In Vivo Knee Kinematics for a Cruciate Sacrificing Total Knee Arthroplasty Having Both a Symmetrical Femoral and Tibial Component.

BACKGROUND: Early total knee arthroplasty (TKA) designs were symmetrical, but lead to complications due to over-constraint leading to loosening and poor flexion. Next-generation TKAs have been designed to include asymmetry, pertaining to the trochlear groove, femoral condylar shapes, and/or the tibial component. More recently, an advanced posterior cruciate sacrificing (PCS) TKA was designed to include both a symmetrical femoral component with a patented V-shaped trochlear groove and a symmetrical tibial component with an ultracongruent insert, in an attempt to reduce inventory costs. Because previous PCS TKA designs produced variable results, the objective of this study is to determine and evaluate the in vivo kinematics for subjects implanted with this symmetrical TKA. METHODS: Twenty-one subjects, implanted with symmetrical PCS fixed-bearing TKA, were asked to perform a weight-bearing deep knee bend (DKB) while under fluoroscopic surveillance. A 3-dimensional to 2-dimensional registration technique was used to determine each subject's anteroposterior translation of lateral and medial femoral condyles as well as tibiofemoral axial rotation and their weight-bearing knee flexion. RESULTS: During the DKB, the average active maximum weight-bearing flexion was 111.7° ± 13.3°. On average, from full extension to maximum knee flexion, subjects experienced -2.5 ± 2.0 mm of posterior femoral rollback of the lateral condyle and 2.5 ± 2.2 mm of medial condyle motion in the anterior direction. This medial condyle motion was consistent for the majority of the subjects, with the lateral condyle exhibiting rollback from 0° to 60° of flexion and then experienced an average anterior motion of 0.3 mm from 60° to 90° of knee flexion. On average, the subjects in this study experienced 6.6°± 3.3° of axial rotation, with most of the rotation occurring in early flexion, averaging 4.9°. CONCLUSION: Although subjects in this study were implanted with a symmetrical PCS TKA, they did experience femoral rollback of the lateral condyle and a normal-like pattern of axial rotation, although less in magnitude than the normal knee. The normal axial rotation pattern occurred because the lateral condyle rolled in the posterior direction, while the medial condyle moved in the anterior direction. Interestingly, the magnitude of posterior femoral rollback and axial rotation for subjects in this study was similar in magnitude reported in previous studies pertaining to asymmetrical TKA designs. It is proposed that more patients be analyzed having this TKA implanted by other surgeons.

Duke Scholars

Author Michael Paul Bolognesi Orthopaedic Surgery