In Vivo Kinematics after a Cruciate-substituting TKA
Rent the article at a discountRent now
* Final gross prices may vary according to local VAT.Get Access
Patterns of motion in the native knee show substantial variability. Guided motion prosthetic designs offer stability but may limit natural variability. To assess these limits, we therefore determined the in vivo kinematic patterns for patients having a cruciate-substituting TKA of one design and determined the intersurgeon variability associated with a guided-motion prosthetic design. Three-dimensional femorotibial contact positions were evaluated for 86 TKAs in 80 subjects from three different surgeons using fluoroscopy during a weightbearing deep knee bend. The average posterior femoral rollback of the medial and lateral condyles for all TKAs from full extension to maximum flexion was −14.0 mm and −23.0 mm, respectively. The average axial tibiofemoral rotation from full extension to maximum flexion for all TKAs was 10.8°. The average weightbearing range of motion (ROM) was 109º (range, 60º–150º; standard deviation, 18.7º). Overall, the TKA showed axial rotation patterns similar to those of the normal knee, although less in magnitude. Surgeon-to-surgeon comparison revealed dissimilarities, showing the surgical technique and soft tissue handling influence kinematics in a guided-motion prosthetic design.
Level of Evidence: Level III, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.
- Andriacchi TP. Functional analysis of pre and post-knee surgery: total knee arthroplasty and ACL reconstruction. J Biomech Eng. 1993;115:575–581. CrossRef
- Banks SA, Markovich GD, Hodge WA. In vivo kinematics of cruciate-retaining and -substituting knee arthroplasties. J Arthroplasty. 1997;12:297–304. CrossRef
- Bellemans J, Banks S, Victor J, Vandenneucker H, Moemans A. Fluoroscopic analysis of the kinematics of deep flexion in total knee arthroplasty: influence of posterior condylar offset. J Bone Joint Surg Br. 2002;84:50–53. CrossRef
- Bertin KC, Komistek RD, Dennis DA, Hoff WA, Anderson DT, Langer T. In vivo determination of posterior femoral rollback for subjects having a NexGen posterior cruciate-retaining total knee arthroplasty. J Arthroplasty. 2002;17:1040–1048. CrossRef
- Blunn GW, Walker PS, Joshi A, Hardinge K. The dominance of cyclic sliding in producing wear in total knee replacements. Clin Orthop Relat Res. 1991;273:253–260.
- Bull AM, Kessler O, Alam M, Amis AA. Changes in knee kinematics reflect the articular geometry after arthroplasty. Clin Orthop Relat Res. 2008;466:2491–2499. CrossRef
- D’Lima DD, Steklov N, Fergly BJ, Banks SA, Colwell CW Jr. In vivo contact stresses during activities of daily living after knee arthroplasty. J Orthop Res. 2008;26:1549–1555. CrossRef
- Dennis DA, Komistek RD, Colwell CE Jr, Ranawat CS, Scott RD, Thornhill TS, Lapp MA. In vivo anteroposterior femorotibial translation of total knee arthroplasty: a multicenter analysis. Clin Orthop Relat Res. 1998;356:47–57. CrossRef
- Dennis DA, Komistek RD, Mahfouz MR, Haas BD, Stiehl JB. Multicenter determination of in vivo kinematics after total knee arthroplasty. Clin Orthop Relat Res. 2003;416:37–57. CrossRef
- Dennis DA, Komistek RD, Mahfouz MR, Walker SA, Tucker A. A multicenter analysis of axial femorotibial rotation after total knee arthroplasty. Clin Orthop Relat Res. 2004;428:180–189. CrossRef
- Dennis DA, Komistek RD, Scuderi GR, Zingde SM. Factors affecting flexion after total knee arthroplasty. Clin Orthop Relat Res. 2007;464:53–60.
- Dennis DA, Komistek RD, Stiehl JB, Walker SA, Dennis KN. Range of motion after total knee arthroplasty: the effect of implant design and weight-bearing conditions. J Arthroplasty. 1998;13:748–752. CrossRef
- Dennis DA, Komistek RD, Walker SA, Cheal EJ, Stiehl JB. Femoral condylar lift-off in vivo in total knee arthroplasty. J Bone Joint Surg Br. 2001;83:33–39. CrossRef
- Dorr LD. Contrary view: wear is not an issue. Clin Orthop Relat Res. 2002;404:96–99. CrossRef
- Draganich LF, Andriacchi TP, Andersson GB. Interaction between intrinsic knee mechanics and the knee extensor mechanism. J Orthop Res. 1987;5:539–547. CrossRef
- Feng EL, Stulberg SD, Wixson RL. Progressive subluxation and polyethylene wear in total knee replacements with flat articular surfaces. Clin Orthop Relat Res. 1994;299:60–71.
- Fregly BJ, Sawyer WG, Harman MK, Banks SA. Computational wear prediction of a total knee replacement from in vivo kinematics. J Biomech. 2005;38:305–314. CrossRef
- Hill PF, Vedi V, Williams A, Iwaki H, Pinskerova V, Freeman MA. Tibiofemoral movement 2: the loaded and unloaded living knee studied by MRI. J Bone Joint Surg Br. 2000;82:1196–1198. CrossRef
- Hsieh HH, Walker PS. Stabilizing mechanisms of the loaded and unloaded knee joint. J Bone Joint Surg Am. 1976;58:87–93.
