Skip to main content
SpringerLink
Log in

Different intraoperative kinematics with comparable clinical outcomes of ultracongruent and posterior stabilized mobile-bearing total knee arthroplasty

  • Knee
  • Published:
Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Purpose

There remains no consensus as to whether mobile total knee arthroplasty (TKA) should use a posterior cruciate ligament-sacrificing ultracongruent (UC) or a posterior cruciate ligament-substituting posterior stabilized (PS) prosthesis. The purpose of this study was to assess intraoperative kinematics and clinical outcomes of UC and PS rotating platform mobile-bearing TKA.

Methods

In this randomized controlled study, mobile UC TKA prostheses (n = 45) were compared with mobile PS TKA prostheses (n = 45) with regard to intraoperative kinematics and clinical outcomes. The passive kinematic study using intraoperative navigation system included anterior/posterior translation, varus/valgus alignment and rotation of femur during flexion. The patients were clinically and radiographically evaluated over a 3-year follow-up.

Results

Paradoxical anterior translation of the femur was 10.8 ± 5.2 mm in the UC knee from 0° to 82° of knee flexion and 8.7 ± 3.0 mm in the PS knee from 0° to 70° of knee flexion (p = 0.027). Paradoxical internal rotation of the femur was 5.8° in the UC knees and 9.9° in the PS knees (p = 0.003). But, there was no significant difference between the groups in regard to the coronal alignment. There was no significant difference in the range of motion, KS knee scores, KS function scores, and WOMAC index scores.

Conclusions

Despite different intraoperative kinematics between mobile UC and mobile PS TKA, neither design reproduced physiologic knee kinematics and there was no difference in clinical outcomes between the two groups. The clinical relevance of the study is that despite different intraoperative kinematics, UC design can be a considerable alternative to PS design in mobile-bearing TKA in respect of clinical outcomes.

Level of evidence

II.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Argenson JN, Scuderi GR, Komistek RD, Scott WN, Kelly MA, Aubaniac JM (2005) In vivo kinematic evaluation and design considerations related to high flexion in total knee arthroplasty. J Biomech 38(2):277–284

    Article  PubMed  Google Scholar 

  2. Bellemans J, Banks S, Victor J, Vandenneucker H, Moemans A (2002) Fluoroscopic analysis of the kinematics of deep flexion in total knee arthroplasty. Influence of posterior condylar offset. J Bone Joint Surg Br 84(1):50–53

    Article  CAS  PubMed  Google Scholar 

  3. Bignozzi S, Zaffagnini S, Akkawi I, Marko T, Bruni D, Neri MP, Colle F, Marcacci M (2014) Three different cruciate-sacrificing TKA designs: minor intraoperative kinematic differences and negligible clinical differences. Knee Surg Sports Traumatol Arthrosc 22(12):3113–3120

    Article  PubMed  Google Scholar 

  4. Blunn GW, Joshi AB, Minns RJ, Lidgren L, Lilley P, Ryd L, Engelbrecht E, Walker PS (1997) Wear in retrieved condylar knee arthroplasties. A comparison of wear in different designs of 280 retrieved condylar knee prostheses. J Arthroplasty 12(3):281–290

    Article  CAS  PubMed  Google Scholar 

  5. Casino D, Zaffagnini S, Martelli S, Lopomo N, Bignozzi S, Iacono F, Russo A, Marcacci M (2009) Intraoperative evaluation of total knee replacement: kinematic assessment with a navigation system. Knee Surg Sports Traumatol Arthrosc 17(4):369–373

    Article  PubMed  Google Scholar 

  6. Daniilidis K, Skwara A, Vieth V, Fuchs-Winkelmann S, Heindel W, Stuckmann V, Tibesku CO (2012) Highly conforming polyethylene inlays reduce the in vivo variability of knee joint kinematics after total knee arthroplasty. Knee 19(4):260–265

    Article  PubMed  Google Scholar 

  7. Dennis DA, Komistek RD, Mahfouz MR, Haas BD, Stiehl JB (2003) Multicenter determination of in vivo kinematics after total knee arthroplasty. Clin Orthop Relat Res 416:37–57

    Article  PubMed  Google Scholar 

  8. Dennis DA, Komistek RD, Mahfouz MR, Outten JT, Sharma A (2005) Mobile-bearing total knee arthroplasty: do the polyethylene bearings rotate? Clin Orthop Relat Res 440:88–95

    Article  PubMed  Google Scholar 

  9. Dennis DA, Komistek RD, Mahfouz MR, Walker SA, Tucker A (2004) A multicenter analysis of axial femorotibial rotation after total knee arthroplasty. Clin Orthop Relat Res 428:180–189

    Article  PubMed  Google Scholar 

  10. Fantozzi S, Catani F, Ensini A, Leardini A, Giannini S (2006) Femoral rollback of cruciate-retaining and posterior-stabilized total knee replacements: in vivo fluoroscopic analysis during activities of daily living. J Orthop Res 24(12):2222–2229

