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Knee Surgery, Sports Traumatology, Arthroscopy

Published in:

01-04-2019 | KNEE

Asymmetric polyethylene inserts promote favorable kinematics and better clinical outcome compared to symmetric inserts in a mobile bearing total knee arthroplasty

Authors: Gianluca Castellarin, Silvia Pianigiani, Bernardo Innocenti

Published in: Knee Surgery, Sports Traumatology, Arthroscopy | Issue 4/2019

Abstract

Purpose

This study aims at comparing the effects of symmetric and asymmetric designs for the polyethylene insert currently available and also for mobile bearing total knee arthroplasty (TKA). The investigation was performed both clinically and biomechanically through finite element analysis.

Methods

303 patients, with a mobile bearing TKA, were analyzed retrospectively. All patients received the same femoral and tibial components; for the insert, 151 patients received a symmetric design (SD) and 152 an asymmetric design (AD). Additionally, a 3D finite element model of a lower leg was developed, resurfaced with the same TKAs and analysed during gait and squat activities. TKA kinematics, and bone-stresses were investigated for the two insert solutions.

Results

After surgery, patients’ average flexion improved from 105°, with 5° of preoperative extension deficit, to 120° (AD-group) and 115° (SD-group) at the latest follow-up. There was no postoperative extension deficit. No pain affected the AD-group, while an antero-lateral pain was reported in some patients of the SD-group. Patients of the AD-group presented a better ability to perform certain physical routines. Biomechanically, the SD induced higher tibial-bone stresses than the AD. Both designs replicated similar kinematics, comparable to literature. However, SD rotates more on the tray, reducing the motion between femoral and polyethylene components, while AD permits greater insert rotation.

Conclusion

The biomechanical analysis justifies the clinical findings. TKA kinematics is similar for the two designs, although the asymmetric solution shows less bone stress, thus resulting as more suitable to be cemented, avoiding lift-off issues, inducing less pain. Clinically, and biomechanically, an asymmetric mobile bearing insert could be a valid alternative to symmetric mobile bearing insert.

Level of evidence

Case–control study retrospective comparative study, III.

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Title: Asymmetric polyethylene inserts promote favorable kinematics and better clinical outcome compared to symmetric inserts in a mobile bearing total knee arthroplasty
Authors: Gianluca Castellarin
Silvia Pianigiani
Bernardo Innocenti
Publication date: 01-04-2019
Publisher: Springer Berlin Heidelberg
Published in: Knee Surgery, Sports Traumatology, Arthroscopy / Issue 4/2019
Print ISSN: 0942-2056
Electronic ISSN: 1433-7347
DOI: https://doi.org/10.1007/s00167-018-5207-9

At a glance: The STEP trials

Springer Medicine

Asymmetric polyethylene inserts promote favorable kinematics and better clinical outcome compared to symmetric inserts in a mobile bearing total knee arthroplasty

Abstract

Purpose

Methods

Results

Conclusion

Level of evidence

At a glance: The STEP trials

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusion

Level of evidence

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