A simple extension of a previously reported object recognition technique has been used to implement a six-degree-of-freedom position/orientation estimator for the measurement of knee replacement motion from two-dimensional (2-D) fluoroscopic images. Computer modeling studies and controlled mechanical tests were performed to assess the accuracy of the technique. The results indicate that knee rotations can be measured with an accuracy of approximately one degree and that sagittal plane translations can be measured with an accuracy of approximately 0.5 mm. The measurement technique is uniquely well suited for performing dynamic kinematic measurements on individuals with knee replacements, and for performing comparative studies among subjects with different designs of knee replacements.

O ur purpose was to determine the mechanism which allows the maximum knee flexion in vivo after a posterior-cruciate-ligament (PCL)-retaining total knee arthroplasty. Using three-dimensional computer-aided design videofluoroscopy of deep squatting in 29 patients, we determined that in 72% of knees, direct impingement of the tibial insert posteriorly against the back of the femur was the factor responsible for blocking further flexion.In view of this finding we defined a new parameter termed the 'posterior condylar offset'. In 150 consecutive arthroplasties of the knee, the magnitude of posterior condylar offset was found to correlate with the final range of flexion. Total knee arthroplasty (TKA) gives good subjective and objective results during the first 15 years after implantation. Nevertheless, it is clear that the function and subjective findings do not match those of the normal knee. The range of flexion of the knee obtained after TKA is often limited and may be determined by several factors, including the length of the quadriceps, capsular tightness, surgical technique, postoperative physiotherapy and the design of the implant.

We performed a prospective, randomised trial of 44 patients to compare the functional outcomes of a posterior-cruciate-ligament-retaining and posterior-cruciate-ligament-substituting total knee arthroplasty, and to gain a better understanding of the in vivo kinematic behaviour of both devices. At follow-up at five years, no statistically significant differences were found in the clinical outcome measurements for either design. The prevalence of radiolucent lines and the survivorship were the same. In a subgroup of 15 knees, additional image-intensifier analysis in the horizontal and sagittal planes was performed during step-up and lunge activity. Our analysis revealed striking differences. Lunge activity showed a mean posterior displacement of both medial and lateral tibiofemoral contact areas (roll-back) which was greater and more consistent in the cruciate-substituting than in the cruciate-retaining group (medial p < 0.0001, lateral p = 0.011). The amount of posterior displacement could predict the maximum flexion which could be achieved (p = 0.018). Forward displacement of the tibiofemoral contact area in flexion during stair activity was seen more in the cruciate-retaining than in the cruciate-substituting group. This was attributed mainly to insufficiency of the posterior cruciate ligament and partially to that of the anterior cruciate ligament. We concluded that, despite similar clinical outcomes, there are significant kinematic differences between cruciate-retaining and cruciate-substituting arthroplasties.

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