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    Biomechanics & Joint Replacement of The Knee: PGI Balisi JI Cabalza JI Feliciano JI Fernandez A. JI Fernandez K

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    Gio Balisi
    The document discusses the biomechanics of the native knee joint and total knee replacement (TKR). It describes the bones, ligaments, and movements of the knee. It explains how TKR aims to restore alignment and balance ligaments to replicate native knee function. The goals of TKR design are outlined as well as factors that can lead to prosthesis loosening or wear over time.

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    Biomechanics & Joint Replacement of The Knee: PGI Balisi JI Cabalza JI Feliciano JI Fernandez A. JI Fernandez K

    Uploaded by

    Gio Balisi
    49 views46 pages
    The document discusses the biomechanics of the native knee joint and total knee replacement (TKR). It describes the bones, ligaments, and movements of the knee. It explains how TKR aims to restore alignment and balance ligaments to replicate native knee function. The goals of TKR design are outlined as well as factors that can lead to prosthesis loosening or wear over time.

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    The document discusses the biomechanics of the native knee joint and total knee replacement (TKR). It describes the bones, ligaments, and movements of the knee. It explains how TKR aims to restore alignment and balance ligaments to replicate native knee function. The goals of TKR design are outlined as well as factors that can lead to prosthesis loosening or wear over time.

    Copyright:

    © All Rights Reserved
    Download as PPTX, PDF, TXT or read online from Scribd
    Download as pptx, pdf, or txt
    49 views46 pages

    Biomechanics & Joint Replacement of The Knee: PGI Balisi JI Cabalza JI Feliciano JI Fernandez A. JI Fernandez K

    Uploaded by

    Gio Balisi
    The document discusses the biomechanics of the native knee joint and total knee replacement (TKR). It describes the bones, ligaments, and movements of the knee. It explains how TKR aims to restore alignment and balance ligaments to replicate native knee function. The goals of TKR design are outlined as well as factors that can lead to prosthesis loosening or wear over time.

    Copyright:

    © All Rights Reserved
    Download as PPTX, PDF, TXT or read online from Scribd
    Download as pptx, pdf, or txt
    of 46

    BIOMECHANICS & JOINT

    REPLACEMENT OF THE
    KNEE
    PGI Balisi
    JI Cabalza
    JI Feliciano
    JI Fernandez A.
    JI Fernandez K.
    BIOMECHANICS OF THE KNEE
    • Knee joint
    • Largest
    • Most superficial
    • Hinge type of synovial joint
    KNEE JOINT ARTICULATIONS
    • Consist of three articulations:
    • 2 femorotibial articulations (lateral and medial)
    • 1 femoropatellar articulation
    BIOMECHANICS OF THE KNEE

    • Relevant bone geometry:


    • Femur
    • Tibia
    TIBIOFEMORAL ALIGNMENT
    Weight Bearing Axis
    -from the center of the hip to
    the center of the ankle of the
    limb passing through the
    center of the knee
    TIBIOFEMORAL MALALIGNMENT

    Valgus Varus
    Malalignment malalignment
    “MEDIAL” “LATERAL”
    TIBIOFEMORAL MALALIGNMENT
    KNEE JOINT
    MOTION
    • Four principal
    movements
    1. Flexion
    2. Extension
    3. External rotation
    4. Internal rotation
    MOVEMENTS OF THE KNEE JOINT AND
    MUSCLE PRODUCING THEM
    FEMORAL ROLLBACK
    • Biomechanical functions:
    to increase the lever arm of the quadriceps
    To allow clearance of the femur from the tibia
    ROTATION DURING FLEXION-EXTENSION
    • Extension to full flexion: tibia internally
    rotates
    • Full flexion to extension: tibia externally
    rotates
    • SCREW-HOME MECHANISM
    • external rotation of the tibia on the
    femur that occurs during the terminal
    degrees of knee extension
    • Results in tightening of both the cruciate
    ligaments and locking the knee
    • Unlocking of knee: reverse of locking and
    initiated by Popliteus muscle
    SCREW-HOME MECHANISM
    • Tibial external rotation accompanies
    terminal extension

    • Why?
    • Bony and meniscal surface
    geometry
    • Ligamentous tension
    • Muscle actions
    PATELLOFEMORAL JOINT
    • act as the pulley for the quadriceps
    • increase the power of the quadriceps
    by increasing the moment arm
    • Patellectomy: reduces quadriceps
    strength by at least 20%.
    PATELLOFEMORAL JOINT ALIGNMENT
    Q angle
    • intersection of lines joining the center of the patella
    with the anterior superior iliac spine and the tibial
    tubercle.
    • normal: between 5 and 20°
    • Women > men
    • >20°: associated with patellofemoral instability and
    pain
    PATELLA & TROCHLEAR GEOMETRY
    Patella Geometry
    • equal medial and lateral facets
    • both concave.

    • concave lateral facet


    • smaller concave medial facet.

    • convex smaller medial facet


    PATELLA & TROCHLEAR GEOMETRY
    Patella
    • sits in the trochlea
    • provides the bony restraint of the
    patellofemoral joint.

