Skip to main content
SpringerLink
Log in

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.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. Baker PN, van der Meulen JH, Lewsey J, Gregg PJ (2007) The role of pain and function in determining patient satisfaction after total knee replacement. Data from the National Joint Registry for England and Wales. J Bone Joint Surg Br 89(7):893–900

    PubMed  CAS  Google Scholar 

  2. Banks SA, Hodge WA (1996) Accurate measurement of three-dimensional knee replacement kinematics using single-plane fluoroscopy. IEEE Trans Biomed Eng 43(6):638–649

    Article  PubMed  CAS  Google Scholar 

  3. Barnes CL, Sharma A, Blaha JD, Nambu SN, Carroll ME (2011) Kneeling is safe for patients implanted with medial-pivot total knee arthroplasty designs. J Arthroplast 26(4):549–554

    Article  Google Scholar 

  4. Bellemans J, Banks S, Victor J, Vandenneucker H, Moemans A (2002) Fluoroscopic analysis of the kinematics of deep flexion in total knee arthroplasty. Influence of posterior condylar offset. J Bone Joint Surg Br 84(1):50–53

    Article  PubMed  CAS  Google Scholar 

  5. Berger RA, Crossett LS, Jacobs JJ, Rubash HE (1998) Malrotation causing patellofemoral complications after total knee arthroplasty. Clin Orthop Relat Res 356:144–153

    Article  PubMed  Google Scholar 

  6. Coughlin KM, Incavo SJ, Doohen RR, Gamada K, Banks S, Beynnon BD (2007) Kneeling kinematics after total knee arthroplasty: anterior–posterior contact position of a standard and a high-flex tibial insert design. J Arthroplast 22(2):160–165

    Article  Google Scholar 

  7. DeFrate LE, Papannagari R, Gill TJ, Moses JM, Pathare NP, Li G (2006) The 6 degrees of freedom kinematics of the knee after anterior cruciate ligament deficiency: an in vivo imaging analysis. Am J Sports Med 34(8):1240–1246

    Article  PubMed  Google Scholar 

  8. Dossett H, Swartz G, Estrada N, Lefevre G, Kwasman B (2012) Kinematically versus mechanically aligned total knee arthroplasty. Orthopedics 35(2):e160

    PubMed  Google Scholar 

  9. Hamai S, Miura H, Higaki H, Matsuda S, Shimoto T, Sasaki K, Yoshizumi M, Okazaki K, Tsukamoto N, Iwamoto Y (2008) Kinematic analysis of kneeling in cruciate-retaining and posterior-stabilized total knee arthroplasties. J Orthop Res 26(4):435–442

    Article  PubMed  Google Scholar 

  10. Howell SM, Hodapp EE, Kuznik K, Hull ML (2009) In vivo adduction and reverse axial rotation (external) of the tibial component can be minimized. Orthopedics 32(5):319

    Article  PubMed  Google Scholar 

  11. Howell SM, Howell SJ, Cohen J, Hull ML (2012) Does kinematically-aligned total knee arthroplasty restore function without failure regardless of alignment category? Clin Orthop Relat Res

  12. Howell SM, Hull ML (2012) Kinematically aligned TKA with MRI-based cutting guides. In: Thienpont E (ed) Improving accuracy in knee arthroplasty. Jaypee Brothers Medical Publishers (P) Ltd., New Delhi, pp 207–232

    Chapter  Google Scholar 

  13. Howell SM, Hull ML (2012) Principles of kinematic alignment in total knee arthroplasty with and without patient specific cutting blocks (OtisKnee). In: Scott S (ed) Insall and scott surgery of the knee, vol 1, 5th edn. Elsevier, Philadelphia, pp 1255–1268

    Chapter  Google Scholar 

  14. Howell SM, Kuznik K, Hull ML, Siston RA (2008) Results of an initial experience with custom-fit positioning total knee arthroplasty in a series of 48 patients. Orthopedics 31(9):857–863

    Article  PubMed  Google Scholar 

  15. Howell SM, Rogers SL (2009) Method for quantifying patient expectations and early recovery after total knee arthroplasty. Orthopedics 32(12):884–890

    Article  PubMed  Google Scholar 

  16. Ikeuchi M, Yamanaka N, Okanoue Y, Ueta E, Tani T (2007) Determining the rotational alignment of the tibial component at total knee replacement: a comparison of two techniques. J Bone Joint Surg Br 89(1):45–49

