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J-curve design total knee arthroplasty: the posterior stabilized shows wider medial pivot compared to the cruciate retaining during chair raising

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Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Purpose

Which total knee arthroplasty (TKA) design represents the better solution to restore a correct knee biomechanics is still debated. The aim of this study was to compare posterior stabilized (PS) and cruciate retaining (CR) version of the same TKA design (femoral component with an anatomic sagittal radius—J-curve design) by the use of dynamic Roentgen stereophotogrammetric analysis (RSA). The hypothesis was that the two models influence differently in vivo knee kinematic.

Methods

A cohort of 16 randomly selected patients was evaluated 9 months after surgery: Zimmer PERSONA® was implanted, eight with CR design and eight with PS design. The kinematic evaluations were performed using a Dynamic RSA (BI-STAND DRX 2) developed in our Institute, during the execution of the sit-to-stand motor task. The motion parameters were obtained using the Grood and Suntay decomposition and the low-point kinematics methods.

Results

PS TKA lateral femoral compartment had a wider anterior translation (17 ± 2 mm) than the medial one (11 ± 2 mm), while the two compartments of CR TKA showed a similar anterior translation (medial: 9 ± 2 mm/lateral: 11 ± 2 mm). T test for comparison between CR and PS TKA of antero-posterior translation showed a statistically significant difference (p < 0.05) in the flexion range between 15° and 40°. The CR prosthesis did not anteriorly translate during flexion. The PS design translated anteriorly showing a roll-forward mechanism during extension from 80° to 18° of flexion and a posterior translation from 18° to 0°. The same significant differences (p < 0.05) between the PS and CR groups were found comparing the low-point positions of the femoral condyles in the range of flexion between 25° and 40° for the medial compartment and between 15° and 25° for the lateral compartment.

Conclusions

Dynamic RSA was able to investigate for the first time in vivo the kinematic behaviour of PS and CR version of the same TKA J-curve design. PS type showed a medial pivot during sit-to-stand motion task, while the CR type showed a cylindrical movement. Further studies are needed to evaluate the impact of different TKA designs on clinical results.

Level of evidence

IV.

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Abbreviations

ACL:

Anterior cruciate ligament

AEC:

Automatic exposure control

AP:

Anterior/posterior

BMI:

Body mass index

fps:

frames per second

FU:

Follow-up

HIPAA:

Health Insurance Portability and Accountability Act

OA:

Osteoarthritis

PCL:

Posterior cruciate ligament

PS:

Posterior stabilized

CR:

Cruciate retaining

RSA:

Roentgen stereophotogrammetric analysis

TKA:

Total knee arthroplasty

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Funding

This study was partially funded by Zimmer Inc., Warshaw, Indiana, USA.

Author information

Authors and Affiliations

  1. Laboratorio di Biomeccanica ed Innovazione Tecnologica, IRCCS Istituto Ortopedico Rizzoli, via di Barbiano 1/10, 40136, Bologna, BO, Italy

    Marco Bontempi

  2. Clinica Ortopedica e Traumatologica II, IRCCS Istituto Ortopedico Rizzoli, via Pupilli 1, 40136, Bologna, BO, Italy

    Tommaso Roberti di Sarsina, Giulio Maria Marcheggiani Muccioli, Nicola Pizza & Stefano Zaffagnini

  3. DIBINEM, Università degli Studi di Bologna, via Pupilli 1, 40136, Bologna, BO, Italy

    Umberto Cardinale

  4. QUVI, Università degli Studi di Bologna, Corso D’Augusto 237, 47921, Rimini, RN, Italy

    Laura Bragonzoni

Authors
  1. Marco Bontempi
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  2. Tommaso Roberti di Sarsina
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  3. Giulio Maria Marcheggiani Muccioli
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  4. Nicola Pizza
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  5. Umberto Cardinale
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  6. Laura Bragonzoni
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  7. Stefano Zaffagnini
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Corresponding author

Correspondence to Giulio Maria Marcheggiani Muccioli.

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The authors declare that they have no conflict of interest.

Ethical approval

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

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Bontempi, M., Roberti di Sarsina, T., Marcheggiani Muccioli, G.M. et al. J-curve design total knee arthroplasty: the posterior stabilized shows wider medial pivot compared to the cruciate retaining during chair raising. Knee Surg Sports Traumatol Arthrosc 28, 2883–2892 (2020). https://doi.org/10.1007/s00167-019-05645-6

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