Biomechanics of Knee Replacement

  • John J. O’Connor
  • John W. Goodfellow


The development of knee replacement over the past 30 years has been quite different to that of hip replacement. All hip prostheses use the ball and socket geometry of the natural joint and development has concentrated on the design of stems and on methods of fixation of components to the bone. In contrast, the optimum design of the articular surfaces of knee prostheses is still controversial and many fundamentally different designs are used in current practice. In this chapter, we review the range of designs of knee prostheses and classify them according to the extent that they use and rely on retained ligaments. The review is introduced by a description of the functions of the ligaments of the knee. The chapter concludes with a discussion of the design of surface-replacement knee prostheses which allow the retention of all the ligaments, and the need for meniscal bearings in such designs is explained.


Anterior Cruciate Ligament Articular Surface Femoral Condyle Posterior Cruciate Ligament Tibial Plateau 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


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  1. 1.
    Maquet P (1989) On the movement of animals. Springer, Berlin. Translation of: Borelli GA (1679) Di Motu AnimaliumGoogle Scholar
  2. 2.
    Kurosawa H, Walker PS, Abe S, Garg A, Hunter T (1985) Geometry and motion of the knee for implant and orthotic design. J Biomech 18 (7): 487–99PubMedCrossRefGoogle Scholar
  3. 3.
    Daniel DM, Stone ML (1990) Case studies. In: Daniel DM, Akeson WH, O’Connor JJ (ed) Knee Ligaments: Structure, Function, Injury and Repair, Raven, New York, pp 31–55Google Scholar
  4. 4.
    O’Connor JJ, Shercliff TL, Biden E, Goodfellow JW (1989) The geometry of the knee in the sagittal plane. Proc Inst Mech Eng Part H, J Engng Med 203: 223–33Google Scholar
  5. 5.
    O’Connor J, Shercliff T, FitzPatrick D, Bradley J, Daniel D, Biden E, Goodfellow J (1990) Geometry of the knee. In: Daniel DM, Akeson WH, O’Connor JJ (eds) Knee ligaments: Structure, function, injury, and repair. Raven, New York, pp 163–200Google Scholar
  6. 6.
    Weber WE, Weber EFW (1836) Mechanik der menschlichen Gehwerkzeuge. In: Dietrichschen Buchhandlung, GöttingenGoogle Scholar
  7. 7.
    Baratta R, Solomonow M, Zhou BH, Letson D, Chuinard R, d’Ambrosia R (1988) The role of the antagonist musculature in maintaining knee stability. Am J Sports Med 16 (2): 113–22PubMedCrossRefGoogle Scholar
  8. 8.
    Morrison JB (1968) Bioengineering analysis of force actions transmitted by the knee joint. Biomed Eng 90: 164–70Google Scholar
  9. 9.
    Morrison JB (1970) The mechanics of the knee joint in relation to normal walking. J Biomech 3: 51–61PubMedCrossRefGoogle Scholar
  10. 10.
    Harrington IJ (1976) A bioengineering analysis of force actions at the knee in normal and pathological gait. Biomed Eng 11: 167–72PubMedGoogle Scholar
  11. 11.
    Collins JJ, O’Connor JJ (1991) Muscle-ligament interactions at the knee during walking. Proc Inst Mech Eng Part H, J Engng Med 205: 11–18Google Scholar
  12. 12.
    Shiers LGP (1954) Arthroplasty of the knee — preliminary report of a new method. J Bone Joint Surg [Br] 36: 553–60Google Scholar
  13. 13.
    Waldius B (1957) Arthroplasty of the knee using an endoprosthesis. Acta Orthop Scand [Suppl] 24Google Scholar
  14. 14.
    Lettin AW, Ware HS, Morris RW (1991) Survivor analysis and confidence limits. J Bone Joint Surg [Br] 73 (5): 729–31Google Scholar
  15. 15.
    Heinert K, Engelbrecht E (1988) Langzeitvergleich der Knie-endoprothesensysteme “St. Georg”. Chirurg 59: 755Google Scholar
  16. 16.
