In Vivo Kinematic Comparison of Posterior Cruciate-Retaining and Posterior Stabilized Total Knee Arthroplasties Under Passive and Weight-Bearing Conditions

doi:10.1016/j.arth.2004.11.012

The Journal of Arthroplasty

Volume 20, Issue 6, September 2005, Pages 777-783

https://doi.org/10.1016/j.arth.2004.11.012 Get rights and content

Abstract

An in vivo comparison of flexion kinematics for posterior cruciate-retaining (PCR) and posterior stabilized (PS) total knee arthroplasty (TKA) was performed. Twenty patients who underwent bilateral paired TKAs were included in this prospective study. Both PCR and PS prostheses were from the same TKA series with comparable surface geometries, and all were implanted by a single surgeon. Of these 20 patients, 3-dimensional kinematics during flexion could be analyzed using a computer model fitting technique in 18 patients. The follow-up period ranged from 18 to 53 months. In the PCR TKA, an anterior femoral translation from 30° to 60° of flexion was observed in the weight-bearing condition. In contrast, flexion kinematics for the PS TKA was characterized by the maintenance of a constant contact position under weight-bearing conditions and posterior femoral rollback in passive flexion.

Section snippets

Materials and Methods

Between January 1998 and July 2000, a prospective comparative study was conducted for 20 subjects with bilateral osteoarthritis who were implanted with both a PCR and a PS TKA (P.F.C. Σ series, Depuy, A Johnson and Johnson Company, Warsaw, Ind). Inclusion criteria were as follows: (1) bilateral osteoarthritic knees with similar roentgenographic grades, (2) bilateral TKAs (PCR type in one knee and PS type in the contralateral knee) performed with a time interval of less than 2 years, and (3)

Clinical Results

All TKAs were judged clinically successful (the knee score of the Knee Society Score ≧85) and all patients achieved postoperative flexion values of 90° or more. Preoperative and postoperative ranges of motion in each group are shown in Table 1. The mean flexion angles in the PCR and PS knees were 113° ± 19° and 113° ± 21° preoperatively, whereas corresponding values at the follow-up were 121° ± 16° and 131° ± 12°. In the comparisons between the groups, no significant difference was detected

Discussion

Fluoroscopic motion analysis using a computer model-fitting technique has emerged as an accurate method for evaluating the 3-dimensional in vivo kinematics of TKA and has been used to examine the effect of prosthetic design and surgical procedure on postoperative knee kinematics 7, 8, 9, 10, 11, 12, 13, 14, 15. Specifically, a comparison of PCR and PS TKAs has been a topic of keen interest. However, in previous studies, comparisons have been made between different patients with varied

Acknowledgment

The authors gratefully thank Shigeki Maruyama, MD (Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine), and Todd Langer, MS (Rocky Mountain Musculoskeletal Research Laboratory), for assisting in the data collection and analysis. We also acknowledge Mrs Janina Tubby for her assistance in preparation of this manuscript.

References (15)

T.P. Andriacchi et al.
Retention of the posterior cruciate in total knee arthroplasty
J Arthroplasty
(1988)
T.P. Andriacchi et al.
The influence of total knee-replacement design on walking and stair-climbing
J Bone Joint Surg Am
(1982)
M.W. Becker et al.
Bilateral total knee arthroplasty. One cruciate retaining and one cruciate substituting
Clin Orthop
(1991)
L.D. Dorr et al.
Functional comparison of posterior cruciate-retained versus cruciate-sacrificed total knee arthroplasty
Clin Orthop
(1988)
M.A. Freeman et al.
Should the posterior cruciate ligament be retained or resected in condylar nonmeniscal knee arthroplasty? The case for resection
J Arthroplasty
(1988)
D.S. Pereira et al.
Posterior cruciate ligament-sparing versus posterior cruciate ligament- sacrificing arthroplasty. Functional results using the same prosthesis
J Arthroplasty
(1998)
D.A. Dennis et al.
In vivo anteroposterior femorotibial translation of total knee arthroplasty: a multicenter analysis
Clin Orthop
(1998)

There are more references available in the full text version of this article.

