The effect of geometry of the tibial polyethylene insert on the tibiofemoral contact kinematics in Advance Medial Pivot total knee arthroplasty

Go Omori, Naoaki Onda, Masashi Shimura, Toyohiko Hayashi, Takashi Sato, Yoshio Koga
Journal of Orthopaedic Science: Official Journal of the Japanese Orthopaedic Association 2009, 14 (6): 754-60

BACKGROUND: In modern total knee arthroplasty (TKA), it is important to reproduce both medial pivot motion and posterior femoral rollback to obtain greater postoperative knee flexion. Several studies have reported the factors affecting knee motion and range of motion after TKA. The purpose of this study was to evaluate the effect of the tibial insert geometry on the tibiofemoral contact kinematics, especially focusing on the medial pivot motion and posterior femoral rollback.

METHODS: Seven cadaveric knees were replaced with the Advance Medial Pivot TKA, and two different geometries of polyethylene tibial insert, the standard medial pivot design (MP-design) and double high design (DH-design), were biomechanically compared. Four experimental configurations were evaluated in each specimen in this order: (1) the MP-design with posterior cruciate ligament (PCL) retaining, (2) the DH-design with PCL retaining, (3) the MP-design with PCL sacrificing, and (4) the DH-design with PCL sacrificing.

RESULTS: Under the PCL-retaining condition, both designs showed no medial pivot but bicondylar femoral rollback more than 60 degrees of knee flexion. In the MP-design, tibiofemoral contact point (estimated contact point, ECP) of the medial compartment was located on the posterior lip of the ball-insocket structure while demonstrating greater than 120 degrees of knee flexion. The posterior translation was also the same in both designs. On the other hand, ECP of the MP-design and the DH-design showed only medial pivot pattern under the PCL-sacrificing condition. In the DH-design, ECP of the lateral compartment showed paradoxical anterior translation from 0 degrees to 60 degrees of knee flexion. Total posterior translation was significantly greater in the lateral compartment than that in the medial compartment.

CONCLUSIONS: The results of this study suggest that in this type of TKA system the ball-in-socket geometry in the MP-design has an advantage for reproducing medial pivot motion in the PCL-sacrificing condition, and the flexion path structure in the DH-design is considered to be both effective and safe for femoral rollback in the PCL-retaining condition. However, neither design is sufficient to reproduce medial pivot motion and posterior femoral rollback. Therefore, a different design of tibial insert is needed for more physiological kinematics after TKA.

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