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Mobility of the rotating platform in low contact stress knee arthroplasty is durable

  • Knee
  • Published:
Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Purpose

The mobile bearing or rotating platform (RP) in total knee arthroplasty (TKA) is originally part of a low contact stress (LCS) concept, with bearing undersurface mobility compensating higher bearing upper-surface congruency. The in vivo range of axial femorotibial rotation in RP knees has been the subject of many studies, but always involving the performance of relatively low demanding task conditions. Hardly any study has addressed the maintenance of this rotation over time.

Methods

Two consecutive series of patients with LCS RP knees were studied in a cross-sectional study of 1- and 5-year follow-up. They were assessed using optoelectronic movement analysis during gait and the performance of a sit-to-walk (STW) task with and without turning steps.

Results

A mean range of rotation (SD) was found in the 1-year group of 13.4° (3.7) during gait, 17.8° (6.8) during STW straight, and 17.9° (6.9) during STW with turning. The range in the 5-year group was 11.2° (6.0) during gait, 18.5° (8.7) during STW straight, and 18.3° (8.3) during STW with turning. A so-called paradoxical axial rotation pattern during gait and STW straight occurred in both groups in a normal prevalence.

Conclusion

The amount and pattern of rotation in a LCS RP knee does not become impaired between 1 and 5 years postoperatively. The theoretical benefit of RP TKA has not been proven in any clinical study so far, and studies with suitable long-term follow-up need to prove whether this mobility also leads to improved prosthesis survival. However, our findings support the functioning of the rotating platform at a basal science level and illustrate the need for the use of more complex tasks in kinematic studies.

Level of evidence

Therapeutic study, Level III.

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Author information

Authors and Affiliations

  1. Department of Orthopedic Surgery, Diakonessen Hospital, Bosboomstraat 1, 3582 KE, Utrecht, The Netherlands

    Arthur Zürcher

  2. Department of Rehabilitation Medicine, VU University Medical Center, Amsterdam, The Netherlands

    Kim van Hutten

  3. Department of Rehabilitation Medicine, VU University Medical Center, MOVE Research Institute Amsterdam, Amsterdam, The Netherlands

    Jaap Harlaar

  4. Department of Orthopedic Surgery, Slotervaart Hospital and VU University Medical Center, Amsterdam, The Netherlands

    Ruud Pöll

Authors
  1. Arthur Zürcher
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  2. Kim van Hutten
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  3. Jaap Harlaar
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  4. Ruud Pöll
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Corresponding author

Correspondence to Arthur Zürcher.

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Conflict of interest

This study was financially supported by an unrestricted Grant from DePuy (Johnson & Johnson Medical) and Biomet. All the authors declare that they have no other conflict of interest.

Electronic supplementary material

Below is the link to the electronic supplementary material.

Online Resource 1

The straight-ahead variant of moving from sit to walk is illustrated. Light-emitting diode femoral markers were attached to an epicondylar frame and tibial markers to a band around the shank. Cameras were positioned in the corners of the laboratory (not visible) (MPG 467 kb)

Online Resource 2

The crossover stepping variant of moving from sit to walk is illustrated. Light-emitting diode femoral markers were attached to an epicondylar frame and tibial markers to a band around the shank. Cameras were positioned in the corners of the laboratory (not visible) (MPG 594 kb)

Online Resource 3

The sidestepping variant of moving from sit to walk is illustrated. Light-emitting diode femoral markers were attached to an epicondylar frame and tibial markers to a band around the shank. Cameras were positioned in the corners of the laboratory (not visible) (MPG 537 kb)

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Zürcher, A., van Hutten, K., Harlaar, J. et al. Mobility of the rotating platform in low contact stress knee arthroplasty is durable. Knee Surg Sports Traumatol Arthrosc 25, 2580–2585 (2017). https://doi.org/10.1007/s00167-015-3823-1

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  • DOI: https://doi.org/10.1007/s00167-015-3823-1

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