Biomechanics of the knee : with application to the pathogenesis and the surgical treatment of osteoarthritis

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Bibliographic Information

Biomechanics of the knee : with application to the pathogenesis and the surgical treatment of osteoarthritis

Paul G.J. Maquet

Springer-Verlag, 1984

2nd ed. expanded and revised.

  • Germany
  • U.S.
  • : softcover

Other Title

Biomécanique du genou

Uniform Title

Biomécanique du genou

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Includes index

"Softcover reprint of the hardcover 2nd edition 1984"--T.p.verso of softcover

Description and Table of Contents

Volume

Germany ISBN 9783540124894

Description

Pathological conditions affecting the hip and knee joints occupy a particular place amongst the important orthopaedic entities affect ing the extremities. On the one hand they are relatively frequent and on the other they mean for the patient limitation of his ability to walk, because of their considerable detrimental effects. A purposeful basic treatment of these joint diseases (and here osteoarthritis takes pride of place) is only possible if it stems from a reliable biomechanical analysis of the normal and pathological stressing of the joint in question. Whilst the situation in the hip can be considered to be fundamentally clarified, a comprehensive representation of the knee is still lacking, particularly when taking into account the latest knowledge of biomechanics. Recently our concepts of the kinematics of the knee have been completely changed, but the clinically important question of articular stressing remains unanswered. Dr. Maquet has carried out pioneer work in this field for some years in adapting, by analogy, to the knee joint principles already accepted for the hip joint. Since the knee is not a ball and socket joint, a complicated problem arises for which new thoughts are necessary. The results of the numerous operations carried out by Dr. Maquet according to the biomechanical considerations demon strate that his thinking is fundamentally correct. Above all, it is here again proven (as earlier in the case of the hip) that healing of osteoarthritis depends decisively on reducing and evenly dis tributing joint pressure."
Volume

: softcover ISBN 9783642617331

Description

Pathological conditions affecting the hip and knee joints occupy a particular place amongst the important orthopaedic entities affect ing the extremities. On the one hand they are relatively frequent and on the other they mean for the patient limitation of his ability to walk, because of their considerable detrimental effects. A purposeful basic treatment of these joint diseases (and here osteoarthritis takes pride of place) is only possible if it stems from a reliable biomechanical analysis of the normal and pathological stressing of the joint in question. Whilst the situation in the hip can be considered to be fundamentally clarified, a comprehensive representation of the knee is still lacking, particularly when taking into account the latest knowledge of biomechanics. Recently our concepts of the kinematics of the knee have been completely changed, but the clinically important question of articular stressing remains unanswered. Dr. Maquet has carried out pioneer work in this field for some years in adapting, by analogy, to the knee joint principles already accepted for the hip joint. Since the knee is not a ball and socket joint, a complicated problem arises for which new thoughts are necessary. The results of the numerous operations carried out by Dr. Maquet according to the biomechanical considerations demon strate that his thinking is fundamentally correct. Above all, it is here again proven (as earlier in the case of the hip) that healing of osteoarthritis depends decisively on reducing and evenly dis tributing joint pressure.

