Methodological Considerations for the Biomechanical Assessment of Frontal Plane Mid-Flexion Instability Following Total Knee Arthroplasty

Andrews, Samantha
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[Honolulu] : [University of Hawaii at Manoa], [August 2016]
Uncertainty exists within biomechanical outcome based research, mostly due to differences in methodologies. Differences in biomechanical modeling, processing, and scaling are common in biomechanics research, with a direct comparison of these methods producing significantly different results when applied to the same data set. The magnitude of these outcome differences can significantly change the management of osteoarthritic patients before and after surgical treatment. Additionally, biomechanical variables are often presented without consideration of influential variables, such as walking velocity and kinematic variables preceding detrimental kinetics that may produce significant damage to the joint surface or the implanted prosthetic. Therefore, in order to make meaningful conclusions about specifically clinical questions, such as the existence of mid-flexion instability of the knee in single and multiple radius following total knee arthroplasty, methodological considerations must be explored and recommendations must be determined. Based on the results of this dissertation, recommendations were made for the collection of biomechanical data. Through the use of an array based marker set, processed using Visual3D and allometrically scaled for walking velocity, comparison between time periods and between groups can be made more effectively. Consideration of varus angle and varus velocity, immediately preceding a peak in knee adduction moment during loading, must also be included in analyses, as these variables could indicate a lack of neuromuscular control is the cause of detrimental gait patterns following total knee arthroplasty. Applied to the specific question of the existence of mid-flexion instability, the results of the current study refute previous research, as no difference in frontal plane stability was revealed between single and multiple radius implants following surgery.
Ph.D. University of Hawaii at Manoa 2016.
Includes bibliographical references.
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