Comparison of Mechanical Performance between Circular Frames and Biplanar Distraction Devices for Knee Joint Distraction

James My Chowdhury; Beth Lineham; Matthew Pallett; Hemant G Pandit; Todd D Stewart; Paul J Harwood

doi:10.5005/jp-journals-10080-1530

Comparison of Mechanical Performance between Circular Frames and Biplanar Distraction Devices for Knee Joint Distraction

Strategies Trauma Limb Reconstr. 2021 May-Aug;16(2):71-77. doi: 10.5005/jp-journals-10080-1530.

Authors

James My Chowdhury¹, Beth Lineham¹, Matthew Pallett², Hemant G Pandit³, Todd D Stewart², Paul J Harwood¹

Affiliations

¹ Department of Trauma and Orthopaedics, Leeds General Infirmary, Leeds Teaching Hospital NHS Trust, Leeds, United Kingdom.
² Institute of Medical and Biological Engineering, School of Mechanical Engineering, University of Leeds, Leeds, United Kingdom.
³ Leeds Institute of Rheumatic and Musculoskeletal Medicine (LIRMM), Chapel Allerton Hospital, Leeds Teaching Hospital NHS Trust, Leeds, United Kingdom.

Abstract

Aim and objective: This study was designed to test and compare the mechanical performance of the biplanar ArthroSave KneeReviver and a circular frame construct with the intended use of providing a mechanically favourable environment for cartilage regeneration across a knee joint.

Materials and methods: Three similar constructs of the two devices were applied to biomechanical testing sawbones, with the knee distracted by 8 mm. The constructs were vertically loaded to 800 N in an Instron testing machine at 20 mm/minute. Tests were conducted in neutral hip flexion and at 12° of hip flexion and extension, to mimic leg position in gait. Displacement measurements were taken from the Instron machine, and three-dimensional joint motion was recorded using an Optotrak Certus motion capture system.

Results: Overall axial rigidity was similar between the two devices (circular frame, 81.6 N/mm ± 5.9; and KneeReviver, 79.5 N/mm ± 25.1 with hip neutral) and similar in different hip positions. At the point of joint contact, the overall rigidity of the circular frame increased significantly more than the KneeReviver (491 N/mm ± 27 and 93 N/mm ± 32, respectively, p <0.001). There was more variability between models in the KneeReviver. There was more off-axis motion in the KneeReviver, mainly due to increasing knee flexion on loading. This was exacerbated with the hip in flexion and extension but remained small, with the maximal off-axis displacement being 7 mm/3°.

Conclusion: The circular frame provides a similar mechanical environment to the novel KneeReviver device, for which most clinical data are available. These findings suggest that both devices appear a viable option for knee joint distraction (KJD). Further clinical data will help inform mode of application.

Clinical significance: KJD is a relatively novel technique for use in osteoarthritis (OA), and it remains unclear which distraction devices provide appropriate mechanics. Our testing gives evidence to support either option for further use.

How to cite this article: Chowdhury JMY, Lineham B, Pallett M, et al. Comparison of Mechanical Performance between Circular Frames and Biplanar Distraction Devices for Knee Joint Distraction. Strategies Trauma Limb Reconstr 2021;16(2):71-77.

Keywords: Arthrodiastasis; Arthrodistraction; Biomechanical study; Circular frame; External fixator; Knee; Knee joint distraction; Knee osteoarthritis; Pain.