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Impact of femoro-tibial size combinations and TKA design on kinematics

  • Knee Arthroplasty
  • Published:
Archives of Orthopaedic and Trauma Surgery Aims and scope Submit manuscript

Abstract

Introduction

The variability in patients’ femoral and tibial anatomy requires to use different tibia component sizes with the same femoral component size. These size combinations are allowed by manufacturers, but the clinical impact remains unclear. Therefore, the goals of our study were to investigate whether combining different sizes has an impact on the kinematics for two well-established knee systems and to compare these systems’ kinematics to the native kinematics.

Materials and methods

Six fresh frozen knee specimens were tested in a force controlled knee rig before and after implantation of a cruciate retaining (CR) and a posterior-stabilized (PS) implant. Femoro-tibial kinematics were recorded using a ultrasonic-based motion analysis system while performing a loaded squat from 30° to 130°. In each knee, the original best fit inlay was then replaced by different inlays simulating a smaller or bigger tibia component. The kinematics obtained with the simulated sizes were compared to the original inlay kinematics using descriptive statistics.

Results

For all size combinations, the difference to the original kinematics reached an average of 1.3 ± 3.3 mm in translation and − 0.1 ± 1.2° in rotation with the CR implant. With the PS implant, the average differences reached 0.4 ± 2.7 mm and  − 0.2 ± 0.8°. Among all knees, no size combination consistently resulted in significantly different kinematics.

Each knee showed a singular kinematic pattern. For both knee systems, the rotation was smaller than in the native knee, but the direction of the rotation was preserved. The PS showed more rollback and the CR less rollback than the native knee.

Conclusion

TKA systems designed with a constant tibio-femoral congruency among size combinations should enable to combine different sizes without having substantial impact on the kinematics. The rotational pattern was preserved by both TKA systems, while the rollback could only be maintained by the PS design.

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Acknowledgements

The authors thank Rachel Lang, Aesculap AG, for her support in planning the study and Adrian Sauer, Aesculap AG, for his support in performing the tests.

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Authors and Affiliations

  1. Aesculap AG, Research and Development, Am Aesculap Platz 1, 78532, Tuttlingen, Germany

    Ingrid Dupraz & Thomas M. Grupp

  2. Department of Orthopaedic Surgery, Physical Medicine and Rehabilitation, University Hospital of Munich (LMU), Munich, Germany

    Christoph Thorwächter, Thomas M. Grupp, Florian Hammerschmid, Matthias Woiczinski, Volkmar Jansson, Peter E. Müller & Arnd Steinbrück

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  1. Ingrid Dupraz
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Corresponding author

Correspondence to Ingrid Dupraz.

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Conflict of interest

(ID, IMG) are employees of the Aesculap AG, Tuttlingen, a manufacturer of orthopaedic implants. Three of the authors (VJ, PEM, AS) are advising surgeons in Aesculap R&D project. Four of the authors (VJ, PEM, AS, MW) received institutional funding from Aesculap.

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Appendix

Appendix

Appendix A: Kinematics obtained with different Columbus DD size combinations.

Figures 

Fig. 9
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Translation of the medial condyle (APMED) obtained with different Columbus DD size combinations

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Fig. 10
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Translation of the lateral condyle (APLAT) obtained with different Columbus DD size combinations

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Fig. 11
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Rotation obtained with different Columbus DD size combinations

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11.

Appendix B: Kinematics obtained with different Vega PS size combinations.

Figures 

Fig. 12
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Translation of the medial condyle (APMED) obtained with different Vega PS size combinations

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Fig. 13
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Translation of the lateral condyle (APLAT) obtained with different Vega PS size combinations

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Fig. 14
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Rotation obtained with different Vega PS size combinations

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Appendix C: Medial and lateral translation of the condyles for the native knee and after TKA.

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Fig.15
figure 15

Translation of the medial condyle (APMED) for the native knee and after TKA

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15, 16, 17.

Fig. 16
figure 16

Translation of the lateral condyle (APLAT) for the native knee and after TKA

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Fig. 17
figure 17

Rotation for the native knee and after TKA

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Dupraz, I., Thorwächter, C., Grupp, T.M. et al. Impact of femoro-tibial size combinations and TKA design on kinematics. Arch Orthop Trauma Surg 142, 1197–1212 (2022). https://doi.org/10.1007/s00402-021-03923-y

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