Cited by (120)

Effect of weight-bearing in bicruciate-retaining total knee arthroplasty during high-flexion activities
2022, Clinical Biomechanics
To evaluate the effect of weight-bearing on the kinematics of the bicruciate-retaining total knee arthroplasty design during high knee flexion activities.
The kinematics of 21 bicruciate-retaining total knee arthroplasties were evaluated under fluoroscopy, with two- and three-dimensional image registrations, during squatting (weight-bearing) and active-assisted knee flexion (non-weight-bearing). The following variables were measured: knee range of motion, axis of femoral rotation and varus-valgus angle relative to the tibial component, anteroposterior translation of the medial and lateral contact points, and the kinematic pathway of the joint surfaces.
From 20° to 100° of flexion, the femoral external rotation during weight-bearing was larger than that during non-weight-bearing. There were no differences in the varus-valgus angles between the two conditions. From 10° to 50° of flexion, the medial contact point during weight-bearing was located posterior to the point of contact during non-weight-bearing; this difference between the two weight-bearing conditions was significant. From 0° to 90° of flexion, the lateral contact point in weight-bearing was located posterior to the contact point in non-weight-bearing; this difference between the two weight-bearing conditions was also significant.
The anteroposterior position of the medial and lateral contact points of the bicruciate-retaining total knee arthroplasty design was significantly more posterior in the mid-range of knee flexion in weight-bearing than in non-weight-bearing. However, no anterior translation of the bicruciate-retaining total knee arthroplasty design was observed. Therefore, bicruciate-retaining total knee arthroplasty appears to have good anteroposterior stability throughout the range of knee flexion, regardless of the weight-bearing condition.
Comparison of in vivo kinematics of total knee arthroplasty between cruciate retaining and cruciate substituting insert
2021, Asia-Pacific Journal of Sports Medicine, Arthroscopy, Rehabilitation and Technology
Citation Excerpt :
This is conceivable that the femoral component rotated along the shape of insert that has spherical rotary arc design. Several in vivo kinematic studies have found that paradoxical anterior femoral movement of the medial femoral condyle during knee flexion can occur in conventional TKA.12,14–16 This is supported by our fluoroscopic data, showing that paradoxical anterior femoral movement was observed in both CR and CS TKAs.
The decision to choose cruciate retaining (CR) insert or cruciate substituting (CS) insert during total knee arthroplasty (TKA) remains a controversial issue. We hypothesized that there are different knee kinematics between CR and CS inserts and that a raised anterior lip design would offer a potential minimization of the paradoxical movement and provide joint stability. The objective of this study was to evaluate and compare kinematics of a CR and CS TKA of the same single-radius design.
We investigated the in vivo knee kinematics of 20 knees with a CR TKA (10 knees in the CR insert and 10 knees in the CS insert). Patients were examined during deep knee flexion using fluoroscopy and femorotibial motion was determined using a 2- to 3-dimensional registration technique, which used computer-assisted design models to reproduce the spatial positions of the femoral and tibial components. We evaluated the knee range of motion (ROM), femoral axial rotation relative to the tibial component, anteroposterior translation, and kinematic pathway of the nearest point of the medial and lateral femoral condyles on the tibial tray.
The average ROM was 121.0 ± 17.3° in CR and 110.8 ± 12.4° in CS. The amount of femoral axial rotation was 7.2 ± 3.9° in CR, and 7.4 ± 2.7° in CS. No significant difference was observed in the amount of anterior translation between CR and CS. The CR and CS inserts had a similar kinematic pattern up to 100° flexion that was central pivot up to 70° flexion and then paradoxical anterior femoral movement until 100° flexion.
The present study demonstrated that there was no significant difference between the inserts in knee kinematics. These kinematic results suggested that the increased anterior lip could not control anterior movement in the CS insert.
A Validated Forward Solution Dynamics Mathematical Model of the Knee Joint: Can It Be an Effective Alternative for Implant Evaluation?
2020, Journal of Arthroplasty
Mathematical modeling is among the most common computational tools for assessing total knee arthroplasty (TKA) mechanics of different implant designs and surgical alignments. The main objective of this study is to describe and validate a forward solution mathematical of the knee joint to investigate the effects of TKA design and surgical conditions on TKA outcomes.
A 12-degree of freedom mathematical model of the human knee was developed. This model includes the whole lower extremity of the human body and comprises major muscles and ligaments at the knee joint. The muscle forces are computed using a proportional–integral–derivative controller, and the joint forces are calculated using a contact detection algorithm. The model was validated using telemetric implants and fluoroscopy, and the sensitivity analyses were performed to determine how sensitive the model is to both implant design, which was analyzed by varying medial conformity of the polyethylene, and surgical alignment, which was analyzed by varying the posterior tibial tilt.
The model predicted the tibiofemoral joint forces with an average accuracy of 0.14× body weight (BW), 0.13× BW, and 0.17× BW root-mean-square errors for lateral, medial, and total tibiofemoral contact forces. With fluoroscopy, the kinematics were validated with an average accuracy of 0.44 mm, 0.62 mm, and 0.77 root-mean-square errors for lateral anteroposterior position, medial anteroposterior position, and axial rotation, respectively. Increasing medial conformity resulted in reducing the paradoxical anterior sliding midflexion. Furthermore, increasing posterior tibial slopes shifted the femoral contact point more posterior on the bearing and reduced the tension in the posterior cruciate ligament.
A forward solution dynamics model of the knee joint was developed and validated using telemetry devices and fluoroscopy data. The results of this study suggest that a validated mathematical model can be used to predict the effects of component design and surgical conditions on TKA outcomes.
