Abstract
Instability is reported to account for around 20% of early TKR revisions. The concept of restoring the “Envelope of Laxity” (EoL) mandates a balanced knee through a continuous arc of functional movement. We therefore hypothesised that a single radius (SR) design should confer this stability since it has been proposed that the SR promotes normal medial collateral ligament (MCL) function with isometric stability throughout the full arc of motion.
Our aim was to characterise the EoL and stability offered by a SR cruciate retaining (CR)-TKR, which maintains a SR from 10–110° flexion. This was compared with that of the native knee throughout the arc of flexion in terms of anterior, varus/valgus and internal/ external laxity to assess whether a SR CR-TKR design can mimic normal knee joint kinematics and stability.
Eight fresh frozen cadaveric lower limbs were physiologically loaded on a custom jig. The operating surgeon performed anterior drawer, varus/ valgus and internal/external rotation tests to determine ‘maximum’ displacements in 1) native knee and 2) single radius CR-TKR (Stryker Triathlon) at 0°, 30°, 60°, 90° and 110° flexion. Displacements were recorded using computer navigation. Significance was determined by linear modelling (p≤0.05).
The key finding of this work was that the EoL offered by the SR CR-TKR was largely equivalent to that of the native knee from 0–110°. The EoL increased significantly with flexion angle for both native and replaced knees. Overall, after TKR anterior laxity was comparable with the native knee, whilst total varus-valgus and internal-external rotational laxities reduced by only 1°. However, separated varus and valgus laxities at 110° significantly increased after TKR as did anterior laxity at 30° flexion.
In conclusion, the overall EoL offered by the SR CR-TKR is comparable to that of the native knee. In the absence of soft tissue deficiency, the implant appears to offer reliable and reproducible stability throughout the functional range of movement, with exception of anterior laxity at 30° and varus and valgus laxity when the knee approaches high flexion. These shortcomings should offer scope for future work.
