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In vivo kinematic comparison between an ultra-congruent and a posterior-stabilized total knee arthroplasty design by RSA

Abstract

Purpose

The aim of the present study was to compare the in vivo under weight-bearing kinematic behavior of a posterior-stabilized (PS) and an ultra-congruent (UC) total knee arthroplasty (TKA) model during a sit-to-stand motor task, a common activity of daily life.

Methods

A cohort of 16 randomly selected patients (8 PS Persona Zimmer, 8 UC Persona Zimmer) was evaluated through dynamic radiostereometric analysis (RSA) at a minimum of 9 months after TKA, during the execution of a sit-to-stand. The anteroposterior (AP) translation of the femoral component and the AP translation of the low point of medial and lateral femoral compartments were compared through Student’s t test (p < 0.05).

Results

A significantly greater anterior translation of the femoral component was found for the PS group compared to the UC group. The flexion interval where statistical significance was found was between 30° and 0° (p = 0.017). Both groups showed a significantly greater anterior translation of the low point of the lateral compartment with respect to the medial one (PS: p = 0.012, UC: p = 0.018). This was consistent with a medial-pivot pattern. Furthermore, a significantly greater anterior translation of the medial compartment was found in the PS group compared to the UC group (p = 0.001). The same pattern was observed for the lateral compartment (p = 0.006).

Conclusions

The TKA designs evaluated in the present study showed comparable in-vivo kinematics with regards to medial pivot pattern but differences in absolute AP translation. Specifically, the UC design showed greater AP stability than the PS design. This finding could be positive in terms of implant stability, but negative in terms of premature polyethylene wear and thus implant failure. This remains to be verified in studies with a larger sample size and longer follow-up.

Level of evidence

IV.

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Funding

The authors did not receive support from any organization for the submitted work.

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Affiliations

Authors

Contributions

TRDS participated in study design, data interpretation, and drafted the manuscript; DA participated in study design, data interpretation, and drafted the manuscript; SDP contributed in methods development and data interpretation, helped to draft the manuscript and performed statistical analysis; RZ participated in kinematics data collection and analysis, and helped to draft the manuscript; NP contributed in data interpretation and helped to draft the manuscript; GMMM supervised the clinical interpretation; SZ and LB participated in study design, coordinated activities and helped to draft the manuscript. All the authors read the final manuscript and approved it.

Corresponding author

Correspondence to Domenico Alesi.

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Conflict of interest

The authors have no conflicts of interest to declare that are relevant to the content of this article.

Ethical approval

Ethics Committee of the IRCCS Rizzoli Orthopaedic Institute (IRB statement: 0012645 approved 2014/04/03).

Informed consent

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

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Roberti di Sarsina, T., Alesi, D., Di Paolo, S. et al. In vivo kinematic comparison between an ultra-congruent and a posterior-stabilized total knee arthroplasty design by RSA. Knee Surg Sports Traumatol Arthrosc (2021). https://doi.org/10.1007/s00167-021-06629-1

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Keywords

  • Radiostereometric analysis
  • Ultra-congruent design
  • Posterior-stabilized design
  • TKA
  • Kinematics analysis