    Scuderi GR, Insall JN, Windsor RE, Moran MC (1989) Survivorship of cemented total knee replacements. J Bone Joint Surg [Br] 71 (5): 798–803Google Scholar
  17. 17.
    Engelbrecht E, Heinert K (1988) Experience with a surface and total knee replacement: Further development of the model St. Georg. In: Niwa S, Paul JP, Yamamoto S (eds) Total knee replacement. Springer Verlag, Tokyo, pp 257–275Google Scholar
  18. 18.
    Freeman MAR, Swanson SAV, Zahir A (1972) Total replacement of the knee using metal-polyethylene two-part prosthesis. Proc R Soc Med 65: 374–5PubMedGoogle Scholar
  19. 19.
    Insall J, Scott WN, Ranawat CS (1979) The Total Condylar knee prosthesis, a report of 220 cases. J Bone Joint Surg [Am] 61 (2): 173–80Google Scholar
  20. 20.
    Attenborough CG (1978) The Attenborough total knee replacement. J Bone Joint Surg [Br] 60 (3): 320–6Google Scholar
  21. 21.
    Deane G (1974) A new concept in knee joint design. In: International Congress Series, no. 324. Excerpta Medica, Amsterdam, pp 244–247Google Scholar
  22. 22.
    Mathews LS, Sonstegard DA, Kaufer H (1973) The Spherocentric knee. Clin Orthop 94: 234–41Google Scholar
  23. 23.
    Insall JN, Lachiewicz PF, Burstein AH (1982) The posterior stabilized condylar prosthesis: A modification of the Total Condylar design: 2–4 year clinical experience. J Bone Joint Surg [Am] 64 (9): 1317–23Google Scholar
  24. 24.
    Ewald FC, Jacobs MA, Miegel RE, Walker PS, Poss R, Sledge CB (1984) Kinematic total knee replacement. J Bone Joint Surg [Am] 66 (7): 1032–40Google Scholar
  25. 25.
    Hungerford DS, Kenna RV (1983) Preliminary experience with a porous coated total knee replacement used without cement. Clin Orthop 176: 95–107PubMedGoogle Scholar
  26. 26.
    Ritter MA, Keating EM, Faris PM (1989) Design features and clinical results of the anatomic graduated components (AGC) total knee replacement. Contemp Orthop 19 (6): 641–7Google Scholar
  27. 27.
    Rosenberg AG, Barden R, Galante JO (1989) A comparison of cemented and cementless fixation with the Miller-Galante total knee arthroplasty. Orthop Clin North Am 20 (1): 97–111PubMedGoogle Scholar
  28. 28.
    Miller J, Johnson JA (1990) Anthropometric aspects of knee prosthesis design. In: Coombs R, Gristina A, Hungerford D (eds) Joint replacement, state of the art. Orthotext, London, pp 189–91Google Scholar
  29. 29.
    Bowden FP, Tabor D (1964) Friction and lubrication of solids, part I I. Oxford University Press, LondonGoogle Scholar
  30. 30.
    Briscoe BJ, Pooley CM, Tabor D (1975) Friction and transfer of some polymers in unlubricated sliding. In: Lee L-H (ed) Advances in polymer friction and wear. Plenum, New York, pp 191–202Google Scholar
  31. 31.
    Landy M, Walker PS (1988) Wear of ultra-high-molecular-weight polyethylene components of 90 retrieved knee prostheses. J Arthroplasty, Supp1: 73–85Google Scholar
  32. 32.
    Wright TM, Bartel DL (1986) The problem of surface damage in polyethylene total knee components. Clin Orthop 205: 65–74Google Scholar
  33. 33.
    Dowling JM, Atkinson JR, Dowson D, Charnley J (1978) The characteristics of acetabular cups worn in the human body. J Bone Joint Surg [Br] 60 (3): 375–82Google Scholar
  34. 34.
    Wroblewski BM (1985) Direction and rate of socket wear in Charnley low friction arthroplasty. J Bone Joint Surg [Br] 67: 757–61Google Scholar
  35. 35.
    Rose RM, Nusbaum HJ, Schneider H, Ries SB, Paul I, Crugnola A, Simon SR, Radin EL (1980) On the true wear rate of ultra-high-molecular-weight polyethylene in the total hip prosthesis. J Bone Joint Surg [Am] 62 (4): 537–49Google Scholar
  36. 36.
    Rose RM, Cimono WR, Ellis E, Crugnola AM (1982) Exploratory investigations on the structure dependence of the wear resistance of polyethylene. Wear 77: 89–104CrossRefGoogle Scholar
  37. 37.
