Abstract
Purpose
The objective of this study was to evaluate the in vivo knee kinematics to assess the available functional motion of the characteristic mobile-bearing prosthesis design and to examine whether the artificial joint would work in vivo according to its design concept.
Methods
We studied 14 knees (11 patients) implanted with the Vanguard RP Hi-Flex prosthesis. This prosthesis has a highly original form of post-cam called a PS saddle design with high compatibility, and with a rotating plate mobile-bearing mechanism. The cylinder-type post-cam is designed to enable contact in early flexion ranges, and to prevent paradoxical anterior femoral component movement. Each patient performed weight-bearing deep knee bending under fluoroscopic surveillance. Motion between each component including the polyethylene insert was analyzed using the 2D/3D registration technique.
Results
The mean range of motion was 122.0°. The mean femoral component rotation for the tibial tray was 5.0°. No paradoxical anterior movement of the nearest point was confirmed between the femoral component and the tibial tray in the early flexion ranges. Initial contact of the post-cam was confirmed at a knee flexion angle of 33.8°. Subsequently, the wide contact of the post-cam was maintained until flexion reached 120° in all knees, but disengagement of the post-cam was observed in two knees when flexion was ≥130°.
Conclusions
The results of this study demonstrated that the prosthesis design generally works in vivo as intended by its design concept. The present kinematic data may provide useful information for improvement of high-flex type prostheses.
Similar content being viewed by others
References
Argenson JN, Parratte S, Ashour A, Komistek RD, Scuderi GR (2008) Patient-reported outcome correlates with knee function after a single-design mobile-bearing TKA. Clin Orthop Relat Res 466:2669–2676
Han HS, Kang SB, Yoon KS (2007) High incidence of loosening of the femoral component in legacy posterior stabilised-flex total knee replacement. J Bone Joint Surg Br 89:1457–1461
Buechel FF Sr (2002) Long-term followup after mobile-bearing total knee replacement. Clin Orthop Relat Res 404:40–50
Sorrells RB, Voorhorst PE, Murphy JA, Bauschka MP, Greenwald AS (2004) Uncemented rotating-platform total knee replacement: a five to twelve-year follow-up study. J Bone Joint Surg Am 86:2156–2162
Jordan LR, Olivo JL, Voorhorst PE (1997) Survivorship analysis of cementless meniscal bearing total knee arthroplasty. Clin Orthop Relat Res 338:119–123
Mahoney OM, Kinsey TL, D’Errico TJ, Shen J (2012) No functional advantage of a mobile bearing posterior stabilized TKA. Clin Orthop Relat Res 470:33–44
Lädermann A, Lübbeke A, Stern R, Riand N, Fritschy D (2008) Fixed-bearing versus mobile-bearing total knee arthroplasty: a prospective randomised, clinical and radiological study with mid-term results at 7 years. Knee 15:206–210
Matsuda S, Mizu-uchi H, Fukagawa S, Miura H, Okazaki K, Matsuda H, Iwamoto Y (2010) Mobile-bearing prosthesis did not improve mid-term clinical results of total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 18:1311–1316
Watanabe T, Tomita T, Fujii M, Hashimoto J, Sugamoto K, Yoshikawa H (2005) Comparison between mobile-bearing and fixed-bearing knees in bilateral total knee replacements. Int Orthop 29:179–181
Bhan S, Malhotra R, Kiran EK, Shukla S, Bijjawara M (2005) A comparison of fixed-bearing and mobile-bearing total knee arthroplasty at a minimum follow-up of 4.5 years. J Bone Joint Surg Am 87:2290–2296
Hasegawa M, Sudo A, Fukuda A, Uchida A (2006) Dislocation of posterior-stabilized mobile-bearing knee prosthesis. A case report. Knee 13:478–1482
Lu YC, Huang CH, Chang TK, Ho FY, Cheng CK, Huang CH (2010) Wear-pattern analysis in retrieved tibial inserts of mobile-bearing and fixed-bearing total knee prostheses. J Bone Joint Surg Br 92:500–507
Banks S, Bellemans J, Nozaki H, Whiteside LA, Harman M, Hodge WA (2008) Knee motions during maximum flexion in fixed and mobile-bearing arthroplasties. Clin Orthop Relat Res 410:131–138
Watanabe T, Yamazaki T, Sugamoto K, Tomita T, Hashimoto H, Maeda D, Tamura S, Ochi T, Yoshikawa H (2004) In vivo kinematics of mobile-bearing knee arthroplasty in deep knee bending motion. J Orthop Res 22:1044–1049
Tamaki M, Tomita T, Yamazaki T, Hozack WJ, Yoshikawa H, Sugamoto K (2008) In vivo kinematic analysis of a high-flexion posterior stabilized fixed-bearing knee prosthesis in deep knee-bending motion. J Arthroplasty 23:879–885
Tamaki M, Tomita T, Watanabe T, Yamazaki T, Yoshikawa H, Sugamoto K (2009) In vivo kinematic analysis of a high-flexion, posterior-stabilized, mobile-bearing knee prosthesis in deep knee bending motion. J Arthroplasty 24:972–978
Moynihan AL, Varadarajan KM, Hanson GR, Park SE, Nha KW, Suggs JF, Johnson T, Li G (2010) In vivo knee kinematics during high flexion after a posterior-substituting total knee arthroplasty. Int Orthop 34:497–503
Shimizu N, Tomita T, Yamazaki T, Yoshikawa H, Sugamoto K (2011) The effect of weight-bearing condition on kinematics of a high-flexion, posterior-stabilized knee prosthesis. J Arthroplasty 26:1031–1037
Komistek RD, Dennis DA, Mahfouz MR, Walker S, Outten J (2004) In vivo polyethylene bearing mobility is maintained in posterior stabilized total knee arthroplasty. Clin Orthop Relat Res 428:207–213
Futai K, Tomita T, Yamazaki T, Tamaki M, Yoshikawa H, Sugamoto K (2011) In vivo kinematics of mobile-bearing total knee arthroplasty during deep knee bending under weight-bearing conditions. Knee Surg Sports Traumatol Arthrosc 19:914–920
Tanaka A, Nakamura E, Okamoto N, Banks SA, Mizuta H (2011) Three-dimensional kinematics during deep-flexion kneeling in mobile-bearing total knee arthroplasty. Knee 18:412–416
Yamazaki T, Watanabe T, Nakajima Y, Sugamoto K, Tomita T, Yoshikawa H, Tamura S (2004) Improvement of depth position in 2-D/3-D registration of knee implants using single-plane fluoroscopy. IEEE Trans Med Imaging 23:602–612
Yamazaki T, Watanabe T, Nakajima Y, Sugamoto K, Tomita T, Maeda D, Sahara W, Yoshikawa H, Tamura S (2005) Visualization of femorotibial contact in total knee arthroplasty using X-ray fluoroscopy. Eur J Radiol 53:84–89
Grood ES, Suntay WJ (1983) A joint coordinate system for the clinical description of three-dimensional motions: application to the knee. J Biomech Eng 105:136–144
Shiramizu K, Vizesi F, Bruce W, Herrmann S, Walsh WR (2009) Tibiofemoral contact areas and pressures in six high flexion knees. Int Orthop 33:403–406
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Kurita, M., Tomita, T., Yamazaki, T. et al. In vivo kinematics of high-flex mobile-bearing total knee arthroplasty, with a new post-cam design, in deep knee bending motion. International Orthopaedics (SICOT) 36, 2465–2471 (2012). https://doi.org/10.1007/s00264-012-1673-8
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00264-012-1673-8