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Are undesirable contact kinematics minimized after kinematically aligned total knee arthroplasty? An intersurgeon analysis of consecutive patients

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

Abstract

Purpose

Tibiofemoral contact kinematics or knee implant motions have a direct influence on patient function and implant longevity and should be evaluated for any new alignment technique such as kinematically aligned total knee arthroplasty (TKA). Edge loading of the tibial liner and external rotation (reverse of normal) and adduction of the tibial component on the femoral component are undesirable contact kinematics that should be minimized. Accordingly, this study determined whether the overall prevalence of undesirable contact kinematics during standing, mid kneeling near 90 degrees and full kneeling with kinematically aligned TKA are minimal and not different between groups of consecutive patients treated by different surgeons.

Methods

Three surgeons were asked to perform cemented, kinematically aligned TKA with patient-specific guides in a consecutive series of patients with their preferred cruciate-retaining (CR) implant. In vivo tibiofemoral contact positions were obtained using a 3- to 2-dimensional image registration technique in 69 subjects (Vanguard CR–TKA N = 22, and Triathlon CR–TKA N = 47).

Results

Anterior or posterior edge loading of the tibial liner was not observed. The overall prevalence of external rotation of the tibial component on the femoral component of 6 % was low and not different between surgeons (n.s.). The overall prevalence of adduction of the tibial component on the femoral component of 4 % was low and not different between surgeons (n.s.).

Conclusions

Kinematically aligned TKA minimized the undesirable contact kinematics of edge loading of the tibial liner, and external rotation and adduction of the tibial component on the femoral component during standing and kneeling, which suggests an optimistic prognosis for durable long-term function.

Level of evidence

III.

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Conflict of interest

No authors have signed any agreement with a commercial interest related to this study which would in any way limit publication of any and all data generated for the study or to delay publication for any reason. One of the authors (S.M.H.) is a paid consultant and receives royalties from Biomet Sports Medicine, Inc, and is a consultant and receives research support from Stryker Orthopaedics. One author (M.L.H.) receives research support from Stryker Orthopaedics. One author (J.V.V.) is a consultant for Stryker Orthopaedics. One author (T.D.M.) is a consultant and receives royalties from Arthrex, Inc.

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Correspondence to Joseph V. Vernace.

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Ethical Board Review statement: Approved by the BioMed IRB, San Diego, CA.

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Howell, S.M., Hodapp, E.E., Vernace, J.V. et al. Are undesirable contact kinematics minimized after kinematically aligned total knee arthroplasty? An intersurgeon analysis of consecutive patients. Knee Surg Sports Traumatol Arthrosc 21, 2281–2287 (2013). https://doi.org/10.1007/s00167-012-2220-2

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  • DOI: https://doi.org/10.1007/s00167-012-2220-2

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