Top

Knee Surgery, Sports Traumatology, Arthroscopy

Published in:

01-09-2011 | Knee

Sagittal plane kinematics of fixed- and mobile-bearing total knee replacements

Authors: Carsten O. Tibesku, Kiriakos Daniilidis, Volker Vieth, Adrian Skwara, Walter Heindel, Susanne Fuchs-Winkelmann

Published in: Knee Surgery, Sports Traumatology, Arthroscopy | Issue 9/2011

Abstract

Purpose

The objective of this prospective, randomized, patient- and observer-blinded study was to analyze, in vivo, the knee joint kinematics in the sagittal plane in a patient population that had received either a fixed or a mobile TKA.

Methods

Thirty-one patients (57 knees) were evaluated by means of fluoroscopy during unloaded flexion and extension against gravity as well as during step up and step down with full weight bearing. In these 31 patients, 22 fixed-bearing TKAs, 16 mobile-bearing TKAs, and 19 natural knee joints were included. Fluoroscopic radiographs were evaluated by measuring the “patella tendon angle” in relation to the knee flexion angle, as a measure of anteroposterior translation, as well as the “kinematic index,” as a measure of reproducibility.

Results

During unloaded movement, fluoroscopic analysis did not show a significant difference between both types of prosthesis design and the natural knee. In the weight-bearing movement, both types of TKA designs revealed a more linear patellar tendon angle curve, with a greater angle in extension and in flexion than in the natural knees. In the mobile-bearing group, interindividual deviations from the mean during weight-bearing movements were significantly less than in the fixed-bearing group.

Conclusions

No functional advantage of mobile-bearing TKA over fixed-bearing devices could be found. Both TKA designs showed the typical kinematics of an anterior instability. These results only apply to cruciate retaining mobile-bearing TKA with a bearing that allows both rotation and anteroposterior translation, using a sagittal plane kinematics analysis evaluated by such methodology. A possible influence of less variability of the kinematic pattern on clinical results still needs to be confirmed.

Level of evidence

Prospective comparative study, Level II.

Banks SA, Hodge WA (2004) Implant design affects knee arthroplasty kinematics during stair-stepping. Clin Orthop Relat Res 426:187–193PubMedCrossRef

Banks SA, Markovich GD, Hodge WA (1997) In vivo kinematics of cruciate-retaining and -substituting knee arthroplasties. J Arthroplasty 12:297–304PubMedCrossRef

Banks SA, Markovich GD, Hodge WA (1997) The mechanics of knee replacements during gait. In vivo fluoroscopic analysis of two designs. Am J Knee Surg 10:261–267PubMed

Berman AT, Bosacco SJ, Israelite C (1991) Evaluation of total knee arthroplasty using isokinetic testing. Clin Orthop Relat Res 271:106–113PubMed

Berman AT, Zarro VJ, Bosacco SJ, Israelite C (1987) Quantitative gait analysis after unilateral or bilateral total knee replacement. J Bone Joint Surg Am 69:1340–1345PubMed

Bourne RB, Masonis J, Anthony M (2003) An analysis of rotating-platform total knee replacements. Clin Orthop Relat Res 410:173–180PubMedCrossRef

Callaghan JJ, Insall JN, Greenwald AS, Dennis DA, Komistek RD, Murray DW, Bourne RB, Rorabeck CH, Dorr LD (2001) Mobile-bearing knee replacement: concepts and results. Instr Course Lect 50:431–449PubMed

Dennis DA, Komistek RD, Colwell CE Jr, Ranawat CS, Scott RD, Thornhill TS, Lapp MA (1998) In vivo anteroposterior femorotibial translation of total knee arthroplasty: a multicenter analysis. Clin Orthop Relat Res 356:47–57PubMedCrossRef

Dennis DA, Komistek RD, Mahfouz MR (2003) In vivo fluoroscopic analysis of fixed-bearing total knee replacements. Clin Orthop Relat Res 410:114–130PubMedCrossRef

10.

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

11.

Dennis DA, Komistek RD, Mahfouz MR, Walker SA, Tucker A (2004) A multicenter analysis of axial femorotibial rotation after total knee arthroplasty. Clin Orthop Relat Res 428:180–189PubMedCrossRef

12.

Fantozzi S, Leardini A, Banks SA, Marcacci M, Giannini S, Catani F (2004) Dynamic in vivo tibio-femoral and bearing motions in mobile bearing knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 12:144–151PubMedCrossRef

13.