    Article  PubMed  Google Scholar 

  11. Fitzpatrick CK, Clary CW, Cyr AJ, Maletsky LP, Rullkoetter PJ (2013) Mechanics of post-cam engagement during simulated dynamic activity. J Orthop Res 31(9):1438–1446

    Article  PubMed  PubMed Central  Google Scholar 

  12. Hamai S, Miura H, Higaki H, Shimoto T, Nakanishi Y, Iwamoto Y (2008) Kinematic analysis of mobile-bearing total knee arthroplasty using a 6-DOF knee simulator. J Orthop Sci 13(6):543–549

    Article  CAS  PubMed  Google Scholar 

  13. Hauschild O, Konstantinidis L, Strohm PC, Niemeyer P, Suedkamp NP, Helwig P (2009) Reliability of leg alignment using the OrthoPilot system depends on knee position: a cadaveric study. Knee Surg Sports Traumatol Arthrosc 17(10):1143–1151

    Article  PubMed  Google Scholar 

  14. Heyse TJ, Becher C, Kron N, Ostermeier S, Hurschler C, Schofer MD, Tibesku CO, Fuchs-Winkelmann S (2010) Patellofemoral pressure after TKA in vitro: highly conforming vs. posterior stabilized inlays. Arch Orthop Trauma Surg 130(2):191–196

    Article  PubMed  Google Scholar 

  15. Hilding MB, Lanshammar H, Ryd L (1996) Knee joint loading and tibial component loosening. RSA and gait analysis in 45 osteoarthritic patients before and after TKA. J Bone Joint Surg Br 78(1):66–73

    CAS  PubMed  Google Scholar 

  16. Hofmann AA, Tkach TK, Evanich CJ, Camargo MP (2000) Posterior stabilization in total knee arthroplasty with use of an ultracongruent polyethylene insert. J Arthroplasty 15(5):576–583

    Article  CAS  PubMed  Google Scholar 

  17. Hozack WJ, Rothman RH, Booth RE Jr, Balderston RA (1989) The patellar clunk syndrome. A complication of posterior stabilized total knee arthroplasty. Clin Orthop Relat Res 241:203–208

    PubMed  Google Scholar 

  18. Kim JIOK, Jeon SH, Choi HW (2011) Short-term results of posterior cruciate sacrificing and substitution total knee arthroplasty. Knee Surg Relat Res 23:79–87

    Google Scholar 

  19. Kim YH, Kim JS, Park JW, Joo JH (2011) Comparison of the low contact stress and press fit condylar rotating-platform mobile-bearing prostheses in total knee arthroplasty: a prospective randomized study. J Bone Joint Surg Am 93(11):1001–1007

    PubMed  Google Scholar 

  20. Lachiewicz PF, Soileau ES (2009) Fifteen-year survival and osteolysis associated with a modular posterior stabilized knee replacement. A concise follow-up of a previous report. J Bone Joint Surg Am 91(6):1419–1423

    Article  PubMed  Google Scholar 

  21. Laskin RS, Maruyama Y, Villaneuva M, Bourne R (2000) Deep-dish congruent tibial component use in total knee arthroplasty: a randomized prospective study. Clin Orthop Relat Res 380:36–44

    Article  PubMed  Google Scholar 

  22. Lombardi AV Jr, Mallory TH, Waterman RA, Eberle RW (1995) Intercondylar distal femoral fracture. An unreported complication of posterior-stabilized total knee arthroplasty. J Arthroplasty 10(5):643–650

    Article  PubMed  Google Scholar 

  23. Maruyama S, Yoshiya S, Matsui N, Kuroda R, Kurosaka M (2004) Functional comparison of posterior cruciate-retaining versus posterior stabilized total knee arthroplasty. J Arthroplasty 19(3):349–353

    Article  PubMed  Google Scholar 

  24. Matsuzaki T, Matsumoto T, Kubo S, Muratsu H, Matsushita T, Kawakami Y, Ishida K, Oka S, Kuroda R, Kurosaka M (2014) Tibial internal rotation is affected by lateral laxity in cruciate-retaining total knee arthroplasty: an intraoperative kinematic study using a navigation system and offset-type tensor. Knee Surg Sports Traumatol Arthrosc 22(3):615–620

    Article  PubMed  Google Scholar 

  25. Mikulak SA, Mahoney OM, dela Rosa MA, Schmalzried TP (2001) Loosening and osteolysis with the press-fit condylar posterior-cruciate-substituting total knee replacement. J Bone Joint Surg Am 83-A(3):398–403

    CAS  PubMed  Google Scholar 

  26. Ploegmakers MJ, Ginsel B, Meijerink HJ, de Rooy JW, de Waal Malefijt MC, Verdonschot N, Banks SA (2010) Physical examination and in vivo kinematics in two posterior cruciate ligament retaining total knee arthroplasty designs. Knee 17(3):204–209