    Rose RM, Goldfarb EV, Ellis E, Crugnola AM (1983) On the pressure dependence of the wear of ultra-high-molecular-weight polyethylene. Wear 92: 99–111CrossRefGoogle Scholar
  38. 38.
    Harris WH, Schiller AL, Scholler JM, Freiberg RA, Scott R (1976) Extensive localised bone resorption in the femur following total hip replacement. J Bone Joint Surg [Am] 58: 612–8Google Scholar
  39. 39.
    Jasty MJ, Floyd WE, Schiller AL, Goldring SR, Harris WH (1986) Localised osteolysis in stable non-septic total hip replacement. J Bone Joint Surg [Am] 68: 912–9Google Scholar
  40. 40.
    Nolan JF, Buckhill TM (1992) Aggressive granulomatosis from polyethylene failure in an uncemented knee replacement. J Bone Joint Surg [Br] 74 (1): 23–4Google Scholar
  41. 41.
    Goodfellow JW, O’Connor JJ (1978) The mechanics of the knee and prosthesis design. J Bone Joint Surg [Br] 60: 358–69Google Scholar
  42. 42.
    Black J (1978) The future of polyethylene. J Bone Joint Surg [Br] 60 (3): 305–6Google Scholar
  43. 43.
    Rostoker W, Galante JO (1979) Contact pressure dependence of wear rates of ultra-high-molecular-weight polyethene. J Biomed Mater Res 13: 957–64PubMedCrossRefGoogle Scholar
  44. 44.
    Burwell JT, Strang CD (1952) J Appl Phys, A 212: 470Google Scholar
  45. 45.
    Gunston RH, MacKenzie RI (1976) Complications of polycentric knee arthroplasty. Clin Orthop 120: 11–7PubMedGoogle Scholar
  46. 46.
    Marmor L (1976) The Modular (Marmor) knee — case report with a minimum follow-up of 2 years. Clin Orthop 120: 86–94PubMedGoogle Scholar
  47. 47.
    Williams EA, Hargadon EJ, Davies DRA (1979) Late failure of the Manchester prosthesis. J Bone Joint Surg [Br] 61 (4): 451–4Google Scholar
  48. 48.
    Engh GA (1988) Failure of the polyethylene bearing surface of a total knee replacement within four years: A case report. J Bone Joint Surg [Am] 70: 1093–6Google Scholar
  49. 49.
    Christensen OM, Christiansen TG, Johansen T (1990) Polyethylene failure in a PCA unicompartmental prosthesis. Acta Orthop Scand 61: 578–9PubMedCrossRefGoogle Scholar
  50. 50.
    Lindstrand A, Ryd L, Stenström A (1990) Polyethylene failure in two total knees: wear of thin, metal-backed PCA tibial components. Acta Orthop Scand 61: 575–7PubMedCrossRefGoogle Scholar
  51. 51.
    Engh GA, Kimberly AD, Hanes CK (1992) Polyethylene wear of metal-backed tibial components in total and unicompartmental knee prostheses. J Bone Joint Surg [Br] 74 (1): 9–17Google Scholar
  52. 52.
    Jones SMG, Pinder IM, Moran CG, Malcolm AJ (1992) Polyethylene wear in uncemented knee replacements. J Bone Joint Surg [Br] 74 (1): 18–22Google Scholar
  53. 53.
    Scott RD (1982) Duopatellar total knee replacement. Orthop Clin North Am 13: 89PubMedGoogle Scholar
  54. 54.
    Bayley JC, Scott RD, Ewald FC, Holmes GB (1988) Failure of the metal-backed patellar component after total knee replacement. J Bone Joint Surg [Am] 70 (5): 668–74Google Scholar
  55. 55.
    Windsor RE, Scuderi GR, Insall JN (1989) Patellar fractures in total knee arthoplasty. J Arthroplasty 4: S63–7PubMedCrossRefGoogle Scholar
  56. 56.
    Merkow RL, Soudry M, Insall JN (1985) Patellar dislocation following total knee arthroplasty. J Bone Joint Surg [Am] 67: 1321Google Scholar
  57. 57.
    Miller RK, O’Connor JJ, Goodfellow JN (to be published) Patello-femoral forces after knee replacement — an in vitro studyGoogle Scholar
  58. 58.
    Jeffrey RS, Morris RW, Denham RA (1991) Coronal alignment after total knee replacement. J Bone Joint Surg [Br] 73 (5): 709–14Google Scholar
  59. 59.
    Lotke P, Ecker ML (1977) Influence of positioning of prosthesis in total knee replacement. J Bone Joint Surg [Am] 59 (1): 77–9Google Scholar
  60. 60.