Fuchs S, Floren M, Skwara A, Tibesku CO (2002) Quantitative gait analysis in unconstrained total knee arthroplasty patients. Int J Rehabil Res 25:65–70PubMedCrossRef

14.

Fuchs S, Tibesku CO, Floren M, Thorwesten L (2000) Interdependence of clinical and isokinetic results after bicondylar knee prostheses with special emphasis on quality of life results. Int Orthop 24:268–271PubMedCrossRef

15.

Harman MK, Banks SA, Hodge WA (2001) Polyethylene damage and knee kinematics after total knee arthroplasty. Clin Orthop Relat Res 392:383–393PubMedCrossRef

16.

Heinert G, Kendoff D, Preiss S, Gehrke T, Sussmann P (2010) Patellofemoral kinematics in mobile-bearing and fixed-bearing posterior stabilised total knee replacements: a cadaveric study. Knee Surg Sports Traumatol Arthrosc Doi: 10.1007/s0016701013200

17.

Hoff WA, Komistek RD, Dennis DA, Gabriel SM, Walker SA (1998)Three-dimensional determination of femoral-tibial contact positions under in vivo conditions using fluoroscopy. Clin Biomech (Bristol, Avon) 13: 455–472

18.

Jacobs W, Anderson P, Limbeek J, Wymenga A (2004) Mobile bearing vs fixed bearing prostheses for total knee arthroplasty for post-operative functional status in patients with osteoarthritis and rheumatoid arthritis. Cochrane Database Syst Rev 2: CD003130

19.

Judge JO, Davis RB 3rd, Ounpuu S (1996) Step length reductions in advanced age: the role of ankle and hip kinetics. J Gerontol A Biol Sci Med Sci 51:M303–M312PubMedCrossRef

20.

Kaplan FS, Nixon JE, Reitz M, Rindfleish L, Tucker J (1985) Age-related changes in proprioception and sensation of joint position. Acta Orthop Scand 56:72–74PubMedCrossRef

21.

Komistek RD, Allain J, Anderson DT, Dennis DA, Goutallier D (2002) In vivo kinematics for subjects with and without an anterior cruciate ligament. Clin Orthop Relat Res 404:315–325PubMedCrossRef

22.

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 428:207–213PubMedCrossRef

23.

Koralewicz LM, Engh GA (2000) Comparison of proprioception in arthritic and age-matched normal knees. J Bone Joint Surg Am 82-A(11):1582–1588PubMed

24.

Mont MA, Booth RE Jr, Laskin RS, Stiehl JB, Ritter MA, Stuchin SA, Rajadhyaksha AD (2003) The spectrum of prosthesis design for primary total knee arthroplasty. Instr Course Lect 52:397–407PubMed

25.

Nozaki H, Banks SA, Suguro T, Hodge WA (2002) Observations of femoral rollback in cruciate-retaining knee arthroplasty. Clin Orthop Relat Res 404:308–314PubMedCrossRef

26.

Price AJ et al (2003) A mobile-bearing total knee prosthesis compared with a fixed-bearing prosthesis. A multicentre single-blind randomised controlled trial. J Bone Joint Surg Br 85:62–67PubMedCrossRef

27.

Ranawat CS (2002) History of total knee replacement. J South Orthop Assoc 11:218–226PubMed

28.

Rees JL, Beard DJ, Price AJ, Gill HS, McLardy-Smith P, Dodd CA, Murray DW (2005) Real in vivo kinematic differences between mobile-bearing and fixed-bearing total knee arthroplasties. Clin Orthop Relat Res 432:204–209PubMedCrossRef

29.

Rees JL, Price AJ, Beard DJ, Robinson BJ, Murray DW (2002) Defining the femoral axis on lateral knee fluoroscopy. Knee 9:65–68PubMedCrossRef

30.

Robinson BJ, Rees JL, Price AJ, Beard DJ, Murray DM (2002) A kinematic study of lateral unicompartmental arthroplasty. Knee 9:237–240PubMedCrossRef

31.

Schmidt R, Komistek RD, Blaha JD, Penenberg BL, Maloney WJ (2003) Fluoroscopic analyses of cruciate-retaining and medial pivot knee implants. Clin Orthop Relat Res 410:139–147PubMedCrossRef

32.