Videofluoroscopic Evaluation of the Influence of a Gradually Reducing Femoral Radius on Joint Kinematics During Daily Activities in Total Knee Arthroplasty
2020, Journal of Arthroplasty
Paradoxical anterior translation in midflexion is reduced in total knee arthroplasties (TKAs) with a gradually reducing femoral radius, when compared to a 2-radii design. This reduction has been shown in finite element model simulations, in vitro tests, intraoperatively, and recently also in vivo during a lunge and unloaded flexion-extension. However, TKA kinematics are task dependent and this reduction has not been tested for gait activities.
Thirty good outcome subjects (≥1 year postoperatively) with a unilateral cruciate-retaining TKA with a gradually reducing (n = 15) or dual (n = 15) femoral radius design were assessed during 5 complete cycles of level walking, stair descent (0.18-m steps), deep knee bend, and sitting down onto and standing up from a chair, using a moving fluoroscope (25 Hz, 1 ms shutter time). Kinematic data were extracted by 2D/3D image registration.
Tibiofemoral ranges of motion for flexion-extension, abduction-adduction, internal-external rotation, and anteroposterior (AP) translation were similar for both groups, whereas the pattern of AP translation-flexion-coupling differed. The subjects with the dual-radii design showed a sudden change in direction of AP translation around 30° of flexion, which was not present in the subjects with the gradually reducing femoral radius design.
Through the unique ability of moving fluoroscopy, the present study confirmed that the gradually reducing femoral radii eliminated the paradoxical sudden anterior translation at 30° present in the dual-radii design in vivo during daily activities, including gait and stair descent.
In Vivo Knee Kinematics for a Cruciate Sacrificing Total Knee Arthroplasty Having Both a Symmetrical Femoral and Tibial Component
2020, Journal of Arthroplasty
Early total knee arthroplasty (TKA) designs were symmetrical, but lead to complications due to over-constraint leading to loosening and poor flexion. Next-generation TKAs have been designed to include asymmetry, pertaining to the trochlear groove, femoral condylar shapes, and/or the tibial component. More recently, an advanced posterior cruciate sacrificing (PCS) TKA was designed to include both a symmetrical femoral component with a patented V-shaped trochlear groove and a symmetrical tibial component with an ultracongruent insert, in an attempt to reduce inventory costs. Because previous PCS TKA designs produced variable results, the objective of this study is to determine and evaluate the in vivo kinematics for subjects implanted with this symmetrical TKA.
Twenty-one subjects, implanted with symmetrical PCS fixed-bearing TKA, were asked to perform a weight-bearing deep knee bend (DKB) while under fluoroscopic surveillance. A 3-dimensional to 2-dimensional registration technique was used to determine each subject’s anteroposterior translation of lateral and medial femoral condyles as well as tibiofemoral axial rotation and their weight-bearing knee flexion.
During the DKB, the average active maximum weight-bearing flexion was 111.7° ± 13.3°. On average, from full extension to maximum knee flexion, subjects experienced −2.5 ± 2.0 mm of posterior femoral rollback of the lateral condyle and 2.5 ± 2.2 mm of medial condyle motion in the anterior direction. This medial condyle motion was consistent for the majority of the subjects, with the lateral condyle exhibiting rollback from 0° to 60° of flexion and then experienced an average anterior motion of 0.3 mm from 60° to 90° of knee flexion. On average, the subjects in this study experienced 6.6°± 3.3° of axial rotation, with most of the rotation occurring in early flexion, averaging 4.9°.
Although subjects in this study were implanted with a symmetrical PCS TKA, they did experience femoral rollback of the lateral condyle and a normal-like pattern of axial rotation, although less in magnitude than the normal knee. The normal axial rotation pattern occurred because the lateral condyle rolled in the posterior direction, while the medial condyle moved in the anterior direction. Interestingly, the magnitude of posterior femoral rollback and axial rotation for subjects in this study was similar in magnitude reported in previous studies pertaining to asymmetrical TKA designs. It is proposed that more patients be analyzed having this TKA implanted by other surgeons.
Kinematic Performance of Gradually Variable Radius Posterior-Stabilized Primary TKA During Various Activities: An In Vivo Study Using Fluoroscopy
2020, Journal of Arthroplasty
Posterior-stabilized total knee arthroplasty (TKA) with gradually variable radii (G-curve) femoral condylar geometry is now available. It is believed that a G-curve design would lead to more mid-flexion stability leading to reduced incidence of paradoxical anterior slide. The objective of this study was to assess the in vivo kinematics for subjects implanted with this type of TKA under various conditions of daily living.
Tibiofemoral kinematics of 35 patients having posterior-stabilized TKA with G-curve design were analyzed using fluoroscopy while performing three activities: weight-bearing deep knee bend, gait, and walking down a ramp. The subjects were assessed for range of motion, condylar translation, axial rotation, cam-spine engagement, and condylar lift-off.
The average weight-bearing flexion during deep knee bend was 111.4°. On average, the subjects exhibited 5.4 mm of posterior rollback of the lateral condyle and 2.0 mm of the medial condyle from full extension to maximum knee flexion. The femur consistently rotated externally with flexion, and the average axial rotation was 5.2°. Overall movement of the condyles during gait and ramp-down activity was small. No incidence of condylar lift-off was observed.
Subjects in this study experienced consistent magnitudes of posterior femoral rollback and external rotation of the femur with weight-bearing flexion. The variation is similar to that previously reported for normal knee where the lateral condyle moves consistently posterior compared to the medial condyle. Subjects experienced low overall mid-flexion paradoxical anterior sliding and no incidence of condylar lift-off leading to mid-flexion stability.