    Bargren JH, Blaha JD, Freeman MAR (1983) Alignment in total knee arthroplasty. Correlated biomechanical and clinical observations. Clin Orthop 173: 178Google Scholar
  61. 61.
    Johnson F, Leitl S, Waugh W (1980) The distribution of load across the knee — a comparison of static and dynamic measurements. J Bone Joint Surg [Am] 62: 346–349Google Scholar
  62. 62.
    Hsu RWW, Himeno S, Coventry MB, Chao EYS (1990) Normal axial alignment of lower extremity and load-bearing distribution at the knee. Clin Orthop 255: 215–27PubMedGoogle Scholar
  63. 63.
    O’Connor J, Biden E, Bradley J, FitzPatrick D, Young S, Kershaw C, Daniel D, Goodfellow J (1990) The muscle-stabilized knee. In: Daniel DM, Akeson WH, O’Connor JJ (eds) Knee ligaments: Structure, function, injury, and repair. Raven, New York, pp 239–78Google Scholar
  64. 64.
    Brantigan OC, Voshell AF (1941) The mechanics of the ligaments and menisci of the knee joint. J Bone Joint Surg [Am] 23: 44–66Google Scholar
  65. 65.
    Brantigan OC, Voshell AF (1943) The tibial collateral ligament: Its function, its bursae, and its relation to the medial meniscus. J Bone Joint Surg [Am] 25 (1): 121–31Google Scholar
  66. 66.
    Wang C-J, Walker PS, Wolf B (1973) The effects of flexion and rotation on the length patterns of the ligaments of the knee. J Biomech 6: 587–96PubMedCrossRefGoogle Scholar
  67. 67.
    Kapandji IA (1987) The Lower Limb, 5th edn. Churchill Livingstone, London (The Physiology of the Joints, Vol 2 )Google Scholar
  68. 68.
    Knutson K, Lindstrand A, Lidgren L (1986) Survival of knee arthroplasties. A nationwide multicenter investigation of 8000 cases. J Bone Joint Surg [Br] 68 (5): 795–9Google Scholar
  69. 69.
    Shrive NG (1973) The weight-bearing role of the menisci of the knee. J Bone Joint Surg [Br] 56: 381Google Scholar
  70. 70.
    Shrive NG, O’Connor JJ, Goodfellow JW (1978) Load-bearing in the knee joint. Clin Orthop 131: 279–287PubMedGoogle Scholar
  71. 71.
    Seedhom BB, Dowson D, Wright V (1973) Function of the menisci, a preliminary study. J Bone Joint Surg [Br] 56: 381Google Scholar
  72. 72.
    Seedhom BB, Dowson D, Wright V (1974) Functions of the menisci, a preliminary study. In: International Congress Series, no. 324. Excerpta Medica, AmsterdamGoogle Scholar
  73. 73.
    Walker PS, Erkmann MJ (1975) The role of the menisci in force transmission across the knee. Clin Orthop 109: 184–92PubMedCrossRefGoogle Scholar
  74. 74.
    Bradley J, Goodfellow JW, O’Connor JJ (1987) A radiographic study of bearing movement in Unicompartmental Oxford knee replacement. J Bone Joint Surg [Br] 69 (4): 598–601Google Scholar
  75. 75.
    O’Connor JJ, Goodfellow JW, Bradley JA (1988) Quadriceps forces following meniscal knee arthroplasty — An in vitro study. Trans Orthop Res Soc p 357Google Scholar
  76. 76.
    Goodfellow JW, Kershaw CJ, Benson MKD’A, O’Connor JJ (1988) The Oxford knee for unicompartmental osteoarthritis. J Bone Joint Surg [Br] 70: 692–701Google Scholar
  77. 77.
    Goodfellow JW, O’Connor J (1986) Clinical results of the Oxford knee. Clin Orthop 205: 21–42PubMedGoogle Scholar
  78. 78.
    Carr A, Keyes G, Miller R, O’Connor J, Goodfellow J (to be published) Medial unicompartmental arthroplasty: A survival analysis of the Oxford meniscal kneeGoogle Scholar
  79. 79.
    Argenson J-N, O’Connor JJ (1992) Polyethylene wear in meniscal knee replacement: A 1–9 year retrieval analysis of the Oxford knee. J Bone Joint Surg [Br] 74: 228–232Google Scholar

Copyright information

© Springer-Verlag Tokyo 1992

Authors and Affiliations

  • John J. O’Connor
    • 1
  • John W. Goodfellow
    • 2
  1. 1.Department of Engineering ScienceOxfordUK
  2. 2.Nuffield Orthopaedic CentreHeadington, OxfordUK

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