- Insall JN, Hood RW, Flawn LB, Sullivan DJ. The total condylar knee prosthesis in gonarthrosis: a five to nine-year follow-up of the first one hundred consecutive replacements. J Bone Joint Surg Am. 1983;65:619–628.
- Insall JN, Scuderi GR, Komistek RD, Math K, Dennis DA, Anderson DT. Correlation between condylar lift-off and femoral component alignment. Clin Orthop Relat Res. 2002;403:143–152. CrossRef
- Iwaki H, Pinskerova V, Freeman MA. Tibiofemoral movement 1: the shapes and relative movements of the femur and tibia in the unloaded cadaver knee. J Bone Joint Surg Br. 2000;82:1189–1195. CrossRef
- Johal P, Williams A, Wragg P, Hunt D, Gedroyc W. Tibio-femoral movement in the living knee: a study of weight bearing and non-weight bearing knee kinematics using `interventional’ MRI. J Biomech. 2005;38:269–276. CrossRef
- Komistek RD, Dennis DA. Fluoroscopic Analysis of Total Knee Replacement. Surgery of the Knee. Vol 2, Ed 3. New York, NY: Churchill Livingstone; 2001:1695.
- Komistek RD, Dennis DA, Mahfouz M. In vivo fluoroscopic analysis of the normal human knee. Clin Orthop Relat Res. 2003;410:69–81. CrossRef
- Komistek RD, Mahfouz MR, Bertin KC, Rosenberg A, Kennedy W. In vivo determination of total knee arthroplasty kinematics: a multicenter analysis of an asymmetrical posterior cruciate retaining total knee arthroplasty. J Arthroplasty. 2008;23:41–50. CrossRef
- Kurosawa H, Walker PS, Abe S, Garg A, Hunter T. Geometry and motion of the knee for implant and orthotic design. J Biomech. 1985;18:487–499. CrossRef
- Lewis P, Rorabeck CH, Bourne RB, Devane P. Posteromedial tibial polyethylene failure in total knee replacements. Clin Orthop Relat Res. 1994;299:11–17.
- Moro-oka T, Hamai S, Miura H, Shimoto T, Higaki H, Fregly BJ, Iwamoto Y, Banks SA. Dynamic activity dependence of in vivo normal knee kinematics. J Orthop Res. 2008;26:428–434. CrossRef
- Mahfouz MR, Hoff WA, Komistek RD, Dennis DA. A robust method for registration of three-dimensional knee implant models to two-dimensional fluoroscopy images. IEEE Trans Med Imaging. 2003;22:1561–1574. CrossRef
- Markolf KL, Finerman GM, Amstutz HC. In vitro measurements of knee stability after bicondylar replacement. J Bone Joint Surg Am. 1979;61:547–557.
- Massin P, Gournay A. Optimization of the posterior condylar offset, tibial slope, and condylar roll-back in total knee arthroplasty. J Arthroplasty. 2006;21:889–896. CrossRef
- Noble PC, Gordon MJ, Weiss JM, Reddix RN, Conditt MA, Mathis KB. Does total knee replacement restore normal knee function? Clin Orthop Relat Res. 2005;431:157–165. CrossRef
- Stiehl JB, Dennis DA, Komistek RD, Crane HS. In vivo determination of condylar lift-off and screw-home in a mobile-bearing total knee arthroplasty. J Arthroplasty. 1999;14:293–299. CrossRef
- Stiehl JB, Dennis DA, Komistek RD, Keblish PA. In vivo kinematic analysis of a mobile bearing total knee prosthesis. Clin Orthop Relat Res. 1997;345:60–66. CrossRef
- Stiehl JB, Komistek RD, Dennis DA. Detrimental kinematics of a flat on flat total condylar knee arthroplasty. Clin Orthop Relat Res. 1999;365:139–148. CrossRef
- Stiehl JB, Komistek RD, Dennis DA, Paxson RD, Hoff WA. Fluoroscopic analysis of kinematics after posterior-cruciate-retaining knee arthroplasty. J Bone Joint Surg Br. 1995;77:884–889.
- Victor J, Banks S, Bellemans J. Kinematics of posterior cruciate ligament-retaining and -substituting total knee arthroplasty: a prospective randomised outcome study. J Bone Joint Surg Br. 2005;87:646–655. CrossRef
- Victor J, Bellemans J. Physiologic kinematics as a concept for better flexion in TKA. Clin Orthop Relat Res. 2006;452:53–58. CrossRef
- In Vivo Kinematics after a Cruciate-substituting TKA
Clinical Orthopaedics and Related Research®
Volume 468, Issue 3 , pp 807-814
- Cover Date
- Print ISSN
- Online ISSN
- Additional Links
- Industry Sectors
- Author Affiliations
- 1. AZ St-Lucas, St-Lucaslaan, 8310, Brugge, Belgium
- 2. Center for Musculoskeletal Research, University of Tennessee-Knoxville, Knoxville, TN, USA
- 3. Knoxville Orthopaedic Clinic, Knoxville, TN, USA
- 4. UZ Leuven, Leuven, Belgium