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Comparison of stability and kinematics of the natural knee versus a PS TKA with a ‘third condyle’

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

Abstract

Purpose

The goal of this study was to compare the kinematics of knees before and after total knee arthroplasty (TKA) that relies on an inter-condylar ‘third condyle’. The hypothesis was that the ‘third condyle’ provides sufficient flexion stability and induces a close to normal femoral rollback, thus granting natural joint kinematics.

Methods

Intra-operative navigation data were collected from 29 consecutive cases that received a cemented TKA (HLS Noetos, Tornier SA, France) designed with an inter-condylar ‘third condyle’ that engages within the tibial insert beyond 35° flexion. Operations were guided by a non-image-based system (BLU-IGS, Orthokey Italia srl, Italy) that recorded relative femoral and tibial positions in native and implanted knees during: passive range of motion, anterior drawer test at 90° flexion, and varus–valgus stress tests at full extension and at 30° flexion.

Results

The total internal tibial rotation during flexion was similar for native (8.2 ± 4.2°) and implanted knees (8.0 ± 5.4°). The lateral femoral condyle was more posterior in implanted knees (1.2 ± 9.4 mm) than in native knees (9.5 ± 3.6 mm) throughout early flexion (p < 0.01), but this difference diminished beyond 100° flexion (n.s.). The implanted knees did not exhibit paradoxical external tibial rotation. Varus–valgus laxity in full extension was lower for implanted knees than for native knees (p = 0.0221), but at 30° flexion was almost identical for both native and implanted knees. Anteroposterior laxity was similar in implanted and native knees.

Conclusions

The ‘third condyle’ TKA provides similar anteroposterior and mediolateral stability to the natural knee. This feature granted an adequate balance between laxity and constraint to reproduce natural joint kinematics, including smooth femoral rollback, without causing paradoxical external tibial rotation.

Level of evidence

Comparative study, Level III.

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Author information

Authors and Affiliations

  1. Clinica Ortopedica e Traumatologica II, Laboratorio di Biomeccanica ed Innovazione Tecnologica, Istituto Ortopedico Rizzoli, Via di Barbiano 1\10, 40136, Bologna, Italy

    Stefano Zaffagnini, Simone Bignozzi, Francesca Colle, Bharat Sharma & Maurilio Marcacci

  2. Laboratorio di NanoBiotecnologie (NaBi), Istituto Ortopedico Rizzoli, Via di Barbiano 1\10, 40136, Bologna, Italy

    Francesca Colle & Maurilio Marcacci

  3. The Biorobotic Institute, Scuola Superiore Sant’Anna, Pisa, Italy

    Francesca Colle

  4. Accelerate Innovation Management SA, 1 Rue de la Navigation, 1201, Geneva, Switzerland

    Mo Saffarini

  5. Lyon-Ortho-Clinic, Clinique de la Sauvegarde, 8 Avenue Ben Gourion, 69009, Lyon, France

    David Dejour

  6. Department of Orthopedics, Medical University of Sofia, 8 Byalo More Street, 1527, Sofia, Bulgaria

    Plamen Slavov Kinov

Authors
  1. Stefano Zaffagnini
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  2. Simone Bignozzi
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  3. Mo Saffarini
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  4. Francesca Colle
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  7. Maurilio Marcacci
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  8. David Dejour
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Correspondence to Simone Bignozzi.

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Zaffagnini, S., Bignozzi, S., Saffarini, M. et al. Comparison of stability and kinematics of the natural knee versus a PS TKA with a ‘third condyle’. Knee Surg Sports Traumatol Arthrosc 22, 1778–1785 (2014). https://doi.org/10.1007/s00167-014-3016-3

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  • DOI: https://doi.org/10.1007/s00167-014-3016-3

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