View all citing articles on Scopus

: Benefits or funds were received in partial or total support of the research material described in this article from DePuy Japan, Inc.

View full text

Original ArticleIn Vivo Kinematic Comparison of Posterior Cruciate-Retaining and Posterior Stabilized Total Knee Arthroplasties Under Passive and Weight-Bearing Conditions

Abstract

Section snippets

Materials and Methods

Clinical Results

Discussion

Acknowledgment

Retention of the posterior cruciate in total knee arthroplasty

J Arthroplasty

The influence of total knee-replacement design on walking and stair-climbing

J Bone Joint Surg Am

Bilateral total knee arthroplasty. One cruciate retaining and one cruciate substituting

Clin Orthop

Functional comparison of posterior cruciate-retained versus cruciate-sacrificed total knee arthroplasty

Clin Orthop

Should the posterior cruciate ligament be retained or resected in condylar nonmeniscal knee arthroplasty? The case for resection

J Arthroplasty

Posterior cruciate ligament-sparing versus posterior cruciate ligament- sacrificing arthroplasty. Functional results using the same prosthesis

J Arthroplasty

In vivo anteroposterior femorotibial translation of total knee arthroplasty: a multicenter analysis

Clin Orthop

Original Article
In Vivo Kinematic Comparison of Posterior Cruciate-Retaining and Posterior Stabilized Total Knee Arthroplasties Under Passive and Weight-Bearing Conditions