Effects of the Medial Plateau Bearing Insert Conformity on Mid-Flexion Paradoxical Motion in a Posterior-Stabilized Total Knee Arthroplasty Design

Khasian, Milad; Meccia, Bradley; LaCour, M; Komistek, Richard D.

doi:10.1016/j.arth.2021.01.071

Cited by 8 publications

(4 citation statements)

References 48 publications

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“…This implant is considered to induce posterior translation of the femur during flexion relying on a post cam mechanism [5]. Contrary to that belief, during the early stages of flexion, the body pushes the femur so that the femoral component slides anteriorly producing a ‘paradoxical motion’ [19]. The alterations in normal knee kinematics have raised concerns about its ability to meet the steadily increasing patients’ expectations [40].…”

Section: Introductionmentioning

confidence: 99%

Medial pivot design does not yield superior results compared to posterior-stabilised total knee arthroplasty: a systematic review and meta-analysis of randomised control trials

Kakoulidis

Panagiotidou

Profitiliotis³

et al. 2022

Knee Surg Sports Traumatol Arthrosc

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Purpose The aim of this meta-analysis was a comparison between medial pivot (MP) and posterior-stabilised (PS) knee designs regarding functional and radiological outcomes as well as gait parameters. Methods A systematic literature search was conducted in PubMed, Cochrane Library, Science Direct and Clinical Trials.gov from conception up to April 2022, to identify eligible randomised control trials (RCTs). The extracted data were analysed according to the Preferred Reporting Items for Systematic reviews and Meta-Analysis (PRISMA) statement. Results Fifteen studies met inclusion criteria, enrolling 1101 patients who underwent 1242 total knee arthroplasties (TKAs). A total of 1158 TKAs (581 MP/577 PS) were included in the quantitative analysis. Mean follow-up ranged from 6 months up to 6.6 years. MP knees showed comparable range of motion (ROM) with PS design 1, 2 and 4 years postoperatively (p = 0.2, p = 0.25, p = 0.34, respectively). No statistical diference was found in patient-related outcome measures (PROMs) (p > 0.05). Mean walking speed (MWS), length of stay (LOS), radiographic alignment and complications rates were also similar between the two groups (p > 0.05). Discussion The present meta-analysis demonstrated that the theoretical biomechanical advantage of MP implants does not have a better impact on patient satisfaction compared to the traditional PS knees. Level of evidence I.

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Section: Introductionmentioning

confidence: 99%

Medial pivot design does not yield superior results compared to posterior-stabilised total knee arthroplasty: a systematic review and meta-analysis of randomised control trials

Kakoulidis

Panagiotidou

Profitiliotis³

et al. 2022

Knee Surg Sports Traumatol Arthrosc

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“…On the other hand, medial paradoxical anterior translation has been reported in posterior‐stabilized (PS) and cruciate‐retaining (CR) TKAs with low conformity surface [5, 8, 14]. A recent study demonstrated that paradoxical anterior translation can be reduced by increasing medial conformity of the bearing insert in PS TKA [13]. These studies combined with the results of the present study indicate that high medial conformity may contribute to the suppression of paradoxical anterior translation.…”

Section: Discussionmentioning

confidence: 99%

Mobile medial pivot (lateral slide) type total knee arthroplasty exhibits a medial pivot pattern: three-dimensional motion analysis using cadaveric knees

