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Knee Arthroplasty With a Medially Conforming Ball-and-Socket Tibiofemoral Articulation Provides Better Function

  • Symposium: Papers Presented at the Annual Meetings of the Knee Society
  • Published:
Clinical Orthopaedics and Related Research®

Abstract

Background

A knee design with a ball-and-socket articulation of the medial compartment has a femoral rollback profile similar to the native knee. Compared to a conventional, posterior-stabilized knee design, it provides AP stability throughout the entire ROM. However, it is unclear whether this design difference translates to clinical and functional improvement.

Questions/purposes

We asked whether the medially conforming ball-and-socket design differences would be associated with (1) improved ROM; and (2) improved American Knee Society, WOMAC, Oxford Knee, SF-36, and Total Knee Function Questionnaire scores compared to a conventional, fixed-bearing posterior-stabilized TKA.

Patients and Methods

We enrolled 82 patients in a single-center, single-blinded, randomized, controlled trial comparing the medially conforming ball-and-socket design knee prosthesis to a posterior-stabilized total knee prosthesis. Our primary end point was ROM. Our secondary end points were American Knee Society, WOMAC, Oxford Knee, SF-36, and Total Knee Function Questionnaire scores. All patients were followed at 1 and 2 years.

Results

The mean ROM was 100.1° and 114.9° in the posterior-stabilized and medially conforming ball-and-socket groups, respectively. The physical component scores of SF-36 and Total Knee Function Questionnaire were better in the medially conforming ball-and-socket group. We found no difference in American Knee Society, WOMAC, and Oxford Knee scores.

Conclusions

Both implant designs similarly relieved pain and improved function. The medially conforming ball-and-socket articulation provided better high-end function as reflected by the Total Knee Function Questionnaire.

Level of Evidence

Level I, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.

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References

  1. Aglietti P, Rinonapoli E. Total condylar knee arthroplasty: a five-year follow-up study of 33 knees. Clin Orthop Relat Res. 1984;186:104–111.

    PubMed  Google Scholar 

  2. Amin A, Al-Taiar A, Sanghrajka AP, Kang N, Scott G. The early radiological follow-up of a medial rotational design of total knee arthroplasty. Knee. 2008;15:222–226.

    Article  CAS  PubMed  Google Scholar 

  3. Bellamy N, Buchanan WW, Goldsmith CH, Campbell J, Stitt LW. Validation study of WOMAC: a health status instrument for measuring clinically important patient relevant outcomes to antirheumatic drug therapy in patients with osteoarthritis of the hip or knee. J Rheumatol. 1988;15:1833–1840.

    CAS  PubMed  Google Scholar 

  4. Bellemans J, Banks S, Victor J, Vandenneucker H, Moemans A. Fluoroscopic analysis of the kinematics of deep flexion in total knee arthroplasty: influence of posterior condylar offset. J Bone Joint Surg Br. 2002;84:50–53.

    Article  CAS  PubMed  Google Scholar 

  5. Bertin KC. Cruciate-retaining total knee arthroplasty at 5 to 7 years followup. Clin Orthop Relat Res. 2005;436:177–183.

    Article  PubMed  Google Scholar 

  6. Blaha JD. The rationale for a total knee implant that confers anteroposterior stability throughout range of motion. J Arthroplasty. 2004;19:22–26.

    Article  PubMed  Google Scholar 

  7. Blaha JD, Mancinelli CA, Simons WH, Kish VL, Thyagarajan G. Kinematics of the human knee using an open chain cadaver model. Clin Orthop Relat Res. 2003;410:25–34.

    Article  PubMed  Google Scholar 

  8. Bottros J, Gad B, Krebs V, Barsoum WK. Gap balancing in total knee arthroplasty. J Arthroplasty. 2006;21:11–15.

    Article  PubMed  Google Scholar 

  9. Chaudhary R, Beaupre LA, Johnston DW. Knee range of motion during the first two years after use of posterior cruciate-stabilizing or posterior cruciate-retaining total knee prostheses: a randomized clinical trial. J Bone Joint Surg Am. 2008;90:2579–2586.

    Article  CAS  PubMed  Google Scholar 

  10. Dalury DF, Barrett WP, Mason JB, Goldstein WM, Murphy JA, Roche MW. Midterm survival of a contemporary modular total knee replacement: a multicentre study of 1970 knees. J Bone Joint Surg Br. 2008;90:1594–1596.

    Article  CAS  PubMed  Google Scholar 

  11. Dalury DF, Gonzales RA, Adams MJ, Gruen TA, Trier K. Midterm results with the PFC Sigma total knee arthroplasty system. J Arthroplasty. 2008;23:175–181.

