ihc7S-Flo0yYcfFSw1_xAQqUnlLsVlMrls5-RkNFPGN4_7Gbn9dP396ktz8-3z16vLm8ZJoUqj7GitgmE0kmGLahBCsUGgGMDuGeOj7KQFa3vemb4blQPOuVSylSCsMXtxRj4ce-uTf66Yi559djhNJmBcs-aMKcEEF6qi7_9B7-OaQr3dgeraCjFWKXakXIo5Jxz1kvxs0qYZ6INAfRSoq0B9EKj7mnn32LzaGYe_iSdjFeBHIC-HT8P0PPr_rX8ASjyp1w</recordid><startdate>20190401</startdate><enddate>20190401</enddate><creator>Castellarin, Gianluca</creator><creator>Pianigiani, Silvia</creator><creator>Innocenti, Bernardo</creator><general>Springer Berlin Heidelberg</general><general>Springer Nature B.V</general><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7QO</scope><scope>7RV</scope><scope>7TS</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8AO</scope><scope>8FD</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>FR3</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>K9.</scope><scope>KB0</scope><scope>M0S</scope><scope>M1P</scope><scope>NAPCQ</scope><scope>P64</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0001-8992-8865</orcidid></search><sort><creationdate>20190401</creationdate><title>Asymmetric polyethylene inserts promote favorable kinematics and better clinical outcome compared to symmetric inserts in a mobile bearing total knee arthroplasty</title><author>Castellarin, Gianluca ; Pianigiani, Silvia ; Innocenti, Bernardo</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c438t-8bfbb80dfa41e6e8d3381d3e3d0b5112f474b0bb927a97f8c02224846403baa53</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2019</creationdate><topic>Arthroplasty (knee)</topic><topic>Asymmetry</topic><topic>Bearing</topic><topic>Biomechanical engineering</topic><topic>Biomechanics</topic><topic>Biomedical materials</topic><topic>Bone surgery</topic><topic>Comparative studies</topic><topic>Femur</topic><topic>Finite element method</topic><topic>Gait</topic><topic>Inserts</topic><topic>Joint surgery</topic><topic>Kinematics</topic><topic>Knee</topic><topic>Medicine</topic><topic>Medicine & Public Health</topic><topic>Orthopedics</topic><topic>Pain</topic><topic>Patients</topic><topic>Polyethylene</topic><topic>Polyethylenes</topic><topic>Stresses</topic><topic>Surgical implants</topic><topic>Three dimensional models</topic><topic>Tibial components</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Castellarin, Gianluca</creatorcontrib><creatorcontrib>Pianigiani, Silvia</creatorcontrib><creatorcontrib>Innocenti, Bernardo</creatorcontrib><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Biotechnology Research Abstracts</collection><collection>Nursing & Allied Health Database</collection><collection>Physical Education Index</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>ProQuest Pharma Collection</collection><collection>Technology Research Database</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>Engineering Research Database</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Database (Alumni Edition)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>Nursing & Allied Health Premium</collection><collection>Biotechnology and BioEngineering Abstracts</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><collection>MEDLINE - Academic</collection><jtitle>Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Castellarin, Gianluca</au><au>Pianigiani, Silvia</au><au>Innocenti, Bernardo</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Asymmetric polyethylene inserts promote favorable kinematics and better clinical outcome compared to symmetric inserts in a mobile bearing total knee arthroplasty</atitle><jtitle>Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA</jtitle><stitle>Knee Surg Sports Traumatol Arthrosc</stitle><addtitle>Knee Surg Sports Traumatol Arthrosc</addtitle><date>2019-04-01</date><risdate>2019</risdate><volume>27</volume><issue>4</issue><spage>1096</spage><epage>1105</epage><pages>1096-1105</pages><issn>0942-2056</issn><eissn>1433-7347</eissn><abstract>Purpose
This study aims at comparing the effects of symmetric and asymmetric designs for the polyethylene insert currently available and also for mobile bearing total knee arthroplasty (TKA). The investigation was performed both clinically and biomechanically through finite element analysis.
Methods
303 patients, with a mobile bearing TKA, were analyzed retrospectively. All patients received the same femoral and tibial components; for the insert, 151 patients received a symmetric design (SD) and 152 an asymmetric design (AD). Additionally, a 3D finite element model of a lower leg was developed, resurfaced with the same TKAs and analysed during gait and squat activities. TKA kinematics, and bone-stresses were investigated for the two insert solutions.
Results
After surgery, patients’ average flexion improved from 105°, with 5° of preoperative extension deficit, to 120° (AD-group) and 115° (SD-group) at the latest follow-up. There was no postoperative extension deficit. No pain affected the AD-group, while an antero-lateral pain was reported in some patients of the SD-group. Patients of the AD-group presented a better ability to perform certain physical routines. Biomechanically, the SD induced higher tibial-bone stresses than the AD. Both designs replicated similar kinematics, comparable to literature. However, SD rotates more on the tray, reducing the motion between femoral and polyethylene components, while AD permits greater insert rotation.
Conclusion
The biomechanical analysis justifies the clinical findings. TKA kinematics is similar for the two designs, although the asymmetric solution shows less bone stress, thus resulting as more suitable to be cemented, avoiding lift-off issues, inducing less pain. Clinically, and biomechanically, an asymmetric mobile bearing insert could be a valid alternative to symmetric mobile bearing insert.
Level of evidence
Case–control study retrospective comparative study, III.</abstract><cop>Berlin/Heidelberg</cop><pub>Springer Berlin Heidelberg</pub><pmid>30306242</pmid><doi>10.1007/s00167-018-5207-9</doi><tpages>10</tpages><orcidid>https://orcid.org/0000-0001-8992-8865</orcidid></addata></record> |
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| identifier | ISSN: 0942-2056 |
| ispartof | Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA, 2019-04, Vol.27 (4), p.1096-1105 |
| issn | 0942-2056 1433-7347 |
| language | eng |
| recordid | cdi_proquest_miscellaneous_2118313238 |
| source | Springer Online Journals Complete; Wiley Online Library All Journals |
| subjects | Arthroplasty (knee) Asymmetry Bearing Biomechanical engineering Biomechanics Biomedical materials Bone surgery Comparative studies Femur Finite element method Gait Inserts Joint surgery Kinematics Knee Medicine Medicine & Public Health Orthopedics Pain Patients Polyethylene Polyethylenes Stresses Surgical implants Three dimensional models Tibial components |
| title | Asymmetric polyethylene inserts promote favorable kinematics and better clinical outcome compared to symmetric inserts in a mobile bearing total knee arthroplasty |
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