Small differences in tibial contact locations following kinematically aligned TKA from the native contralateral knee

  • Stephanie Nicolet-Petersen
  • Augustine Saiz
  • Trevor Shelton
  • Stephen M. Howell
  • Maury L. HullEmail author



Kinematically aligned (KA) TKA strives to restore native limb and knee alignments without ligament release with the premise that knee function likewise will be closely restored to native to the extent enabled by the components used. This study determined differences in anterior–posterior (AP) tibial contact locations of a KA TKA performed with asymmetric, fixed bearing, posterior cruciate-retaining (PCR) components from those of the native contralateral knee and also determined the incidence of posterior rim contact of the tibial insert during a deep knee bend and a step-up.


Both knees were imaged using single-plane fluoroscopy for 25 patients with a calipered KA TKA and a native knee in the contralateral limb. AP tibial contact locations in each compartment were determined following 3D model-to-2D image registration. Differences in mean AP tibial contact locations in each compartment between the KA TKA knees and the native contralateral knees were analysed. Contact locations either on or beyond the most posterior point of the tibial insert determined the occurrence of posterior rim contact.


Mean AP tibial contact locations for both native and KA TKA knees remained relatively centred in the medial compartment but moved posterior in the lateral compartment during flexion. In both the medial and lateral compartments, differences in mean AP tibial contact locations between the KA TKA knees and the native contralateral knees were more posterior and greatest at 0° flexion for both activities (4 mm, p = 0.0009 and 7 mm, p < 0.0001 for deep knee bend and 6 mm, p < 0.0001 and 8 mm, p < 0.0001 for step-up in the medial and lateral compartments, respectively). The incidence of posterior rim contact of the tibial insert was 16% (4 of 25 patients) but the lowest Oxford Knee Score was 43 for these patients. The median Oxford Knee Score for all patients was 46 (out of 48).


Calipered KA TKA with asymmetric, fixed bearing, PCR components resulted in mean AP tibial contact locations which were relatively centred in the compartments and differed at most from those of the native contralateral knee by approximately 15% of the AP dimension of a mid-sized tibial baseplate. Although posterior rim contact occurred in some patients, all such patients had high patient-reported outcome scores.

Level of evidence

Therapeutic, Level III.


Total knee replacement Total knee arthroplasty Contact kinematics Kinematic alignment Posterior edge loading Deep knee bend Step-up Activities of daily living Tibiofemoral joint 



The authors would like to thank the individuals who participated in this study for their contribution to the advancement of education and research. Lastly, the authors would like to thank Savannah Axume Gamero, Anya Guzman, Yash Taneja, and Caitlyn Munch for assistance with segmentation and image processing.


This study was funded by Zimmer-Biomet, Award number IRU2016-101K:Knees.

Compliance with ethical standards

Conflict of interest

S. M. Howell is a paid consultant for THINK Surgical and Medacta, Inc. M. L. Hull receives research support from Zimmer-Biomet and Medacta, Inc. Remaining authors declare that they have no conflict of interest.

Ethical approval

This study was approved by the University of California Davis Institutional Review Board (IRB#954288).


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Copyright information

© European Society of Sports Traumatology, Knee Surgery, Arthroscopy (ESSKA) 2019

Authors and Affiliations

  1. 1.Department of Biomedical EngineeringUniversity of California DavisDavisUSA
  2. 2.Department of Orthopaedic SurgeryUniversity of California Davis Medical CenterSacramentoUSA
  3. 3.Department of Mechanical EngineeringUniversity of California DavisDavisUSA

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