et al. 2022

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Purpose The purpose of this study was to analyze the dynamic kinematics of the mobile medial pivot-type total knee arthroplasty (MMPTKA) using the three-dimensional (3D)-to-2D registration technique. Methods Cadaveric knees from five humans were used. Computed tomography of the lower limb and preoperative 3D planning for MMPTKA were performed. After performing TKA, passive motion of the knee was observed from a fully extended position to maximum flexion using a flat panel detector. The following parameters were determined: (1) anteroposterior (AP) translations of the medial and lateral most distal points (estimated contact point) of the femoral component, (2) rotational femoral component’s X-axis (FCX) angle, and (3) rotational insert angle. Paired t-tests were used to analyze differences in the AP translation between the medial and lateral most distal points of the femoral component as well as differences in the changes in the rotational angle between the FCX and X-axis of the insert on the tibial component’s axial plane. Results The AP translations of the femoral component’s medial and lateral most distal points were 8.4 ± 2.5 and 13.6 ± 3.3 mm, respectively (p = 0.001). The rotational angles of the FCX and insert were 10.7° ± 4.9° external rotation and 8.9° ± 4.1° internal rotation, respectively (p = 0.004). Conclusions The posterior translation of the lateral side of the femoral component was greater than that of the medial in all cases. Hence, a medial pivot pattern was identified. The femoral component exhibited external rotation throughout knee flexion in all subjects, whereas the mobile insert exhibited internal rotation (opposite pattern relative to the femoral component). This study provides valuable kinematical information of MMPTKA that has not been clear yet.

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“…There are many factors that affects knee joint kinematics after TKA, such as gender, body mass index, and ligament balances. The articular surface geometry of femoral component and tibial insert is one of them 2–5,12,13 . However, there are no reports about in vivo kinematic comparisons between BCS and CR TKAs with the same anatomical surface geometry.…”

Section: Introductionmentioning

confidence: 99%

“…The articular surface geometry of femoral component and tibial insert is one of them. 2 , 3 , 4 , 5 , 12 , 13 However, there are no reports about in vivo kinematic comparisons between BCS and CR TKAs with the same anatomical surface geometry.…”

Section: Introductionmentioning

confidence: 99%

Kinematics of bicruciate stabilized and cruciate retaining total knee arthroplasty

Ishibashi

Yamazaki

Konda

et al. 2021

Journal Orthopaedic Research

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Few studies have been reported about kinematic comparison between bicruciate stabilized and cruciate retaining total knee arthroplasty with the same anatomical surface geometry. The aim of this study was to demonstrate the in vivo kinematics and postoperative patient‐reported outcomes of these two surgeries with the same anatomical surface geometry. We analyzed 17 bicruciate stabilized and 18 cruciate retaining total knee arthroplasties using single‐plane fluoroscopic surveillance with two‐ to three‐dimensional registration techniques during squatting from minimum to maximum flexion. Flexion angle, femoral external rotation, anteroposterior position of the medial and lateral sides, and postoperative 2011 Knee Society Scores were analyzed. Maximum flexion angles were larger for bicruciate stabilized than for cruciate retaining total knee arthroplasties. There was no significant difference in femoral external rotation between the two types. The medial and lateral femoral condyles in bicruciate stabilized type translated more posteriorly during deeper flexion and at maximum flexion angle, respectively, than those in cruciate retaining total knee arthroplasty. Both groups revealed medial pivots in early flexion, but during deep flexion, bicruciate stabilized total knee arthroplasty revealed bicondylar roll‐back and cruciate retaining total knee arthroplasty revealed paradoxical anterior motion. Both groups exhibited similar results in postoperative 2011 Knee Society Scores. Bicruciate stabilized and cruciate retaining total knee arthroplasties with the same anatomical articular surfaces demonstrated different kinematics patterns during squatting. However, there were no significant differences in postoperative 2011 Knee Society Scores between the two types of surgery.

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Effects of the Medial Plateau Bearing Insert Conformity on Mid-Flexion Paradoxical Motion in a Posterior-Stabilized Total Knee Arthroplasty Design

Cited by 8 publications

References 48 publications

Medial pivot design does not yield superior results compared to posterior-stabilised total knee arthroplasty: a systematic review and meta-analysis of randomised control trials

Medial pivot design does not yield superior results compared to posterior-stabilised total knee arthroplasty: a systematic review and meta-analysis of randomised control trials

Mobile medial pivot (lateral slide) type total knee arthroplasty exhibits a medial pivot pattern: three-dimensional motion analysis using cadaveric knees

Kinematics of bicruciate stabilized and cruciate retaining total knee arthroplasty

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