Table of Contents

I. Aims and Limitations of the Work.- II. Review of the Literature.- III. Methods.- I. Mathematical Analysis.- II. Experiments on Anatomical Specimens.- III. Photoelastic Models.- A. Theoretical Basis.- B. Historical.- C. Application and Limitation of the Photoelastic Technique.- IV. Clinical and Radiological Material.- IV. Mechanics of the Knee.- I. Load and Mechanical Stresses.- A. Concept of Load and Stresses. Rigid Models.- B. Articulated Models.- 1. Forces.- 2. Contact Stresses.- II. Mechanical Stress in the Knee.- A. Forces Exerted on the Knee.- 1. Force Exerted on the Knee During Symmetrical Stance on Both Legs.- 2. Forces Exerted on the Knee in Standing on One Leg.- a) Coronal Plane.- b) Sagittal Plane.- 3. Forces Exerted on the Knee During Gait.- a) Displacement of the Centre of Gravity S7.- b) Forces of Inertia Due to the Accelerations of S7.- c) Force P Exerted on the Knee by the Partial Mass S7 of the Body.- d) Position in Space of Point G Which Lies Centrally on the Axis of Flexion of the Knee.- e) Position of the Knee in Relation to the Partial Centre of Gravity S7.- f) Distance a Between the Line of Action of Force P and Point G.- g) Muscular and Ligamentous Forces Balancing Force P.- ?) Formularization.- ?) Calculation.- ?) Critical Analysis of the Chosen Solution.- h.) Curves Illustrating the Forces Transmitted Across the Femoro-Tibial Joint.- i) Patello-Femoral Compressive Force.- B. Weight-Bearing Surfaces of the Joint.- 1. Femoro-Tibial Joint.- a) Technique.- b) Results.- 2. Patello-Femoral Joint.- C. Contact Articular Stresses.- 1. Femoro-Tibial Joint.- 2. Patello-Femoral Joint.- III. Conclusion.- V. The Pathomechanics of Osteoarthritis of the Knee.- I. Theoretical Analysis of the Causes of Knee Osteoarthritis.- A. Medial Displacement of Force R.- B. Lateral Displacement of Force R.- C. Unstable Knees.- D. Evolution of the Maximum Stress in Relation to Several Parameters.- 1. Varus or Valgus Deformity.- a) Magnitude and Line of Action of R.- b) Articular Compressive Stresses.- 2. Strengthening or Weakening of the Muscular Force L.- 3. Cumulative Effect of a Change of the Force L and a Deformity of the Leg.- 4. Modification of Force P.- 5. Horizontal Displacement of S7 in the Coronal Plane.- 6. Conclusion.- E. Posterior Displacement of Force R.- F. Anterior Displacement of Force R.- G. Increase of the Patello-Femoral Compressive Force.- H. Lateral Displacement of the Patello-Femoral Compressive Force.- II. Radiographic Examination of the Osteoarthritic Knee with Demonstration of the Effect of Changes in the Compressive Force on the Stress Distribution.- A. Demonstration of Joint Stresses.- 1. A.-P. View.- 2. Lateral View.- 3. Tangential View.- B. Utility of X-Rays in the Standing Position.- C. Arthrography.- D. Computerized Axial Tomography.- VII. The Use of Photoelastic Models to Illustrate How the Position of Compressive Femoro-Tibial and Patello-Femoral Forces Affects the Distribution of Articular Stresses.- A. Femoro-Tibial Joint.- 1. Normal Load, Centred.- 2. Normal Load, Off Centre.- 3. Inclined Load, Centred.- 4. Inclined Load, Off Centre.- B. Patello-Femoral Joint.- 1. Directional Distribution of the Stresses.- 2. Quantitative Distribution of the Stresses.- IV. Osteoarthritis of the Knee of Mechanical Origin.- VI. Instinctive Mechanisms Which Reduce Stress in the Knee.- I. Effects of Limping.- II. Use of a Walking Stick.- III. Comment and Conclusion.- VII. Biomechanical Treatment of Osteoarthritis of the Knee.- I. Rationale of Biomechanical Treatment.- II. Biomechanical Treatment of Osteoarthritis of the Knee.- A. Correction of Flexion Contracture.- 1. Rationale.- 2. Operative Procedure.- a) Capsulotomy Alone.