Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

At a glance: The STEP trials

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.
ADVANCED SEARCH
Log in
Top
Knee Surgery, Sports Traumatology, Arthroscopy
Published in: Knee Surgery, Sports Traumatology, Arthroscopy 2/2021

01-02-2021 | Knee-TEP | KNEE

Influence of component design on in vivo tibiofemoral contact patterns during kneeling after total knee arthroplasty: a systematic review and meta-analysis

Authors: Joseph T. Lynch, Jennie M. Scarvell, Catherine R. Galvin, Paul N. Smith, Diana M. Perriman

Published in: Knee Surgery, Sports Traumatology, Arthroscopy | Issue 2/2021

Login to get access

Abstract

Purpose

Modern TKR prostheses are designed to restore healthy kinematics including high flexion. Kneeling is a demanding high-flexion activity. There have been many studies of kneeling kinematics using a plethora of implant designs but no comprehensive comparisons. Visualisation of contact patterns allows for quantification and comparison of knee kinematics. The aim of this systematic review was to determine whether there are any differences in the kinematics of kneeling as a function of TKR design.

Methods

A search of the published literature identified 26 articles which were assessed for methodologic quality using the MINORS instrument. Contact patterns for different implant designs were compared at 90° and maximal flexion using quality-effects meta-analysis models.

Results

Twenty-five different implants using six designs were reported. Most of the included studies had small-sample sizes, were non-consecutive, and did not have a direct comparison group. Only posterior-stabilised fixed-bearing and cruciate-retaining fixed-bearing designs had data for more than 200 participants. Meta-analyses revealed that bicruciate-stabilised fixed-bearing designs appeared to achieve more flexion and the cruciate-retaining rotating-platform design achieved the least, but both included single studies only. All designs demonstrated posterior–femoral translation and external rotation in kneeling, but posterior-stabilised designs were more posterior at maximal flexion when compared to cruciate retaining. However, the heterogeneity of the mean estimates was substantial, and therefore, firm conclusions about relative behaviour cannot be drawn.

Conclusion

The high heterogeneity may be due to a combination of variability in the kneeling activity and variations in implant geometry within each design category. There remains a need for a high-quality prospective comparative studies to directly compare designs using a common method.

