Kinematic analysis of stair climbing in rotating platform cruciate-retaining and posterior-stabilized mobile-bearing total knee arthroplasties
The aim of our study was to compare and contrast the effects of two types of mobile-bearing total knee arthroplasties (TKA), namely, the cruciate-retaining (CR) and posterior-stabilized (PS) TKAs, on clinical outcomes and in vivo kinematics during stair climbing.
Materials and methods
The Press-Fit Condylar Sigma rotating platform was used for both CR and PS TKAs. Patient-reported outcomes were assessed using the 2011 Knee Society Score. Quadriceps muscle strength was evaluated by isokinetic dynamometry. In vivo kinematics were evaluated using periodic sagittal plane radiographic images obtained during stair climbing to quantify anteroposterior (AP) tibiofemoral translation, implant flexion and axial rotation angles using image-matching techniques. Outcomes were evaluated in 20 TKAs, which had been undergone with clinical success, including ten knees with CR types and ten knees with PS types.
There were no significant differences between the CR and PS TKA groups (p > 0.05) in isometric extensor torque (1.0 ± 0.2 and 1.1 ± 0.6 N m/kg, respectively) or patient-reported score for stair climbing function (4.0 ± 0.5 and 3.8 ± 0.9, respectively). Both types of TKAs showed stable AP translation in the mid range of knee flexion and paradoxical translation in the low range of flexion, with limited rotation, during stair climbing. There were no significant differences between the CR and PS TKA groups (P > 0.05) in anterior translation from 80° to 40° of knee flexion (4.2 ± 1.2 and 3.5 ± 1.6 mm, respectively), posterior translation from 40° to 10° of knee flexion (2.3 ± 1.9 and 2.0 ± 1.5 mm, respectively), and total external rotation (2.8° ± 4.9° and 0.5° ± 5.0°, respectively).
Both CR and PS types of rotating platform mobile-bearing TKAs provided reproducible knee joint kinematics during stair climbing and equivalent clinical outcomes.
Level of evidence
KeywordsTotal knee arthroplasty Stair climbing Mobile-bearing total knee arthroplasty Image-matching techniques Knee joint kinematics
The authors declare that they have no conflict of interest. No funding was received for this work.
Compliance with ethical standards
Conflict of interest
The authors declare that they have no conflict of interest.
- 13.Ranawat CS, Komistek RD, Rodriguez JA, Dennis DA, Anderle M (2004) In vivo kinematics for fixed and mobile-bearing posterior stabilized knee prostheses. Clin Orthop Relat Res 184–190Google Scholar
- 14.Sawaguchi N, Majima T, Ishigaki T, Mori N, Terashima T, Minami A (2010) Mobile-bearing total knee arthroplasty improves patellar tracking and patellofemoral contact stress: in vivo measurements in the same patients. J Arthroplasty 25(6):920–925. doi: 10.1016/j.arth.2009.07.024 CrossRefPubMedGoogle Scholar
- 19.Minoda Y, Kobayashi A, Iwaki H, Miyaguchi M, Kadoya Y, Ohashi H, Takaoka K (2004) Characteristics of polyethylene wear particles isolated from synovial fluid after mobile-bearing and posterior-stabilized total knee arthroplasties. J Biomed Mater Res 71(1):1–6. doi: 10.1002/jbm.b.30005 CrossRefGoogle Scholar
- 20.Kuwashima U, Hamai S, Okazaki K, Ikebe S, Higaki H et al (2016) Contact stress analysis of the anterior tibial post in bi-cruciate stabilized and mobile-bearing posterior stabilized total knee arthroplasty designs. J Mech Biomed Mater 60:460–467. doi: 10.1016/j.jmbbm.2016.03.003 CrossRefGoogle Scholar
- 24.Nakahara H, Okazaki K, Hamai S, Okamoto S, Kuwashima U, Higaki H, Iwamoto Y (2015) Does knee stability in the coronal plane in extension affect function and outcome after total knee arthroplasty? Knee Surg Sports Traumatol Arthrosc 23(6):1693–1698. doi: 10.1007/s00167-014-3122-2 CrossRefPubMedGoogle Scholar
- 26.Ewald FC (1989) The Knee Society total knee arthroplasty roentgenographic evaluation and scoring system. Clin Orthop Relat Res 248:9–12Google Scholar
- 34.Hamai S, Okazaki K, Shimoto T, Nakahara H, Higaki H, Iwamoto Y (2015) Continuous sagittal radiological evaluation of stair-climbing in cruciate-retaining and posterior-stabilized total knee arthroplasties using image-matching techniques. J Arthroplasty 30(5):864–869. doi: 10.1016/j.arth.2014.12.027 CrossRefPubMedGoogle Scholar
- 37.Ellerkmann RM, Cundiff GW, Melick CF, Nihira MA, Leffler K, Bent AE (2001) Correlation of symptoms with location and severity of pelvic organ prolapse. Am J Obstet Gynecol 185(6):1332–1338. doi: 10.1067/mob.2001.119078
- 38.Skoffer B, Dalgas U, Mechlenburg I, Søballe K, Maribo T (2015) Functional performance is associated with both knee extensor and flexor muscle strength in patients scheduled for total knee arthroplasty: a cross-sectional study. J Rehabil Med 47(5):454–459. doi: 10.2340/16501977-1940 CrossRefPubMedGoogle Scholar
- 45.Öztürk A, Akalın Y, Çevik N, Otuzbir A, Öztkan Y, Dostbakan Y (2016) Posterior cruciate-substituting total knee replacement recovers the flexion arc faster in the early postoperative period in knees with high varus deformity: a prospective randomized study. Arch Orthop Trauma Surg 136(7):999–1006. doi: 10.1007/s00402-016-2482-0 CrossRefPubMedGoogle Scholar