    Article  CAS  PubMed  Google Scholar 

  27. Puloski SK, McCalden RW, MacDonald SJ, Rorabeck CH, Bourne RB (2001) Tibial post wear in posterior stabilized total knee arthroplasty. An unrecognized source of polyethylene debris. J Bone Joint Surg Am 83-A(3):390–397

    CAS  PubMed  Google Scholar 

  28. Roh YW, Jang J, Choi WC, Lee JK, Chun SH, Lee S, Seong SC, Lee MC (2013) Preservation of the posterior cruciate ligament is not helpful in highly conforming mobile-bearing total knee arthroplasty: a randomized controlled study. Knee Surg Sports Traumatol Arthrosc 21(12):2850–2859

    Article  PubMed  Google Scholar 

  29. Siston RA, Daub AC, Giori NJ, Goodman SB, Delp SL (2005) Evaluation of methods that locate the center of the ankle for computer-assisted total knee arthroplasty. Clin Orthop Relat Res 439:129–135

    Article  PubMed  Google Scholar 

  30. Siston RA, Delp SL (2006) Evaluation of a new algorithm to determine the hip joint center. J Biomech 39(1):125–130

    Article  PubMed  Google Scholar 

  31. Siston RA, Giori NJ, Goodman SB, Delp SL (2006) Intraoperative passive kinematics of osteoarthritic knees before and after total knee arthroplasty. J Orthop Res 24(8):1607–1614

    Article  PubMed  Google Scholar 

  32. Suggs JF, Hanson GR, Park SE, Moynihan AL, Li G (2008) Patient function after a posterior stabilizing total knee arthroplasty: cam-post engagement and knee kinematics. Knee Surg Sports Traumatol Arthrosc 16(3):290–296

    Article  PubMed  Google Scholar 

  33. Uvehammer J, Karrholm J, Regner L, Carlsson L, Herberts P (2001) Concave versus posterior-stabilized tibial joint surface in total knee arthroplasty: randomized evaluation of 47 knees. J Arthroplasty 16(1):25–32

    Article  CAS  PubMed  Google Scholar 

  34. Wasielewski RC, Komistek RD, Zingde SM, Sheridan KC, Mahfouz MR (2008) Lack of axial rotation in mobile-bearing knee designs. Clin Orthop Relat Res 466(11):2662–2668

    Article  PubMed  PubMed Central  Google Scholar 

  35. Wolterbeek N, Garling EH, Mertens BJ, van der Linden HM, Nelissen RG, Valstar ER (2012) Kinematics of a highly congruent mobile-bearing total knee prosthesis. Knee Surg Sports Traumatol Arthrosc 20(12):2487–2493

    Article  CAS  PubMed  Google Scholar 

  36. Yoshiya S, Matsui N, Komistek RD, Dennis DA, Mahfouz M, Kurosaka M (2005) In vivo kinematic comparison of posterior cruciate-retaining and posterior stabilized total knee arthroplasties under passive and weight-bearing conditions. J Arthroplasty 20(6):777–783

    Article  PubMed  Google Scholar 

  37. Zingde SM, Leszko F, Sharma A, Mahfouz MR, Komistek RD, Dennis DA (2014) In vivo determination of cam-post engagement in fixed and mobile-bearing TKA. Clin Orthop Relat Res 472(1):254–262

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Orthopaedic Surgery, Hallym University Hospital, Chuncheon, 77, Sakju-ro, Chuncheon-si, Gangwon-do, 200-704, Korea

    Tae Woo Kim

  2. Department of Orthopaedic Surgery, Seoul Jaeil Hospital, 70, Jisan-ro, Pyeongtaek-si, Gyeonggi-do, Korea

    Sang Min Lee

  3. Department of Orthopaedic Surgery, Seoul National University Hospital, 101 Daehang-ro, Jongno-gu, Seoul, 110-744, Korea

    Sahnghoon Lee & Myung Chul Lee

  4. Department of Orthopaedic Surgery, Daehan Hospital, 301, Dobong-ro, Ganbuk-gu, Seoul, 132-703, Korea

    Jak Jang

  5. Department of Orthopaedic Surgery, Seoul National University Bundang Hospital, 82, Gumi-ro 173 Beon-gil, Bundang-gu, Seongnam-si, Gyeonggi-do, 464-707, Korea

    Sang Cheol Seong

Authors
  1. Tae Woo Kim
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Sang Min Lee
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Sang Cheol Seong
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Sahnghoon Lee
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Jak Jang
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Myung Chul Lee
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Myung Chul Lee.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Kim, T.W., Lee, S.M., Seong, S.C. et al. Different intraoperative kinematics with comparable clinical outcomes of ultracongruent and posterior stabilized mobile-bearing total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 24, 3036–3043 (2016). https://doi.org/10.1007/s00167-014-3489-0

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00167-014-3489-0

Keywords

Search

Navigation