Level of evidence

Systematic review and meta-analysis Level IV
Literature
1.
Ardestani MM, Moazen M, Jin Z (2015) Contribution of geometric design parameters to knee implant performance: conflicting impact of conformity on kinematics and contact mechanics. Knee 22:217–224PubMed
2.
Australian Orthopaedic Association National Joint Replacement Registry (AOANJRR) (2019) Hip, knee and shoulder arthroplasty. AOA, Adelaide
3.
Barnes CL, Sharma A, David Blaha J, Nambu SN, Carroll ME (2011) Kneeling is safe for patients implanted with medial-pivot total knee arthroplasty designs. J Arthroplasty 26:549–554PubMed
4.
Bull AMJ, Kessler O, Alam M, Amis AA (2008) Changes in knee kinematics reflect the articular geometry after arthroplasty. Clin Orthop Relat Res 466:2491–2499PubMedPubMedCentral
5.
Coughlin KM, Incavo SJ, Doohen RR, Gamada K, Banks S, Beynnon BD (2007) Kneeling kinematics after total knee arthroplasty: anterior-posterior contact position of a standard and a high-flex tibial insert design. J Arthroplasty 22:160–165PubMed
6.
Delport HP, Banks SA, De SJ, Bellemans J, De Schepper J, Bellemans J (2006) A kinematic comparison of fixed-and mobile-bearing knee replacements. J Bone Jt Surg Br 88:1016–1021
7.
Dennis DA, Komistek RD, Hoff WA, Gabriel SM (1996) In vivo knee kinematics derived using an inverse perspective technique. Clin Orthop Relat Res 331:107–117
8.
Doi SAR, Barendregt JJ, Khan S, Thalib L, Williams GM (2015) Advances in the meta-analysis of heterogeneous clinical trials II: the quality effects model. Contemp Clin Trials 45:123–129PubMed
9.
Galvin CR, Perriman DM, Lynch JT, Pickering MR, Newman P, Smith PN, Scarvell JM (2019) Age has a minimal effect on knee kinematics: a cross-sectional 3D/2D image-registration study of kneeling. Knee 25:988–1002
10.
Galvin CR, Perriman DM, Newman PM, Lynch JT, Smith PN, Scarvell JM (2018) Squatting, lunging and kneeling provided similar kinematic profiles in healthy knees—a systematic review and meta-analysis of the literature on deep knee flexion kinematics. Knee 25:514–530PubMed
11.
Gamada K, Jayasekera N, Kashif F, Fennema P, Schmotzer H, Banks SA (2008) Does ligament balancing technique affect kinematics in rotating platform, PCL retaining knee arthroplasties? Knee Surg Sport Traumatol Arthrosc 16:160–166
12.
Ginsel BL, Banks S, Verdonschot N, Hodge WA (2009) Improving maximum flexion with a posterior cruciate retaining total knee arthroplasty: a fluoroscopic study. Acta Orthop Belg 75:801–807PubMed
13.
Hamai S, Miura H, Higaki H, Matsuda S, Shimoto T, Sasaki K, Yoshizumi M, Okazaki K, Tsukamoto N, Iwamoto Y (2008) Kinematic analysis of kneeling in cruciate-retaining and posterior-stabilized total knee arthroplasties. J Orthop Res 26:435–442PubMed
14.
Hanson GR, Park SE, Suggs JF, Moynihan AL, Nha KW, Freiberg A, Li G (2007) In vivo kneeling biomechanics after posterior stabilized total knee arthroplasty. J Orthop Sci 12:476–483PubMed
15.
Hefzy MS, Kelly BP, Cooke TDV (1998) Kinematics of the knee joint in deep flexion: a radiographic assessment. Med Eng Phys 20:302–307PubMed
16.
Higgins JPT, Thomas J, Chandler J, Cumpston M, Li T, Page M, Welch V (eds) (2019) Cochrane handbook for systematic reviews of interventions, 2nd edn. Wiley-Blackwell, Chichester UK
17.
Howell SM, Hodapp EE, Kuznik K, Hull ML (2009) In vivo adduction and reverse axial rotation (external) of the tibial component can be minimized. Orthopaedics 32:319–326
18.
Howell SM, Hodapp EE, Vernace JV, Hull ML, Meade TD (2013) Are undesirable contact kinematics minimized after kinematically aligned total knee arthroplasty? An intersurgeon analysis of consecutive patients. Knee Surg Sport Traumatol Arthrosc 21:2281–2287
19.
Incavo SJ, Mullins ER, Coughlin KM, Banks S, Banks A, Beynnon BD (2004) Tibiofemoral kinematic analysis of kneeling after total knee arthroplasty. J Arthroplasty 19:906–910PubMed
20.
Insall JN, Lachiewicz PF, Burstein AH (1982) The posterior stabilized condylar prosthesis: a modification of the total condylar design. Two to four-year clinical experience. J Bone Jt Surg Am 64:1317–1323
21.
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
22.
Jiang C, Liu Z, Wang Y, Bian Y, Feng B, Weng X (2016) Posterior cruciate ligament retention versus posterior stabilization for total knee arthroplasty: a meta-analysis. PLoS ONE 11:1–15
23.
Kanekasu K, Banks SA, Honjo S, Nakata O, Kato H (2004) Fluoroscopic analysis of knee arthroplasty kinematics during deep flexion kneeling. J Arthroplasty 19:998–1003PubMed
24.
Kuroyanagi Y, Mu S, Hamai S, Robb WJ, Banks SA (2012) In vivo knee kinematics during stair and deep flexion activities in patients with bicruciate substituting total knee arthroplasty. J Arthroplasty 27:122–128PubMed
25.
Mahoney OM, Kinsey TL, Banks AZ, Banks SA (2009) Rotational kinematics of a modern fixed-bearing posterior stabilized total knee arthroplasty. J Arthroplasty 24:641–645PubMed
26.
McClelland JA, Feller JA, Menz HB, Webster KE (2017) Patients with total knee arthroplasty do not use all of their available range of knee flexion during functional activities. Clin Biomech 43:74–78
27.
Mikashima Y, Tomatsu T, Horikoshi M, Nakatani T, Saito S, Momohara S, Banks SA (2010) In vivo deep-flexion kinematics in patients with posterior-cruciate retaining and anterior-cruciate substituting total knee arthroplasty. Clin Biomech 25:83–87
28.
