A1027. KNEE KINEMATICS IN PATIENTS WITH BILATERAL TKA OF TWO DESIGNS DURING MAXIMUM FLEXION ACTIVITIES

Abstract

Total knee arthroplasty (TKA) increasingly is utilized to treat younger, more physically active, or more culturally diverse patients who desire the ability to perform activities with high knee flexion. As a result, many implant manufacturers have modified designs or introduced new ones to better facilitate deep knee flexion. To date, a mix of studies has reported superior or equivalent flexion performance comparing high-flexion and traditional implant designs. Importantly, many of these studies are conducted with the patient supine in non-weightbearing postures, not in functional postures where differences in joint mechanics are better manifest. The goal of this study was to evaluate weightbearing kneeling and lunging knee kinematics in patients with bilateral TKA of two types.

Nine high functioning patients from the American Southwest provided informed consent to participate in this single-surgeon study. The subjects averaged 74 years of age and included three females. Each subject received a traditional cruciate-retaining TKA in one knee and a flexion-enhanced cruciate-retaining (7 knees) or posterior-stabilized (2 knees) TKA in the other. The traditional knees were an average of 84 months postoperative and had combined Knee Society Scores averaging 183. The knees with new TKA designs were an average of 31 months postoperative and had combined Knee Society scores averaging 188. Subjects were observed performing a weight-bearing lunge to maximum comfortable flexion and partially weightbearing kneeling to maximum comfortable flexion using lateral fluoroscopy. Model-image registration techniques were used to quantify the 3D translations and rotations of the tibial and femoral components.

There were no differences in maximum knee flexion during lunging (115°±12° versus 118°±7°) or kneeling (120°±14° versus 120°±10°) for the traditional and flex-ionenhanced TKA’s. Tibial internal rotation and abduction were not different. The locations of the medial and lateral condyles were significantly more posterior in the traditional design for both activities (p< 0.05).

This study examined maximum flexion knee kinematics in clinically excellent, high performing subjects with bilateral TKA of two types. No clinically important functional differences were observed. Although flexion-enhanced designs may provide improved flexion for patients who demand it, older patients living a Western lifestyle appear to do equally well with the traditional and flexion-enhanced TKA designs.