    Article  PubMed  Google Scholar 

  12. Dawson J, Fitzpatrick R, Murray D, Carr A. Questionnaire on the perceptions of patients about total knee replacement. J Bone Joint Surg Br. 1998;80:63–69.

    Article  CAS  PubMed  Google Scholar 

  13. Dennis DA, Komistek RD, Mahfouz MR, Haas BD, Stiehl JB. Multicenter determination of in vivo kinematics after total knee arthroplasty. Clin Orthop Relat Res. 2003;416:37–57.

    Article  PubMed  Google Scholar 

  14. Ewald FC. The Knee Society total knee arthroplasty roentgenographic evaluation and scoring system. Clin Orthop Relat Res. 1989;248:9–12.

    PubMed  Google Scholar 

  15. Freeman MA, Pinskerova V. The movement of the knee studied by magnetic resonance imaging. Clin Orthop Relat Res. 2003;410:35–43.

    Article  PubMed  Google Scholar 

  16. Insall JN, Dorr LD, Scott RD, Scott WN. Rationale of the Knee Society clinical rating system. Clin Orthop Relat Res. 1989;248:13–14.

    PubMed  Google Scholar 

  17. Insall JN, Lachiewicz PF, Burstein AH. The posterior stabilized condylar prosthesis: a modification of the total condylar design: two to four-year clinical experience. J Bone Joint Surg Am. 1982;64:1317–1323.

    CAS  PubMed  Google Scholar 

  18. Karachalios T, Roidis N, Giotikas D, Bargiotas K, Varitimidis S, Malizos KN. A mid-term clinical outcome study of the Advance Medial Pivot knee arthroplasty. Knee. 2009;16:484–488.

    Article  PubMed  Google Scholar 

  19. Kim YH, Choi Y, Kwon OR, Kim JS. Functional outcome and range of motion of high-flexion posterior cruciate-retaining and high-flexion posterior cruciate-substituting total knee prostheses: a prospective, randomized study. J Bone Joint Surg Am. 2009;91:753–760.

    Article  PubMed  Google Scholar 

  20. Kim YH, Yoon SH, Kim JS. Early outcome of TKA with a medial pivot fixed-bearing prosthesis is worse than with a PFC mobile-bearing prosthesis. Clin Orthop Relat Res. 2009;467:493–503.

    Article  PubMed  Google Scholar 

  21. Komistek RD, Dennis DA, Mahfouz M. In vivo fluoroscopic analysis of the normal human knee. Clin Orthop Relat Res. 2003;410:69–81.

    Article  PubMed  Google Scholar 

  22. Malviya A, Lingard EA, Weir DJ, Deehan DJ. Predicting range of movement after knee replacement: the importance of posterior condylar offset and tibial slope. Knee Surg Sports Traumatol Arthrosc. 2009;17:491–498.

    Article  PubMed  Google Scholar 

  23. Mannan K, Scott G. The Medial Rotation total knee replacement: a clinical and radiological review at a mean follow-up of six years. J Bone Joint Surg Br. 2009;91:750–756.

    Article  CAS  PubMed  Google Scholar 

  24. Marx RG, Jones EC, Atwan NC, Closkey RF, Salvati EA, Sculco TP. Measuring improvement following total hip and knee arthroplasty using patient-based measures of outcome. J Bone Joint Surg Am. 2005;87:1999–2005.

    Article  PubMed  Google Scholar 

  25. Moonot P, Medalla GA, Matthews D, Kalairajah Y, Field RE. Correlation between the Oxford Knee and American Knee Society scores at mid-term follow-up. J Knee Surg. 2009;22:226–230.

    Article  PubMed  Google Scholar 

  26. Moonot P, Mu S, Railton GT, Field RE, Banks SA. Tibiofemoral kinematic analysis of knee flexion for a medial pivot knee. Knee Surg Sports Traumatol Arthrosc. 2009;17:927–934.

    Article  PubMed  Google Scholar 

  27. Nilsdotter AK, Toksvig-Larsen S, Roos EM. Knee arthroplasty: are patients’ expectations fulfilled? A prospective study of pain and function in 102 patients with 5-year follow-up. Acta Orthop. 2009;80:55–61.

    Article  PubMed  Google Scholar 

  28. Pinskerova V, Johal P, Nakagawa S, Sosna A, Williams A, Gedroyc W, Freeman MA. Does the femur roll-back with flexion? J Bone Joint Surg Br. 2004;86:925–931.

