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Modifications of femoral component design in multi-radius total knee arthroplasty lead to higher lateral posterior femoro-tibial translation

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

Abstract

Purpose

As the aims of changes in total knee arthroplasty (TKA) designs are to reinstate more natural kinematics, the current study evaluated the in vivo kinematics in patients who underwent a cruciate retaining gradually changing femoral radius (“G-CURVE”) against a cruciate retaining conventional changing femoral radius (“J-CURVE”) geometry TKA design. The hypothesis of the study is that the G-CURVE design would allow a substantial increase in the femoral rollback compared to the J-CURVE design.

Methods

Retrospective study design. Thirty patients were included (G-CURVE, n = 20; J-CURVE, n = 10). Single-plane fluoroscopic analysis and marker-based motion capture gait analysis was performed to analyse dynamic tibiofemoral motion during weight-bearing and unloaded activities at 24 month after index surgery.

Results

The analysis of the medial and lateral points on the tibia plateau during the unloaded flexion–extension and the weight-bearing lunge activities revealed a significant difference in femoral rollback in G-CURVE TKA above 60° (p = 0.001) and 30° (p = 0.02) of knee flexion, respectively. Moreover, the lateral condyle of the G-CURVE showed a higher extent of femoral rollback while the lateral condyle of the J-CURVE rolled forward.

Conclusion

At 2 years post-operative, the G-CURVE TKA showed significant differences in femoro-tibial translation in comparison with the J-CURVE system, in vivo. The G-CURVE resulted in an increased lateral rollback and simultaneously in an elimination of the paradoxical medial roll-forward present in the J-CURVE design. Moreover, knee kinematics analysis showed significant differences between unloaded and weight-bearing conditions revealing the impact of load and muscle force. The analysis conducted in this study contributes to further understand the principal movement characteristics in widely used older designs in comparison with recently developed concepts to get a better overview on their potential benefits on in vivo kinematics.

Level of evidence

III.

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Acknowledgements

We would like to thank Arne Schlausch for his assistance in the gait and fluoroscopic data acquisition as well as data post-processing.

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Authors and Affiliations

  1. Julius Wolff Institute, Charité - Universitätsmedizin Berlin, Augustenburger Platz 1, 13353, Berlin, Germany

    Philippe Moewis, Heide Boeth, Adam Trepczynski & Georg N. Duda

  2. Center for Muskuloskeletal Surgery, Orthopaedic Department, Charité - Universitätsmedizin Berlin, Berlin, Germany

    Tilman Pfitzner, Patrick Stein & Philipp von Roth

Authors
  1. Tilman Pfitzner
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  2. Philippe Moewis
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  3. Patrick Stein
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  7. Georg N. Duda
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Corresponding author

Correspondence to Philippe Moewis.

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Conflict of interest

Tilman Pfitzner has received payment by Depuy Synthes for board membership, consultancy and development of educational presentations outside the present study. The rest of the authors declare that they have no conflict of interest in relation to this manuscript.

Funding

This study was funded by Depuy Synthes (Research Grant Nr: IIS2013009), BMBF 01EC1408A (OVERLOAD-PrevOP; SPO3) and EFRE (16409608, OrthoLoadLab).

Ethical approval

The local ethics committee approved the study (Approval-Nr: EA1/232/10).

Informed consent

All subjects provided written consent prior to participation.

Additional information

Tilman Pfitzner and Philippe Moewis shared first authorship.

Philipp von Roth and Georg N. Duda shared last authorship.

Appendix

Appendix

See Figs. 6, 7, 8 and 9.

Fig. 6
figure 6

Mean and standard deviations of the lateral (top) and of the medial (bottom) distal points anterior–posterior translation during unloaded flexion–extension, *p < 0.05 (fluoroscopic assessment)

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Fig. 7
figure 7

Mean and standard deviations of the lateral (top) and of the medial (bottom) distal points anterior–posterior translation during weight-bearing lunge, *p < 0.05 (fluoroscopic assessment)

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Fig. 8
figure 8

Mean and standard deviations of the lateral (top) and of the medial (bottom) anterior tangency points anterior–posterior translation during unloaded flexion–extension (fluoroscopic assessment)

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Fig. 9
figure 9

Mean and standard deviations of the lateral (top) and of the medial (bottom) anterior tangency points anterior–posterior translation during weight-bearing lunge (fluoroscopic assessment)

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Pfitzner, T., Moewis, P., Stein, P. et al. Modifications of femoral component design in multi-radius total knee arthroplasty lead to higher lateral posterior femoro-tibial translation. Knee Surg Sports Traumatol Arthrosc 26, 1645–1655 (2018). https://doi.org/10.1007/s00167-017-4622-7

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  • DOI: https://doi.org/10.1007/s00167-017-4622-7

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