Abstract
Total knee arthroplasty (TKA) is widely accepted as a successful surgical intervention to treat osteoarthritis and other degenerative diseases of the knee. However, present statistics on limited survivorship and patient-satisfaction emphasise the need for an optimal endoprosthetic care. Although, the implant design is directly associated with the clinical outcome comprehensive knowledge on the complex relationship between implant design (morphology) and function is still lacking.
The goal of this study was to experimentally analyse the relationship between the trochlear groove design of the femoral component (iTotal CR, ConforMIS, Inc., Bedford, MA, USA) and kinematics in an in vitro test setup based on rapid prototyping of polymer-based replica knee implants.
The orientation of the trochlear groove was modified in five different variations in a self-developed computational framework. On the basis of the reference design, one was medially tilted (−2°) and four were laterally tilted (+2°, +4°, +6°, +8°). For manufacturing, we used rapid prototyping to produce synthetic replicates made of Acrylnitril-Butadien-Styrol (ABS) and subsequent post-processing with acetone vapor. The morpho-functional analysis of the replicates was performed in our experimental knee simulator. Tibiofemoral and patellofemoral kinematics were recorded with an optical tracking system during a semi-active flexion/extension (∼10° to 90°) motion.
Looking at the results, the patellofemoral kinematics, especially the medial/lateral translation and internal/external rotation were mainly affected. During low flexion, the patella had a more laterally position relative to the femur with increasing lateral trochlear orientation. The internal/external rotation initially differentiated and converged with flexion. Regarding the tibiofemoral kinematics, only the tibial internal/external rotation showed notable differences between the modified replica implants.
We presented a workflow for an experimental morpho-functional analysis of the knee and demonstrated its feasibility on the example of the trochlear groove orientation which might be used in the future for comprehensive implant design parameter optimisation, especially in terms of image based computer assisted patient-specific implants.