    Article  CAS  PubMed  Google Scholar 

  29. Pritchett JW. Patient preferences in knee prostheses. J Bone Joint Surg Br. 2004;86:979–982.

    Article  CAS  PubMed  Google Scholar 

  30. Rasquinha VJ, Ranawat CS, Cervieri CL, Rodriguez JA. The press-fit condylar modular total knee system with a posterior cruciate-substituting design: a concise follow-up of a previous report. J Bone Joint Surg Am. 2006;88:1006–1010.

    Article  CAS  PubMed  Google Scholar 

  31. Rinonapoli E, Mancini GB, Azzara A, Aglietti P. Long-term results and survivorship analysis of 89 total condylar knee prostheses. J Arthroplasty. 1992;7:241–246.

    Article  CAS  PubMed  Google Scholar 

  32. Robertsson O, Dunbar M, Pehrsson T, Knutson K, Lidgren L. Patient satisfaction after knee arthroplasty: a report on 27,372 knees operated on between 1981 and 1995 in Sweden. Acta Orthop Scand. 2000;71:262–267.

    Article  CAS  PubMed  Google Scholar 

  33. Schurman DJ, Rojer DE. Total knee arthroplasty: range of motion across five systems. Clin Orthop Relat Res. 2005:132–137.

  34. Shakespeare D, Ledger M, Kinzel V. Flexion after total knee replacement: a comparison between the Medial Pivot knee and a posterior stabilised implant. Knee. 2006;13:371–373.

    Article  PubMed  Google Scholar 

  35. Suggs JF, Hanson GR, Park SE, Moynihan AL, Li G. Patient function after a posterior stabilizing total knee arthroplasty: cam-post engagement and knee kinematics. Knee Surg Sports Traumatol Arthrosc. 2008;16:290–296.

    Article  PubMed  Google Scholar 

  36. van Duren BH, Pandit H, Beard DJ, Zavatsky AB, Gallagher JA, Thomas NP, Shakespeare DT, Murray DW, Gill HS. How effective are added constraints in improving TKR kinematics? J Biomech. 2007;40(Suppl 1):S31–S37.

    PubMed  Google Scholar 

  37. Vince KG, Insall JN, Kelly MA. The total condylar prosthesis: 10- to 12-year results of a cemented knee replacement. J Bone Joint Surg Br. 1989;71:793–797.

    CAS  PubMed  Google Scholar 

  38. Wang H, Simpson KJ, Chamnongkich S, Kinsey T, Mahoney OM. A biomechanical comparison between the single-axis and multi-axis total knee arthroplasty systems for the stand-to-sit movement. Clin Biomech (Bristol, Avon). 2005;20:428–433.

    Article  CAS  Google Scholar 

  39. Weinberger M, Samsa GP, Hanlon JT, Schmader K, Doyle ME, Cowper PA, Uttech KM, Cohen HJ, Feussner JR. An evaluation of a brief health status measure in elderly veterans. J Am Geriatr Soc. 1991;39:691–694.

    CAS  PubMed  Google Scholar 

  40. Weiss JM, Noble PC, Conditt MA, Kohl HW, Roberts S, Cook KF, Gordon MJ, Mathis KB. What functional activities are important to patients with knee replacements? Clin Orthop Relat Res. 2002;404:172–188.

    Article  PubMed  Google Scholar 

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Acknowledgments

We thank Jenni Tahmasebbi for her assistance in clinical assessment and data collection. We also thank Miguel A. Fernandez for his assistance in radiographic assessment and data collection.

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Authors and Affiliations

  1. Department of Trauma & Orthopaedics, University College Hospital, 235 Euston Road, London, NW1 2BU, UK

    Fahad Hossain MRCS, Shelain Patel MRCS, Shin-Jae Rhee MRCS & Fares Sami Haddad FRCS (Tr & Orth)

Authors
  1. Fahad Hossain MRCS
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  2. Shelain Patel MRCS
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  3. Shin-Jae Rhee MRCS
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  4. Fares Sami Haddad FRCS (Tr & Orth)
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Corresponding author

Correspondence to Fahad Hossain MRCS.

Additional information

One or more of the authors (FSH) has received research funding from Smith and Nephew (Memphis, TN), Stryker (Kalamazoo, MI), and Finsbury Orthopaedics (Leatherhead, Surrey, UK).

Each author certifies that his or her institution approved the human protocol for this investigation that all investigations were conducted in conformity with ethical principles of research, and that informed consent for participation in the study was obtained.

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Hossain, F., Patel, S., Rhee, SJ. et al. Knee Arthroplasty With a Medially Conforming Ball-and-Socket Tibiofemoral Articulation Provides Better Function. Clin Orthop Relat Res 469, 55–63 (2011). https://doi.org/10.1007/s11999-010-1493-3

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  • DOI: https://doi.org/10.1007/s11999-010-1493-3

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