In Vivo Anteroposterior Femorotibial Translation of Total Knee Arthroplasty: A Multicenter Analysis

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Abstract

A study was conducted to determine in vivo femorotibial contact patterns for subjects having a posterior cruciate retaining or posterior cruciate substituting total knee arthroplasty. Femorotibial contact of 72 subjects implanted with a total knee replacement, performed by five surgeons, was analyzed using video fluoroscopy. Thirty-one subjects were implanted with a posterior cruciate retaining total knee replacement with a flat polyethylene posterior lipped insert, 12 with a posterior cruciate retaining total knee replacement with a curved insert, and 29 with a posterior cruciate substituting total knee replacement. Each subject performed successive deep knee bends to maximum flexion. Video images at 0°, 30°, 60°, and 90° flexion were downloaded onto a workstation computer. Femorotibial contact paths were determined for the medial and lateral condyles using an interactive model fitting technique. Femorotibial contact anterior to the tibial midline in the sagittal plane was denoted as positive and contact posterior was denoted as negative. Analysis of average femorotibial contact pathways of both posterior cruciate retaining designs revealed posterior femorotibial contact in full extension with anterior translation of femorotibial contact commonly observed in midflexion and terminal flexion. In posterior cruciate substituting designs, anterior femoral translation was seen medially at 30° to 60° flexion but rarely was observed laterally. Posterior femoral rollback laterally from full extension to 90° flexion was seen in 100% of subjects implanted with a posterior cruciate substituting total knee replacement, versus 51.6% (posterior lipped polyethylene insert) and 58.3% (curved insert) of those with a posterior cruciate retaining total knee replacement. Data from this multicenter study are remarkably similar to previous fluoroscopy data from a single surgeon series, showing a lack of customary posterior femoral rollback in both posterior cruciate retaining designs, and conversely showing an average anterior femoral translation with knee flexion. Posterior femoral rollback, less than in normal knees, routinely was observed in posterior cruciate substituting total knee arthroplasty, attributed to engagement of the femoral component cam with the tibial post. The abnormal anterior femoral translation observed in posterior cruciate retaining total knee arthroplasty may be a factor in premature polyethylene wear observed in retrieval studies.

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