In vivo flexion and kinematics of the knee after TKA: comparison of a conventional and a high flexion cruciate-retaining TKA design


This study investigated the in vivo 6DOF knee kinematics and tibiofemoral contact location after total knee arthroplasty using a conventional and a high flexion cruciate retaining component (15 NexGen CR, 11 NexGen CR-Flex). Each patient performed a single-leg lunge while being imaged by a dual fluoroscopic imaging system. Data were analyzed at hyperextension, 0° to 90° in 15° intervals, and at maximum flexion. The average maximum weight-bearing flexion for all the CR patients was 110.1° ± 13.4°, and for all the CR-Flex patients was 108.2° ± 13.2°. No difference was seen in the maximum flexion achieved by the patients, and the kinematics demonstrated by the groups was similar. However, at high flexion, the tibiofemoral articulating surfaces were more conforming in the CR-Flex design than the CR design, suggesting that the use of the high flexion component improved the tibiofemoral contact environment at high flexion in patients who could achieve high flexion.

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This study was supported by a research grant from Zimmer Inc. The guidance of Dr. Harry Rubash and Dr. Andrew Freiberg and the technical assistance of Elizabeth Desouza and Angela Moynihan were greatly appreciated. The experiments performed in the course of this study comply with the laws of the United States.

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Correspondence to Guoan Li.

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Suggs, J.F., Kwon, YM., Durbhakula, S.M. et al. In vivo flexion and kinematics of the knee after TKA: comparison of a conventional and a high flexion cruciate-retaining TKA design. Knee Surg Sports Traumatol Arthrosc 17, 150–156 (2009).

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  • Total knee arthroplasty
  • High flexion
  • In vivo kinematics
  • Biomechanics
  • Knee