Archives of Orthopaedic and Trauma Surgery

, Volume 137, Issue 3, pp 409–416 | Cite as

Does a third condyle TKA restore normal gait kinematics in varus knees? In vivo knee kinematic analysis

  • Dafina Bytyqi
  • Bujar Shabani
  • Laurence Cheze
  • Philippe Neyret
  • Sebastien Lustig
Knee Arthroplasty



Patients with knee osteoarthritis tend to modify spatial and temporal parameters during walking to reduce the pain. Total knee arthroplasty (TKA) is considered the gold standard treatment for end-stage knee osteoarthritis. However, reduced physical function of the knee is partly, but apparently not fully, remedied by surgery. The purpose of this study was to investigate the in vivo, three dimensional knee kinematics during gait at the patients with knee osteoarthritis and the influence of “third condyle” psoterior stabilized (PS) total knee arthroplasty on restoration of normal kinematics.

Materials and Methods

Twenty patients with medial knee osteoarthritis and a control group with age-matched subjects were prospectively collected for this study. The same group of 20 patients were re-assessed 10 months after total knee arthroplasty with “third condyle” PS prosthesis. All subjects were assessed with a 3D, optoelectric knee assessement device, while walking on a treadmill at a self-selected speed. For each participant, knee flexion–extension, abduction–adduction, internal–external rotation and anterior–posterior displacement, were calculated.


The range of flexion/extension was improved significantly (39.9° ± 5.5° vs 44.8° ± 5.1°, p < 0.05) after TKA but it still remained lower than control group (6.9° ± 5.5° vs 2.2° ± 3.9°, p < 0.05). The range of motion in internal-external rotation did not change pre- and post-arthroplasty, but remained lower than the matched control group (6.7° ± 2.4° vs 9.3° ± 2.4, p < 0.05). The maximum posterior displacement during swing phase was significantly higher at post-arthroplasty group comparing with control group (−9.5 ± 2.2 vs −5.7 ± 3 mm, p < 0.05).


Following “third condyle” PS-TKA, patients had better clinical, spatiotemporal and kinematic parameters. Despite improvements, the knee kinematics during gait in TKA group differed from healthy control group. TKA group had a lower extension lower range of axial rotation and an increased tibial posterior displacement.


Knee Gait Kinematics Prosthesis Third condyle 


Compliance with ethical standards

Conflict of interest

Authors Bytyqi Dafina, Shabani Bujar, Cheze Laurence declare that they have no conflict of interest. Sébastien Lustig is consultant for Smith and Nephew and received institutional support from Amplitude and Wright-Tornier. Philippe Neyret received royalties from Wright-Tornier and institutional support from Amplitude and Wright-Tornier.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study.