- b) Capsulotomy Associated with Other Procedures.- 3) Results.- B. Anterior Displacement of the Tibial Tuberosity.- 1. Rationale.- 2. Operative Procedures.- a) Anterior Displacement of the Tibial Tuberosity by Elevating the Tibial Crest.- b) Anterior and Medial Displacement of the Tibial Tuberosity.- c) Anterior Displacement of the Tibial Tuberosity Combined with Upper Tibial Osteotomy.- d) Anterior Displacement of the Tibial Tuberosity Combined with Osteotomy of the Lower End of the Femur.- 3. Anterior Displacement of the Tibial Tuberosity After Patellectomy.- 4. Changes at Arthroscopy.- C. Recentring the Load.- 1. Osteoarthritis of the Knee with a Varus Deformity.- a) Necessity of Overcorrecting the Varus Deformity.- b) Accurate Estimation of Overcorrection.- c) Choice of Procedure: Tibial or Femoral Osteotomy?.- d) Previous Operative Procedures.- e) The Barrel-Vault-Osteotomy for Varus Deformity.- ?) Planning.- ?) Instruments.- ?) Surgical Procedure.- ?) Postoperative Care.- ?) Comments and Examples.- f) Cases Requiring a Derotation of the Leg.- g) Revisions.- ?) Revision After Undercorrection.- ?) Revision After Exaggerated Overcorrection.- h) The Exceptions. Femoral Osteotomy for a Varus Deformity of the Knee.- ?) Planning.- ?) Surgical Procedure.- ?) Postoperative Care.- ?) Second Example.- 2. Osteoarthritis of the Knee with Varus and Flexion Deformity.- 3. Osteoarthritis with a Valgus Deformity.- a) Necessity of Overcorrection.- b) Choice of Procedure: Femoral or Tibial Osteotomy?.- c) Previous Techniques.- d) Distal Femoral Osteotomy with Fixation by Four Steinmann Pins and Two Compression Clamps.- ?) Planning.- ?) Surgical Procedure.- ?) Postoperative Care.- ?) Comments and Examples.- e) Distal Femoral Osteotomy Combined with Anterior Displacement of the Tibial Tuberosity.- f) Revisions.- ?) Revision After Exaggerated Overcorrection.- ?) Revision After Miscorrection.- 4. Bilateral Osteoarthritis with a Valgus Deformity on One Side and a Varus Deformity on the Other Side.- 5. Osteoarthritis with Genu Recurvatum.- 6. Osteoarthritis of the Knee Due to a Distant Deformity.- 7. Rheumatoid Arthritis.- 8. Osteoarthritis of the Knee in Haemophiliacs.- 9. Osteonecrosis of the Medial Condyle of the Femur.- 10. Widespread Osteoarthritis without Deformity.- 11. Histological Confirmation of the Regenerative Process.- D. Critical Analysis of Patellectomy and Other Procedures on the Patella.- 1. Standard Patellectomy.- 2. Coronal Patellectomy.- 3. Sagittal Osteotomy of the Patella.- E. Operative Indications.- VIII. Results.- A. Femoro-Tibial Osteoarthritis.- 1. Osteoarthritis with a Varus Deformity.- a) Valgus Tibial Osteotomy.- b) Valgus Femoral Osteotomy.- 2. Osteoarthritis with a Valgus Deformity.- 3. Correction of a Deformity at a Distance from the Affected Knee.- 4. Complications and Unsatisfactory Results.- 5. Conclusions.- B. Patello-Femoral Osteoarthritis.- 1. Division of the Lateral Retinaculum.- 2. Anterior Displacement of the Tibial Tuberosity.- 3. Complications of the Anterior Displacement of the Tibial Tuberosity.- 4. Conclusions.- IX. Conclusions.- Appendix. Remarks About the Accuracy of the Calculation of Forces and Stresses in the Knee Joint.- A. Introduction.- 1. The Weights.- 2. Formularization.- 3. The Laws.- 4. Direct Personal Measurements.- B. Analysis of the Influence of the Variation of Time Between Two Successive Phases.- C. Influence of a Systematic Error of 10% in All the Measurements of Braune and Fischer.- D. Theory of Cumulated Errors, a Variation of 0.2 mm Being Assumed for All the Measurements.- E. Influence of a Variation of the Weight-Bearing Surfaces.- G. Direct Measurements.- H. Conclusion.- References.

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