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Asymmetrical tibial polyethylene geometry-cruciate retaining total knee arthroplasty does not fully restore in-vivo articular contact kinematics during strenuous activities

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Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Purpose

A new CR TKA design with concave medial and convex lateral tibial polyethylene bearing components was introduced recently to improve functional outcomes. This study aimed to investigate in-vivo articular contact kinematics in unilateral asymmetrical tibial polyethylene geometry CR TKA patients during strenuous knee flexion activities.

Methods

Fifteen unilateral CR TKA patients (68.4 ± 5.8 years; 6 male/9 female) were evaluated for both knees during sit-to-stand, single-leg deep lunges and step-ups using validated combined computer tomography and dual fluoroscopic imaging system. Medial and lateral condylar contact positions were quantified during weight-bearing flexion activities. The Wilcoxon signed-rank test was performed to determine if there is a significant difference in articular contact kinematics during strenuous flexion activities between CR TKA and the non-operated knees.

Results

Contact excursions of the lateral condyle in CR TKAs were significantly more anteriorly located than the contralateral non-operated knee during sit-to-stand (3.7 ± 4.8 mm vs − 7.8 ± 4.3 mm) and step-ups (− 1.5 ± 3.2 mm vs − 6.3 ± 5.8 mm). Contact excursions of the lateral condyle in CR TKAs were significantly less laterally located than the contralateral non-operated knee during sit-to-stand (21.4 ± 2.8 mm vs 24.5 ± 4.7 mm) and single-leg deep lunges (22.6 ± 4.4 mm vs 26.2 ± 5.7 mm, p < 0.05). Lateral condyle posterior rollback was not fully restored in CR TKA patients during sit-to-stand (9.8 ± 6.7 mm vs 12.9 ± 8.3 mm) and step-ups (8.1 ± 4.8 mm vs 12.2 ± 6.4 mm). Lateral pivoting patterns were observed in 80%, 73% and 69% of patients during sit-to-stand, step-ups and single-leg deep lunges respectively.

Conclusion

Although lateral femoral rollback and lateral pivoting patterns were observed during strenuous functional daily activities, asymmetric contact kinematics still persisted in unilateral CR TKA patients. This suggests the specific investigated contemporary asymmetrical tibial polyethylene geometry CR TKA design evaluated in this study does not fully replicate healthy knee contact kinematics during strenuous functional daily activities.

Level of evidence

III.

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Data availablity

Data are available upon request. Only standard software was used for analysis.

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Funding

The study did not receive any funding.

Author information

Authors and Affiliations

  1. Bioengineering Laboratory, Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, Boston, MA, 02114, USA

    Christian Klemt, John Drago, Venkatsaiakhil Tirumala & Young-Min Kwon

Authors
  1. Christian Klemt
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  2. John Drago
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  3. Venkatsaiakhil Tirumala
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  4. Young-Min Kwon
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Contributions

CK: data collection, analysis, write-up; JD: data collection, analysis, write-up; VT: data collection, analysis; Y-MK: analysis, write-up.

Corresponding author

Correspondence to Young-Min Kwon.

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All authors report no conflict of interest or financial disclosures.

Ethical approval

This study was approved by the internal Institutional Review Board at Massachusetts General Hospital/Harvard Medical School (ID: 2013P000821).

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All patients provided written consent prior to enrolment into the study.

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Klemt, C., Drago, J., Tirumala, V. et al. Asymmetrical tibial polyethylene geometry-cruciate retaining total knee arthroplasty does not fully restore in-vivo articular contact kinematics during strenuous activities. Knee Surg Sports Traumatol Arthrosc 30, 652–660 (2022). https://doi.org/10.1007/s00167-020-06384-9

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  • DOI: https://doi.org/10.1007/s00167-020-06384-9

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