  1. 1.
    Minoda Y, Ikebuchi M, Mizokawa S, Ohta Y, Nakamura H (2016) Mobile-bearing TKA improved the anteroposterior joint stability in mid-flexion range comparing to fixed-bearing TKA. Arch Orthop Trauma Surg 136(11):1601–1606CrossRefPubMedGoogle Scholar
  2. 2.
    Vahtrik D, Ereline J, Gapeyeva H, Pääsuke M (2014) Postural stability in relation to anthropometric and functional characteristics in women with knee osteoarthritis following total knee arthroplasty. Arch Orthop Trauma Surg 134(5):685–692CrossRefPubMedGoogle Scholar
  3. 3.
    Stoddard JE, Deehan DJ, Bull AMJ et al (2013) The kinematics and stability of single-radius versus multi-radius femoral components related to Mid-range instability after TKA. J Orthop Res 31:53–58. doi: 10.1002/jor.22170 CrossRefPubMedGoogle Scholar
  4. 4.
    Ezechieli M, Dietzek J, Becher C, et al (2012) The influence of a single-radius-design on the knee stability. Technol Heal Care 20:527–534. doi: 10.3233/THC-2012-0698 Google Scholar
  5. 5.
    Schlepckow P (1992) Three-dimensional kinematics of total knee replacement systems. Arch Orthop Trauma Surg 111:204–209. doi: 10.1007/BF00571478 CrossRefPubMedGoogle Scholar
  6. 6.
    McEwen HMJ, Barnett PI, Bell CJ et al (2005) The influence of design, materials and kinematics on the in vitro wear of total knee replacements. J Biomech 38:357–365. doi: 10.1016/j.jbiomech.2004.02.015 CrossRefPubMedGoogle Scholar
  7. 7.
    Siebold R, Louisia S, Canty J, Bartlett RJ (2007) Posterior stability in fixed-bearing versus mobile-bearing total knee replacement: a radiological comparison of two implants. Arch Orthop Trauma Surg 127:97–104. doi: 10.1007/s00402-006-0232-4 CrossRefPubMedGoogle Scholar
  8. 8.
    Tayot O, Aït Si Selmi T, Neyret P (2001) Results at 11.5 years of a series of 376 posterior stabilized HLS1 total knee replacements. Survivorship analysis, and risk factors for failure. Knee 8:195–205CrossRefPubMedGoogle Scholar
  9. 9.
    Demey G, Servien E, Lustig S et al (2011) Cemented versus uncemented femoral components in total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 19:1053–1059. doi: 10.1007/s00167-010-1347-2 CrossRefPubMedGoogle Scholar
  10. 10.
    McClelland J a, Webster KE, Feller J a, Menz HB (2011) Knee kinematics during walking at different speeds in people who have undergone total knee replacement. Knee 18:151–155. doi: 10.1016/j.knee.2010.04.005 CrossRefPubMedGoogle Scholar
  11. 11.
    Graves SE, Davidson D, Ingerson L, et al (2004) The Australian orthopaedic association national joint replacement registry. Med J Aust. doi:gra10571_fm [pii]Google Scholar
  12. 12.
    Labbe DR, Hagemeister N, Tremblay M, de Guise J (2008) Reliability of a method for analyzing three-dimensional knee kinematics during gait. Gait Posture 28:170–174. doi: 10.1016/j.gaitpost.2007.11.002 CrossRefPubMedGoogle Scholar
  13. 13.
    Hagemeister N, Parent G, Van de Putte M et al (2005) A reproducible method for studying three-dimensional knee kinematics. J Biomech 38:1926–1931. doi: 10.1016/j.jbiomech.2005.05.013 CrossRefPubMedGoogle Scholar
  14. 14.
    Südhoff I, Van Driessche S, Laporte S et al (2007) Comparing three attachment systems used to determine knee kinematics during gait. Gait Posture 25:533–543. doi: 10.1016/j.gaitpost.2006.06.002 CrossRefPubMedGoogle Scholar
  15. 15.
    Magnussen RA, Neyret P, Cheze L, Lustig S (2012) The KneeKG system: a review of the literature. Knee Surg Sport Traumatol Arthrosc 20:633–638. doi: 10.1007/s00167-011-1867-4 CrossRefGoogle Scholar
  16. 16.
    Bytyqi D, Shabani B, Lustig S et al (2014) Gait knee kinematic alterations in medial osteoarthritis: Three dimensional assessment. Int Orthop 38:1191–1198. doi: 10.1007/s00264-014-2312-3 CrossRefPubMedPubMedCentralGoogle Scholar
  17. 17.
    Baker R (2003) ISB recommendation on definition of joint coordinate systems for the reporting of human joint motion—Part I: ankle, hip and spine. J Biomech 36:300–304. doi: 10.1016/S0021-9290(02)00336-6 CrossRefPubMedGoogle Scholar
  18. 18.
    Hatfield GL, Hubley-Kozey CL, Astephen Wilson JL, Dunbar MJ (2011) The effect of total knee arthroplasty on knee joint kinematics and kinetics during gait. J Arthroplasty 26:309–318. doi: 10.1016/j.arth.2010.03.021 CrossRefPubMedGoogle Scholar
  19. 19.
    Mandeville D, Osternig LR, Chou L-S (2007) The effect of total knee replacement on dynamic support of the body during walking and stair ascent. Clin Biomech (Bristol Avon) 22:787–794. doi: 10.1016/j.clinbiomech.2007.04.002 CrossRefGoogle Scholar
  20. 20.
    Saari T, Tranberg R, Zügner R et al (2005) Changed gait pattern in patients with total knee arthroplasty but minimal influence of tibial insert design. Acta Orthop 76:253–260. doi: 10.1080/00016470510030661 CrossRefPubMedGoogle Scholar
  21. 21.
    Saari T, Carlsson L, Karlsson J, Kärrholm J (2005) Knee kinematics in medial arthrosis. Dynamic radiostereometry during active extension and weight-bearing. J Biomech 38:285–292. doi: 10.1016/j.jbiomech.2004.02.009 CrossRefPubMedGoogle Scholar
  22. 22.
    Yue B, Varadarajan KM, Moynihan AL, et al (2011) Kinematics of medial osteoarthritic knees before and after posterior cruciate ligament retaining total knee arthroplasty. J Orthop Res. doi: 10.1002/jor.21203 PubMedGoogle Scholar
  23. 23.
    Dennis DA, Komistek RD, Mahfouz MR, et al (2004) A multicenter analysis of axial femorotibial rotation after total knee arthroplasty. Clin Orthop Relat Res. doi: 10.1097/01.blo.0000148777.98244.84 Google Scholar
  24. 24.
    Uvehammer J, Kärrholm J, Brandsson S (2000) In vivo kinematics of total knee arthroplasty. J Bone Joint Surg Br 82:4–10CrossRefGoogle Scholar
  25. 25.
    van der Linden ML, Rowe PJ, Myles CM et al (2007) Knee kinematics in functional activities seven years after total knee arthroplasty. Clin Biomech (Bristol Avon) 22:537–542. doi: 10.1016/j.clinbiomech.2006.12.005 CrossRefGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2017

Authors and Affiliations

  • Dafina Bytyqi
    • 1
    • 2
    • 3
  • Bujar Shabani
    • 1
    • 2
    • 3
  • Laurence Cheze
    • 1
  • Philippe Neyret
    • 1
    • 2
  • Sebastien Lustig
    • 1
    • 2
  1. 1.Laboratoire de Biomécanique et Mécanique des ChocsUniversity Claude Bernard Lyon 1LyonFrance
  2. 2.Albert Trillat CenterLyonFrance
  3. 3.University of PrishtinaPrishtinaKosovo

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