The Posterolateral Upslope of a Low-conforming Insert Blocks the Medial Pivot During a Deep Knee Bend in TKA: a Comparative Analysis of Two Implants with Different Insert Conformities

Overview

Journal Knee Surg Sports Traumatol Arthrosc

Publisher Wiley

Specialties Emergency Medicine
General Surgery
Orthopedics

Date 2021 Aug 5

PMID 34350484

Citations 9

Authors

Connor M Delman

Delaney Ridenour

Stephen M Howell

Maury L Hull

Affiliations

Soon will be listed here.

Abstract

Purpose: Tibial insert conformity in total knee arthroplasty (TKA) is of interest due to the potential effect on tibiofemoral kinematics. This study determined differences in anterior-posterior movements of the femoral condyles, pivot locations, and internal tibial rotation in different arcs of flexion for two implants with different insert conformities in kinematically aligned TKA.

Methods: Twenty-five patients treated with a medial and lateral low-conforming, posterior cruciate ligament (PCL) retaining (LC CR) implant followed by a medial ball-in-socket and flat, lateral PCL sacrificing (B-in-S CS) implant in the contralateral knee underwent single-plane fluoroscopy during a deep knee bend. Analysis following 3D-to-2D image registration determined tibiofemoral kinematics and patients completed validated outcome scores for both knees.

Results: The mean follow-up of 1.6 ± 0.4 years for the knee with the B-in-S CS implant was shorter than the 2.7 ± 1.2 years for the LC CR implant. From 0º to 30º of flexion, a medial pivot occurred with the tibia rotating internally approximately 5º with both implants. From 30º to 90º, the pivot remained medial and internal rotation increased to 10º with the B-in-S CS implant. In contrast, neither femoral condyle moved more than 1 mm with the LC CR implant from 30º to 60º, but from 60º to 90º degrees, a lateral pivot occurred and internal rotation increased. Internal rotation of the tibia on the femur from 0° to maximum flexion occurred about a medial pivot similar to the native knee for the B-in-S CS implant and was 4.5° greater than that of the LC CR implant (10.4° vs 5.9°). There was no difference in the median patient-reported outcome scores between implant designs.

Conclusions: Tibial insert conformity is a primary determinant of a medial or lateral pivot during a deep knee bend. One explanation for the transition from a medial to lateral pivot between 30º and 60º with the LC CR implant is the chock-block effect of the insert's posterolateral upslope which impedes posterior movement of the lateral femoral condyle. Because there is no posterolateral upslope in the insert of the B-in-S CS implant, the tibia pivots medially throughout flexion similar to the native knee.

Level Of Evidence: Level III.

Citing Articles

A new tibial insert design with ball-in-socket medial conformity and posterior cruciate ligament retention has low tibial baseplate migration after unrestricted kinematically aligned total knee arthroplasty: a cohort study using radiostereometric....

Niesen A, Tirumalai P, Howell S, Hull M Acta Orthop. 2024; 95:758-764.

PMID: 39713914 PMC: 11664436. DOI: 10.2340/17453674.2024.42489.

An Insert Goniometer Can Help Select the Optimal Insert Thickness When Performing Kinematically Aligned Total Knee Arthroplasty with a Medial 1:1 Ball-in-Socket and Lateral Flat Surface Insert and Posterior Cruciate Ligament Retention.

Sanghavi S, Nedopil A, Howell S, Hull M Bioengineering (Basel). 2024; 11(9).

PMID: 39329652 PMC: 11444139. DOI: 10.3390/bioengineering11090910.

Retention of the posterior cruciate ligament stabilizes the medial femoral condyle during kneeling using a tibial insert with ball-in-socket medial conformity.

Harbison G, ODonnell E, Elorza S, Howell S, Hull M Int Orthop. 2024; 48(9):2395-2401.

PMID: 38997513 DOI: 10.1007/s00264-024-06251-z.

Analysis of Variation in Sagittal Curvature of the Femoral Condyles.

Winslow E, Pan X, Hull M J Biomech Eng. 2024; 146(11).

PMID: 38913074 PMC: 11500806. DOI: 10.1115/1.4065813.

Ball-in-socket medial conformity with posterior cruciate ligament retention neither limits internal tibial rotation and knee flexion nor lowers clinical outcome scores after unrestricted kinematically aligned total knee arthroplasty.

Elorza S, ODonnell E, Nedopil A, Howell S, Hull M Int Orthop. 2023; 47(7):1737-1746.

PMID: 37195465 DOI: 10.1007/s00264-023-05834-6.

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