Abstract
Introduction: Previously, in vivo kinematic studies have determined that posterior stabilized (PS) TKA experienced posterior femoral rollback during deep flexion, while posterior cruciate retaining (PCR) experience a paradoxical anterior slide during both gait and deep flexion. The objective of this present study was to analyze the in vivo kinematics for subjects implanted with a PS mobile bearing TKA to determine if there are any distinct advantages.
Methods: Femorotibial contact positions for ten subjects having a mobile bearing PS TKA, implanted by a single surgeon, were analyzed using video fluoroscopy. Each subject,while under fluoroscopic surveillance, performed a weight-bearing deep knee bend to maximum flexion and normal gait. Video images were downloaded to a workstation computer and analyzed at varying degrees of knee flexion. Femorotibial contact paths for the medial and lateral condyles, axial rotation and condylar lift-off were then determined using a computer automated model-fitting technique. Femorotibial contact anterior to the tibial midline in the sagittal plane was denoted as positive and contact posterior was denoted as negative.
Results: During a deep knee bend, subjects having the Sigma PS rotating platform experienced minimal motion of their medial condyle and posterior femoral rollback of their lateral condyle. On average, the subjects experienced −2.3 mm of posterior femoral rollback (PFR) of their lateral condyle. Nine of ten subjects experienced PFR of their lateral condyle. During gait, on average, subjects experienced minimal motion of their medial (0.8 mm) and lateral condyles (−0.4 mm) from heel-strike to toe-off. During a deep knee bend all ten subjects experienced normal axial rotation (average = 4.0°). During gait, 6/10 subjects experienced normal axial rotation, while four subjects experienced less than 0.8 degrees of reverse rotation. Only 1/10 of the subjects experienced greater than 1.0 mm of condylar lift-off during gait or a deep knee bend.
Discussion: Subject in this study experienced normal kinematic patterns during gait and a deep knee bend. Only one subject experienced greater than 1.0 mm of condylar lift-off, during a deep knee bend and gait. At the present time, it is uncertain if the excellent kinematic patterns for the subjects in this study were related to the chosen surgeon, surgical technique or implant design. If implant design was an influencing factor, subjects requiring a TKA may receive benefit from having a PS mobile bearing type TKA.
The abstracts were prepared by Nico Verdonschot. Correspondence should be addressed to him at Orthopaedic Research Laboratory, University Medical Centre, PO Box 9101, 6500 HB Nijmegen, The Netherlands.
