Photogrammetry of knee joint kinematics after hinge arthroplasty

Abstract

Hinge prostheses are the oldest total knee arthroplasties based on the easiest model of knee joint kinematics. The complex knee joint movement is simplified by a hinge rotating around the flexion-extension axis. Nevertheless, different studies showed that in unscathed joints an instant center pathway in the sagittal plane must be expected. The objective of the current photogrammetric investigation was the assessment of these pathways after hinge arthroplasty. Moreover, they were compared with reference pathways from healthy participants. A total of 20 patients were examined on average 12.1 years after implantation of St. Georg hinge prostheses. Apart from this, 50 test persons with unscathed knee joints were investigated. The examination unit consisted of a standardized chair with passive knee joint movement (90-0 degrees flexion) supported by an electric motor. The position of predefined skin markers was assessed by digital camera with online transmission to a PC. The instant center pathway was then evaluated applying the Reuleaux technique based on the changes of skin marker positions. Patients with hinge prostheses showed small pathways almost comparable to dots. Apart from this, courses of the pathways depended on the extent of soft tissue in the knee joint area. Small values were associated with round or oval courses,whereas increasing soft tissue led to triangular and slightly increased dimensions of the courses. Pathways of the reference participants confirmed this observation and additionally showed clearly greater dimensions of the pathways. The instant center pathway of unscathed knee joints showed a dependence of the course on the extent of soft tissue. The same observation was made in patients with hinge prostheses. Moreover,the latter were characterized by very small, almost fixed pathways. These results confirm the neglect of additional movement components in hinge prostheses.