Shi K, Hayashida K, Umeda N, Yamamoto K, Kawai H (2008) Kinematic comparison between mobile-bearing and fixed-bearing inserts in NexGen legacy posterior stabilized flex total knee arthroplasty. J Arthroplasty 223:164–169CrossRef

33.

Skinner HB, Barrack RL, Cook SD (1984) Age-related decline in proprioception. Clin Orthop Relat Res 184:208–211PubMed

34.

Smith TO, Hing CB, Davies L, Donell ST (2009) Fixed versus mobile bearing unicompartmental knee replacement: a meta-analysis. Orthop Traumatol Surg Res 95:599–605PubMedCrossRef

35.

Steiner ME, Simon SR, Pisciotta JC (1989) Early changes in gait and maximum knee torque following knee arthroplasty. Clin Orthop Relat Res 238:174–182PubMed

36.

Stiehl JB, Dennis DA, Komistek RD, Crane HS (1999) In vivo determination of condylar lift-off and screw-home in a mobile-bearing total knee arthroplasty. J Arthroplasty 14:293–299PubMedCrossRef

37.

Stiehl JB, Dennis DA, Komistek RD, Keblish PA (1997) In vivo kinematic analysis of a mobile bearing total knee prosthesis. Clin Orthop Relat Res 345:60–66PubMedCrossRef

38.

Stiehl JB, Komistek RD, Cloutier JM, Dennis DA (2000) The cruciate ligaments in total knee arthroplasty: a kinematic analysis of 2 total knee arthroplasties. J Arthroplasty 15:545–550PubMedCrossRef

39.

Stiehl JB, Komistek RD, Dennis DA (1999) Detrimental kinematics of a flat on flat total condylar knee arthroplasty. Clin Orthop Relat Res 365:139–148PubMedCrossRef

40.

Stiehl JB, Komistek RD, Dennis DA, Paxson RD, Hoff WA (1995) Fluoroscopic analysis of kinematics after posterior-cruciate-retaining knee arthroplasty. J Bone Joint Surg Br 77:884–889PubMed

41.

Sugita T, Sato K, Komistek RD, Mahfouz MR, Maeda I, Sano T (2005) In vivo determination of knee kinematics for Japanese subjects having either a low contact stress rotating platform or an anteroposterior glide total knee arthroplasty. J Arthroplasty 20:154–161PubMedCrossRef

42.

van Eijden TM, de Boer W, Weijs WA (1985) The orientation of the distal part of the quadriceps femoris muscle as a function of the knee flexion-extension angle. J Biomech 18:803–809PubMedCrossRef

43.

Victor J, Banks S, Bellemans J (2005) Kinematics of posterior cruciate ligament-retaining and -substituting total knee arthroplasty: a prospective randomised outcome study. J Bone Joint Surg Br 87:646–655PubMedCrossRef

44.

Wada M, Tatsuo H, Kawahara H, Sato M, Baba H (2001) In vivo kinematic analysis of total knee arthroplasty with four different polyethylene designs. Artif Organs 25:22–28PubMedCrossRef

Title: Sagittal plane kinematics of fixed- and mobile-bearing total knee replacements
Authors: Carsten O. Tibesku
Kiriakos Daniilidis
Volker Vieth
Adrian Skwara
Walter Heindel
Susanne Fuchs-Winkelmann
Publication date: 01-09-2011
Publisher: Springer-Verlag
Published in: Knee Surgery, Sports Traumatology, Arthroscopy / Issue 9/2011
Print ISSN: 0942-2056
Electronic ISSN: 1433-7347
DOI: https://doi.org/10.1007/s00167-011-1462-8

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Sagittal plane kinematics of fixed- and mobile-bearing total knee replacements

Abstract

Purpose

Methods

Results

Conclusions

Level of evidence

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusions

Level of evidence

Please log in to get access to this content

Other articles of this Issue 9/2011

Treatment of periprosthetic femoral fractures of the knee

Expectation, satisfaction and clinical outcome of patients after total knee arthroplasty

Comparison of two minimally invasive implantation instrument-sets for total knee arthroplasty

Anterior labroligamentous periosteal sleeve avulsion lesion in arthroscopic capsulolabral repair for anterior shoulder instability

Hip arthroscopy in patients with painful hip following resurfacing arthroplasty

Secondary patellar resurfacing in the treatment of patellofemoral pain after total knee arthroplasty