In vivo kinematics of total knee arthroplasty

Abstract

We studied the kinetics of the knee in 20 patients (22 knees) 12 months after total knee arthroplasty (TKA), by using three-dimensional radiostereometry and film-exchanger techniques. Eleven knees had a concave (constrained) tibial implant and 11 a posterior-stabilised prosthesis. Eleven normal knees served as a control group.In the posterior-stabilised knees there was less proximal and posterior displacement of the centre of the tibial plateau during extension from 45° to 15°, with a decrease in the anterior translation of the femoral condyles of 4 mm at 45°. There was less internal tibial rotation and increased distal positioning of the centre of the tibial plateau with both designs when compared with the normal knees, and in both the centre of the plateau was displaced posteriorly by more than 1 cm.Increased AP translation has been recorded in all prosthetic designs so far studied by radiostereometry. The use of a posterior-stabilised design of tibial insert could reduce this translation but not to that of the normal knee.

Three different cruciate-sacrificing TKA designs: minor intraoperative kinematic differences and negligible clinical differences

“…Pre-operative tibial rotation during flexion was comparable to passive kinematic data of OA knees reported in [6,31,33,34] where magnitudes of tibial axial rotation are reduced in OA knees compared to normal knees [27,29,30,33]. After surgery, no significant reduction of tibial axial rotation was found, and this result is in contrast to the literature where a reduction of rotation was observed in TKA [22,33,36,41], except for the works of Stiehl et al [34] and Casino et al [6], where no significant reduction was found, or for Baier et al [1] who found that axial rotation increased after TKA. In the present study, all three implants had a lateral compartment translation range similar to pre-operative conditions, while the medial compartment presented a greater translation with respect to pre-operative condition and in extension, it was in a more anterior position.…”

“…Pre‐operative tibial rotation during flexion was comparable to passive kinematic data of OA knees reported in literature (range 4.9°–12.1°) [6, 31, 33, 34] where magnitudes of tibial axial rotation are reduced in OA knees compared to normal knees [27, 29, 30, 33]. After surgery, no significant reduction of tibial axial rotation was found, and this result is in contrast to the literature where a reduction of rotation was observed in TKA [22, 33, 36, 41], except for the works of Stiehl et al [34] and Casino et al [6], where no significant reduction was found, or for Baier et al [1] who found that axial rotation increased after TKA.…”

“…The asymmetric posterior femoral rollback was preserved, and this phenomenon was observed also in other studies [18, 24] after PS TKA. Several studies in literature reported that in the normal knee, the femoral posterior translation is greater on the lateral side than on the medial side which lead to a medial pivot type of axial rotation pattern in which the tibia internally rotates relative to the femur as flexion progresses and externally rotates as the knee extends [8, 16, 18, 19, 36].…”

Kinematic Comparison between Medially Congruent and Posterior-Stabilized Third-Generation TKA Designs

“…Acknowledging these limitations, the results of this study are consistent with the experimental work of the current and other authors [11,17,[20][21][22][23][24]27,34,38], where contemporary pivoting, fixed-bearing TKA designs have failed to reproduce normal knee kinematics [43]. On the other hand, the TKA pivoting design evaluated in this study and other dual-pivoting designs studied by different authors have demonstrated bettercontrolled kinematics that are correlated to better active flexion [23] and better functional muscle coordination [44,45], favoring clinically detectable improved knee stability.…”

Validation of a low-dose hybrid RSA and fluoroscopy technique: Determination of accuracy, bias and precision

“…Analyzing skeletal kinematics with radiostereometric analysis (RSA) following corrective orthopedic surgery allows the quantitative comparison of joints with different implant designs (Uvehammer et al, 2001).…”