    Sulcus angle: 137° ± 8°


    The highest point of the lateral femoral condyle
    is more anterior than the medial and the sulcus
    deepens more distally.
    DEJOUR’S CLASSIFICATION OF TROCHLEAR
    DYSPLASIA
    PATELLA & TROCHLEAR GEOMETRY
    • Variables that determine patella tracking:
    • patella geometry
    • dysplasia of the trochlea and a laterally
    placed tibial tubercle
    • Laterally placed TT: TT–TG is greater than 20
    mm.
    • medial transfer of the TT may be
    indicated.
    MEDIAL PATELLOFEMORAL LIGAMENT
    (MPF)
    • Provides a medial checkrein to the
    patella
    • Commonly disrupted in acute
    patella dislocations.
    • Recurrent dislocation of the
    patella
    • reconstruct the MPFL.
    PATELLOFEMORAL JOINT MOTION
    FUNCTIONAL BIOMECHANICS
    Static elements Dynamic elements
    • alignment of the articulating • coordinated activity of the
    bones muscles.
    • geometry of their weight-
    bearing surfaces
    • laxity of the connecting
    ligaments

    Proprioception helps to optimize knee function within the static


    limits.
    HOW IS STABLE MOVEMENT OF THE KNEE
    ACHIEVED?
    • Primary and Secondary restraints
    • Individual ligaments have primary and secondary functions
    ANTERIOR TRANSLATION
    • Primary restraint to anterior translation of the tibia • FUNCTIONS OF ACL:
    on the femur:
    Anterior cruciate ligament (ACL)
     Resist varus
    • ACL bundles  Resist valgus
    1. Anteromedial (tight in flexion)  Resist rotational forces
    2. Posterolateral (tight in extension)
    • Secondary restraint
    • Iliotibial band (24%)
    • Mid-medial capsule (22%)
    • Mid-lateral capsule (20%)
    • MCL (16%)
    • LCL (12%)
    • Menisci
    POSTERIOR TRANSLATION
    • Primary restraint: posterior cruciate ligament
     Function: resist posterior tibial translation on the fixed femur
    • Secondary restraint: LCL
    INTERNAL ROTATION
    • Primary restraint: ACL
    • Secondary restraint: Popliteal
    oblique ligaments (POL) and
    posteromedial complex
    (PMC)
    EXTERNAL ROTATION
    • Primary restraint:
    Popliteofibular ligament, LCL
    and posterolateral complex at
    30 degrees flexion
    VALGUS
    • Superficial MCL: primary restraint to valgus stress with least effect
    at full extension
    • PMC: tight at full extension but slackens with flexion greater than
    30 degrees
    • Deep MCL: little resistance to valgus load
    • ACL: secondary restraint to valgus force
    VARUS
    • Primary restraint: LCL
     greatest effect at 30 degrees
     least effect at full extension
    • Secondary restraint: posterolateral structures
    POSTEROLATERAL
    STRUCTURES
    SUPERFICIAL
    LAYER
    MIDDLE LAYER DEEP LAYER
    BIOMECHANICS OF KNEE
    ARTHROPLASTY
    Design of TKRs can be classified into:

    I. Surface Replacement (condylar)


    a) Cruciate-sacrificing
    b) PCL-retaining
    c) PCL-substituting prostheses

    II. Constrained
    Condylar TKR
    Stability in the Sagital plane:
    Curved Tibial Articulating Surface
    Stability in the Coronal Plane:
    Median Intercondylar plane

    *The surface is therefore conforming


    PCL-retaining TKR
    • have low conformity with a round-on flat design
    PCL-substituting (or posteriorstabilized)
    increased tibial contouring (conformity) in both
    the sagittal and the coronal planes.

    Sagittal plane stability : femoral cam and tibial


    post
    Coronal plane stability : the conforming
    surfaces and collateral ligaments.
    Kinematics of TKR
    Flexion–extension is controlled by the
    polyethylene insert and the femoral condyles
    (anterior radius and posterior radius)
    The Condylar Compromise

    • Contact stress inversely proportional to constraint.


    • Normal kinematics inversely proportional to
    constraint.
    • High contact stress causes wear.
    • Increased constraint increases loosening.
    BIOMECHANICAL GOALS OF TKR
    • Restore the mechanical axis so that it passes
    through the centers of the hip, knee and ankle.
    • Make the bone cuts perpendicular to the
    mechanical axis.
    • Preserve the level of the joint line.
    • Balance the ligaments.
    • Ensure rigid durable fixation.
    Mechanical alignment is determined by
    the femoral and tibial bone cuts. The
    femur and tibia are cut in order to allow
    the thickness of the prosthesis to re-create
    the original thickness of the bone and
    cartilage in both flexion and extension
    Methods used to judge Femoral
    Component Rotation
    • Epicondylar axis
    • Whiteside’s line
    • Posterior condylar axis
    Ligament balancing
    Preoperative varus deformity
    contracted MCL
    Preoperative valgus deformity
    contracted lateral structures (popliteus, LCL,
    iliotibial band).
    Preoperative fixed flexion deformity
    tight posterior structures (capsule and
    PCL).
    Order of Structure Release
    In varus knee :
    a. Deep MCL
    b. Posteromedial corner with attachment of semimembranosus
    c. Superficial MCL
    d. PCL

    In valgus knee :
    1. Lateral capsule
    2. Iliotibial band (tight in extension)
    3. Popliteus (tight in flexion)
    4. LCL
    5. Intermuscular septum
    6. Lateral head of gastrocnemius
    PATELLOFEMORAL JOINT IN TKR
    Design solutions for patellar implants

     Dome
     Anatomical
     Mobile bearing
    BIOMECHANICS OF TKR FAILURE
    Factors that cause Polyethylene wear in TKR

    1. Thickness of polyethylene
    2. Articular geometry
    3. Polyethylene sterilization
    4. Increased conformity
    5. Use of all polyethylene components
    Factors in TKR design increase the
    probability of loosening

    • flexible implant (low thickness/length ratio);


    • small contact area
    • load transfer at the edges of contact in an
    unbalanced knee
    • features that concentrate stress
    THANK YOU

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