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Kinematics of a highly congruent mobile-bearing total knee prosthesis

  • Knee
  • Published:
Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Purpose

Limited or absent axial rotation of the mobile insert of total knee prostheses could lead to high contact stresses and stresses at the bone-implant interface, which in turn might lead to implant loosening. The aim of this study was to assess knee kinematics and muscle activation and their possible change over time in patients with a highly congruent, mobile-bearing total knee prosthesis.

Methods

A prospective series of 11 rheumatoid arthritis patients was included to participate in this fluoroscopic and EMG study; only 7 patients completed the study. Kinematic evaluations took place 7 months, 1 and 2 years post-operatively. Repeated measurements ANOVA and linear mixed-effects model for longitudinal data were used to compare the differences between the follow-ups.

Results

There are no significant changes in axial rotations between follow-up moments for the femoral component as well as the mobile insert. The insert remained mobile and followed the femoral component from 0° until approximately 60° of knee flexion. Diverging and reversed axial rotations and translations were seen during the dynamic motions.

Conclusions

Knee kinematics and muscle activation do not appear to change in the first 2 post-operative years. Reversed and divergent axial rotations with increasing knee flexion indicate that as soon as the congruency decreases, the femoral component is no longer forced in a certain position by the insert and moves to a self-imposed position. At lower knee flexion angles, the femoral component might be obstructed by the highly congruent insert and therefore might not be able to move freely.

Level of evidence

Therapeutic study, Level IV.

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Acknowledgments

This project was sponsored by European projects DESSOS IST-2004-27252 and MXL FP7/2007-2013. The funding sources had no involvement in the study design; in the collection, analysis or interpretation of the data; in the writing of the report; or in the decision to submit the paper for publication. We acknowledge Dirk Zweers and Richard Baks from the Department of Radiology and André Prins from the Department of Orthopaedics for their help during the measurements.

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Authors and Affiliations

  1. Biomechanics and Imaging Group, Department of Orthopaedics, Leiden University Medical Center, Postbus 9600, J11-S, 2300 RC, Leiden, The Netherlands

    N. Wolterbeek, E. H. Garling, H. M. J. van der Linden, R. G. H. H. Nelissen & E. R. Valstar

  2. Department of Medical Statistics and Bioinformatics, Leiden University Medical Center, Postbus 9600, 2300 RC, Leiden, The Netherlands

    B. J. A. Mertens

  3. Department of Biomechanical Engineering, Faculty of Mechanical, Maritime and Materials Engineering, Delft University of Technology, Mekelweg 2, 2628 CD, Delft, The Netherlands

    E. R. Valstar

Authors
  1. N. Wolterbeek
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  2. E. H. Garling
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  3. B. J. A. Mertens
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  4. H. M. J. van der Linden
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  5. R. G. H. H. Nelissen
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  6. E. R. Valstar
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Corresponding author

Correspondence to N. Wolterbeek.

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Wolterbeek, N., Garling, E.H., Mertens, B.J.A. et al. Kinematics of a highly congruent mobile-bearing total knee prosthesis. Knee Surg Sports Traumatol Arthrosc 20, 2487–2493 (2012). https://doi.org/10.1007/s00167-012-1936-3

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  • DOI: https://doi.org/10.1007/s00167-012-1936-3

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