    PubMed  CAS  Google Scholar 

  17. Incavo SJ, Mullins ER, Coughlin KM, Banks S, Banks A, Beynnon BD (2004) Tibiofemoral kinematic analysis of kneeling after total knee arthroplasty. J Arthroplast 19(7):906–910

    Article  Google Scholar 

  18. Jeffery RS, Morris RW, Denham RA (1991) Coronal alignment after total knee replacement. J Bone Joint Surg Br 73(5):709–714

    PubMed  CAS  Google Scholar 

  19. Klatt BA, Goyal N, Austin MS, Hozack WJ (2008) Custom-fit total knee arthroplasty (OtisKnee) results in malalignment. J Arthroplast 23(1):26–29

    Article  Google Scholar 

  20. Miller MC, Berger RA, Petrella AJ, Karmas A, Rubash HE (2001) Optimizing femoral component rotation in total knee arthroplasty. Clin Orthop Relat Res 392:38–45

    Article  PubMed  Google Scholar 

  21. Rothwell A, Hooper G, Hobbs A, Frampton C (2010) An analysis of the Oxford hip and knee scores and their relationship to early joint revision in the New Zealand Joint Registry. J Bone Joint Surg Br 92(3):413

    PubMed  CAS  Google Scholar 

  22. Sharma L, Lou C, Felson DT, Dunlop DD, Kirwan-Mellis G, Hayes KW, Weinrach D, Buchanan TS (1999) Laxity in healthy and osteoarthritic knees. Arthritis Rheum 42(5):861–870

    Article  PubMed  CAS  Google Scholar 

  23. Singerman R, Pagan HD, Peyser AB, Goldberg VM (1997) Effect of femoral component rotation and patellar design on patellar forces. Clin Orthop Relat Res 334:345–353

    Article  PubMed  Google Scholar 

  24. Siston RA, Goodman SB, Patel JJ, Delp SL, Giori NJ (2006) The high variability of tibial rotational alignment in total knee arthroplasty. Clin Orthop Relat Res 452:65–69

    Article  PubMed  Google Scholar 

  25. Smith CK, Chen JA, Howell SM, Hull ML (2010) An in vivo study of the effect of distal femoral resection on passive knee extension. J Arthroplast 25(7):1137–1142

    Article  Google Scholar 

  26. Spencer BA, Mont MA, McGrath MS, Boyd B, Mitrick MF (2008) Initial experience with custom-fit total knee replacement: intra-operative events and long-leg coronal alignment. Int Orthop 33(6):1571–1575

    Article  PubMed  Google Scholar 

  27. Victor J, Banks S, Bellemans J (2005) Kinematics of posterior cruciate ligament-retaining and -substituting total knee arthroplasty: a prospective randomised outcome study. J Bone Joint Surg Br 87(5):646–655

    PubMed  CAS  Google Scholar 

  28. Wasielewski RC, Galante JO, Leighty RM, Natarajan RN, Rosenberg AG (1994) Wear patterns on retrieved polyethylene tibial inserts and their relationship to technical considerations during total knee arthroplasty. Clin Orthop Relat Res 299:31–43

    PubMed  Google Scholar 

  29. Windsor RE, Scuderi GR, Moran MC, Insall JN (1989) Mechanisms of failure of the femoral and tibial components in total knee arthroplasty. Clin Orthop Relat Res 248:15–19

    PubMed  Google Scholar 

Download references

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.

Author information

Authors and Affiliations

  1. Department of Mechanical Engineering, University of California, Davis, Davis, CA, USA

    Stephen M. Howell, Esther E. Hodapp & Maury L. Hull

  2. 1503 North Cedar Crest Boulevard, Allentown, PA, 18104, USA

    Thomas D. Meade

  3. 101 Bryn Mawr Ave, Suite 200, Bryn Mawr, PA, 19010, USA

    Joseph V. Vernace

Authors
  1. Stephen M. Howell
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Esther E. Hodapp
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Joseph V. Vernace
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Maury L. Hull
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Thomas D. Meade
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Joseph V. Vernace.

Additional information

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

Rights and permissions

Reprints and permissions

About this article

Cite this article

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

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

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

Keywords

Search

Navigation