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In vivo knee kinematics during high flexion after a posterior-substituting total knee arthroplasty

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Abstract

The objective of this study was to investigate biomechanics of TKA patients during high flexion. Six patients (seven knees) with a posterior-substituting TKA and weight-bearing flexion >130° were included in the study. The six degree-of-freedom kinematics, tibiofemoral contact, and cam-post contact were measured during a deep knee bend using dual-plane fluoroscopy. The patients achieved average weight-bearing flexion of 139.5 ± 4.5°. Posterior femoral translation and internal tibial rotation increased steadily beyond 90° flexion, and a sharp increase in varus rotation was noted at maximum flexion. Initial cam-post engagement was observed at 100.3 ± 6.7° flexion. Five knees had cam-post disengagement before maximum flexion. Lateral femoral condylar lift-off was found in five out of seven knees at maximum flexion, and medial condylar lift-off was found in one knee. Future studies should investigate if the kinematic characteristics of posterior-substituting TKA knees noted in this study are causative factors of high knee flexion.

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Acknowledgement

This work was supported by a research grant from Zimmer Inc., Warsaw, IN, USA.

Conflict of interest

One of the coauthors is an employee of Zimmer, Inc. None of the coauthors received any benefits for this work.

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Authors and Affiliations

  1. Department of Orthopaedic Surgery, Bioengineering Laboratory, Massachusetts General Hospital and Harvard Medical School, 55 Fruit Street, GRJ 1215, Boston, MA, 02114, USA

    Angela L. Moynihan, Kartik M. Varadarajan, George R. Hanson, Jeremy F. Suggs & Guoan Li

  2. Department of Orthopaedic Surgery, Dongguk University International Hospital, 814, Siksa-dong, Ilsangong-gu, Goyang-si, Gyeonggi-do Ilsan, South Korea, 411-773

    Sang-Eun Park

  3. Department of Orthopaedic Surgery, Inje University and Ilsanpaik Hospital, Ilsan, South Korea

    Kyung Wook Nha

  4. Department of Mechanical Engineering, Massachusetts Institute of Technology, Cambridge, MA, USA

    Kartik M. Varadarajan & Jeremy F. Suggs

  5. Zimmer Inc., P.O. Box 708, 1800 West Center Street, Warsaw, IN, 46581, USA

    Todd Johnson

Authors
  1. Angela L. Moynihan
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  2. Kartik M. Varadarajan
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  3. George R. Hanson
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  4. Sang-Eun Park
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  5. Kyung Wook Nha
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  6. Jeremy F. Suggs
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  7. Todd Johnson
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  8. Guoan Li
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Corresponding author

Correspondence to Guoan Li.

Electronic supplementary material

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Figure A1

Individual patient translations posteriorly (a) and proximally (b) throughout flexion (GIF 79 kb)

High resolution image file (TIFF 2.4 mb)

Figure A2

Individual patient internal rotation (a) and varus rotation (b) throughout flexion (GIF 67 kb)

High resolution image file (TIFF 2.4 mb)

Figure A3

Medial compartment contact location for each knee throughout flexion in the anteriorposterior direction (a) and in the medial-lateral direction (b) (GIF 75 kb)

High resolution image file (TIFF 2.6 mb)

Figure A4

Lateral compartment contact location for each knee throughout flexion in the anteriorposterior direction (a) and in the medial-lateral direction (b) (GIF 86 kb)

High resolution image file (TIFF 3.2 mb)

Figure A5

Maximum flexion position for each patient knee where contact and condylar lift-off can be seen. Cam-post contact locations and incidences of slight contact are also shown and circled (GIF 148 kb)

High resolution image file (TIFF 3.6 mb)

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Moynihan, A.L., Varadarajan, K.M., Hanson, G.R. et al. In vivo knee kinematics during high flexion after a posterior-substituting total knee arthroplasty. International Orthopaedics (SICOT) 34, 497–503 (2010). https://doi.org/10.1007/s00264-009-0777-2

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  • DOI: https://doi.org/10.1007/s00264-009-0777-2

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