Moonot P, Mu S, Railton GT, Field RE, Banks SA (2009) Tibiofemoral kinematic analysis of knee flexion for a medial pivot knee. Knee Surg Sport Traumatol Arthrosc 17(8):927–934
29.
Moro-oka T, Muenchinger M, Canciani J-P, Banks S (2007) Comparing in vivo kinematics of anterior cruciate-retaining and posterior cruciate-retaining total knee arthroplasty. Knee Surg Sport Traumatol Arthrosc 15:93–99
30.
Most E, Zayontz S, Li G, Otterberg E, Sabbag K, Rubash HE (2003) Femoral rollback after cruciate-retaining and stabilizing total knee arthroplasty. Clin Orthop Relat Res 410:101–113
31.
Mulholland SJ, Wyss UP (2001) Activities of daily living in non-Western cultures: range of motion. Int J Rehabil Res 24:191–198PubMed
32.
Nakamura E, Banks SA, Tanaka A, Sei A, Mizuta H (2009) Three-dimensional tibiofemoral kinematics during deep flexion kneeling in a mobile-bearing total knee arthroplasty. J Arthroplasty 24:1120–1124PubMed
33.
Nakamura S, Ito H, Yoshitomi H, Kuriyama S, Komistek RD, Matsuda S (2015) Analysis of the flexion gap on in vivo knee kinematics using fluoroscopy. J Arthroplasty 30:1237–1342PubMed
34.
Nakamura S, Sharma A, Kobayashi M, Ito H, Nakamura K, Zingde SM, Nakamura T, Komistek RD (2014) 3D in vivo femoro-tibial kinematics of tri-condylar total knee arthroplasty during kneeling activities. Knee 21:162–167PubMed
35.
Niki Y, Takeda Y, Udagawa K, Enomoto H, Toyama Y, Suda Y (2013) Is greater than 145° of deep knee flexion under weight-bearing conditions safe after total knee arthroplasty? A fluoroscopic analysis of Japanese-style deep knee flexion. Bone Jt J 95B:782–787
36.
Okamoto N, Breslauer L, Hedley AK, Mizuta H, Banks SA (2011) In vivo knee kinematics in patients with bilateral total knee arthroplasty of 2 designs. J Arthroplasty 26:914–918PubMed
37.
Schütz P, Taylor WR, Postolka B, Fucentese SF, Koch PP, Freeman MAR, Pinskerova V, List R (2019) Kinematic evaluation of the GMK sphere implant during gait activities: a dynamic videofluoroscopy study. J Orthop Res 37:2337–2347PubMedPubMedCentral
38.
Scott CEH, Bugler KE, Clement ND, MacDonald D, Howie CR, Biant LC (2012) Patient expectations of arthroplasty of the hip and knee. J Bone Jt Surg Br 94:974–981
39.
Scott G, Imam MAA, Eifert A, Freeman MAR, Pinskerova V, Field REE, Skinner J, Banks SA (2016) Can a total knee arthroplasty be both rotationally unconstrained and anteroposteriorly stabilised? Bone Jt Res 5:80–86
40.
Slim K, Nini E, Forestier D, Kwiatkowski F, Panis Y, Chipponi J (2003) Methodological index for non-randomized studies (MINORS): development and validation of a new instrument. ANZ J Surg Surg 73:712–716
41.
Tanaka A, Nakamura E, Okamoto N, Banks SA, Mizuta H (2011) Three-dimensional kinematics during deep-flexion kneeling in mobile-bearing total knee arthroplasty. Knee 18:412–416PubMed
42.
43.
Vertullo CJ, Grimbeek PM, Graves SE, Lewis PL (2017) Surgeon’s preference in total knee replacement: a quantitative examination of attributes, reasons for alteration, and barriers to change. J Arthroplasty 32:2980–2989PubMed
44.
Walker PS, Hajek JV (1972) The load-bearing area in the knee joint. J Biomech 5:581–589PubMed
45.
Watanabe T, Ishizuki M, Muneta T, Banks SA (2013) Knee kinematics in anterior cruciate ligament-substituting arthroplasty with or without the posterior cruciate ligament. J Arthroplasty 28:548–552PubMed
46.
Watanabe T, Muneta T, Koga H, Horie M, Nakamura T, Otabe K, Nakagawa Y, Katakura M, Sekiya I (2016) In-vivo kinematics of high-flex posterior-stabilized total knee prosthesis designed for Asian populations. Int Orthop 40:2295–2302PubMed
47.
Watanabe T, Muneta T, Sekiya I, Banks SA (2015) Intraoperative joint gaps and mediolateral balance affect postoperative knee kinematics in posterior-stabilized total knee arthroplasty. Knee 22:527–534PubMed
48.
49.
Yildirim G, Walker PS, Sussman-Fort J, Aggarwal G, White B, Klein GR (2007) The contact locations in the knee during high flexion. Knee 14:379–384PubMed
Metadata
Title
Influence of component design on in vivo tibiofemoral contact patterns during kneeling after total knee arthroplasty: a systematic review and meta-analysis
Authors
Joseph T. Lynch
Jennie M. Scarvell
Catherine R. Galvin
Paul N. Smith
Diana M. Perriman
Publication date
01-02-2021
Publisher
Springer Berlin Heidelberg
Keywords
Knee-TEP
Knee-TEP
Published in
Knee Surgery, Sports Traumatology, Arthroscopy / Issue 2/2021
Print ISSN: 0942-2056
Electronic ISSN: 1433-7347
DOI
https://doi.org/10.1007/s00167-020-05949-y

Other articles of this Issue 2/2021

Knee Surgery, Sports Traumatology, Arthroscopy 2/2021 Go to the issue

KNEE

Type of bone graft and primary diagnosis were associated with nosocomial surgical site infection after high tibial osteotomy: analysis of a national database

KNEE

A predictive model with radiographic signs can be a useful supplementary diagnostic tool for complete discoid lateral meniscus in adults

KNEE

The sagittal cutting plane affects evaluation of the femoral bone tunnel position on three-dimensional computed tomography after anterior cruciate ligament reconstruction

KNEE

Patellar component size effects patellar tilt in total knee arthroplasty with patellar resurfacing

KNEE

The tibial cut in total knee arthroplasty influences the varus alignment, the femoral roll-back and the tibiofemoral rotation in patients with constitutional varus

KNEE

Additional periarticular catheter shows no superiority over single-shot local infiltration analgesia alone in unicondylar knee replacement