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Quadriceps force in relation of intrinsic anteroposterior stability of TKA design

  • Orthopaedic Surgery
  • Published:
Archives of Orthopaedic and Trauma Surgery Aims and scope Submit manuscript

Abstract

Purpose

Decreased quadriceps strength and fatigue is suspected to be one of the contributing factors for anterior knee pain and malfunction after total knee arthroplasty (TKA). The purpose of this in vitro study was to investigate the amount of quadriceps force required to extend the knee isokinetically after TKA in dependence of different prosthesis designs and the state of the posterior cruciate ligament (PCL).

Materials and methods

Eight fresh frozen human knee specimens underwent testing in a kinematic device simulating an isokinetic knee extension cycle from 120° of flexion to full extension. The quadriceps force was measured after implantation of a cruciate retaining (CR) TKA (Genesis II, Smith&Nephew, Memphis, TN, USA) applying a conventional CR (11 mm) and a highly conforming (deep dished, DD) polyethylene (PE) inlay consecutively before and after resection of the PCL. Finally, tests were repeated with a posterior-stabilized (PS) design.

Results

Simulating a physiological knee extension, no significant differences in the average quadriceps force were detected between the cruciate preserving inlays (CR 1,146.57 ± 88.04 N, DD 1,150.19 ± 97.54 N, P = 0.86) as long as the PCL was intact. After resection of the PCL, the required quadriceps force increased significantly for both designs (CR 1,203.17 ± 91.51 N, P < 0.01 and DD 1,191.88 ± 80.07 N, P < 0.03). After implantation of the posterior stabilized femoral component quad force decreased to its initial levels with forces significantly lower compared to the PCL deficient knees provided with a CR or DD (PS 1,130.91 ± 107.88 N, P < 0.01) inlay. With a deficient PCL there were no statistical differences for the DD design in comparison with CR in mean quad forces (CR 1,203.17 ± 91.51 N vs. DD 1,191.88 ± 80.07 N, P = 0.50) nor in peak forces (CR 1,729.44 ± 161.86 N, DD 1,688.66 ± 123.18 N, P = 0.17).

Discussion

At intact PCL peak quad forces and mean forces beyond 70° of flexion could be shown to be significantly lower with a PS TKA design in comparison with cruciate preserving designs such as CR and DD. In the PCL deficient knee quad forces with a highly conforming implant (DD) and CR were significantly higher than with a PS TKA. The use of PS implants in all PCL deficient knees seems to be advisable.

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Abbreviations

ACL:

Anterior cruciate ligament

ap:

Anteroposterior

CR:

Cruciate retaining

DD:

Deep dished

EF:

Extension/flexion

Hz:

Hertz

ml:

Mediolateral

N:

Newton

Nm:

Newton metre

PCL:

Posterior cruciate ligament

PS:

Posterior stabilized

TKA:

Total knee arthroplasty

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Conflict of interest statement

All authors disclose any financial and personal relationships with other people or organisations that could inappropriately influence the presented work.

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Authors and Affiliations

  1. Department of Orthopedics and Rheumatology, University Hospital Marburg, Baldingerstrasse, 35043, Marburg, Germany

    Thomas Jan Heyse, Nadine Kron, Markus D. Schofer & Susanne Fuchs-Winkelmann

  2. Orthopaedic Surgery, Hannover Medical School (MHH), Hannover, Germany

    Christoph Becher, Sven Ostermeier & Christof Hurschler

  3. Sporthopaedicum Straubing, Straubing, Germany

    Carsten O. Tibesku

Authors
  1. Thomas Jan Heyse
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  2. Christoph Becher
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  3. Nadine Kron
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  4. Sven Ostermeier
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  5. Christof Hurschler
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  6. Markus D. Schofer
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  7. Susanne Fuchs-Winkelmann
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  8. Carsten O. Tibesku
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Correspondence to Thomas Jan Heyse.

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Heyse, T.J., Becher, C., Kron, N. et al. Quadriceps force in relation of intrinsic anteroposterior stability of TKA design. Arch Orthop Trauma Surg 130, 1–9 (2010). https://doi.org/10.1007/s00402-009-0927-4

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  • DOI: https://doi.org/10.1007/s00402-009-0927-4

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