Physical examination and in vivo kinematics in two posterior cruciate ligament retaining total knee arthroplasty designs

Ploegmakers, M.J.M.; Ginsel, B.; Meijerink, H.J.; de Rooy, J.W.; de Waal Malefijt, M.C.; Verdonschot, N.; Banks, S.A.

doi:10.1016/j.knee.2009.09.005

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Volume 17, Issue 3 , Pages 204-209, June 2010

Physical examination and in vivo kinematics in two posterior cruciate ligament retaining total knee arthroplasty designs

M.J.M. Ploegmakers
- Department of Radiology, Jeroen Bosch Hospital, PO Box 90153, 5200 ME's-Hertogenbosch, The Netherlands
- Corresponding author. Tel.: +31 73 699 26 00; fax: +31 73 699 26 01.
B. Ginsel
- Department of Orthopaedics, Radboud University Medical Centre, PO Box 9101, 6500 HB Nijmegen, The Netherlands
H.J. Meijerink
- Department of Orthopaedics, Radboud University Medical Centre, PO Box 9101, 6500 HB Nijmegen, The Netherlands
J.W. de Rooy
- Department of Radiology, Radboud University Medical Centre, PO Box 9101, 6500 HB Nijmegen, The Netherlands
M.C. de Waal Malefijt
- Department of Orthopaedics, Radboud University Medical Centre, PO Box 9101, 6500 HB Nijmegen, The Netherlands
N. Verdonschot
- Orthopaedic Research Laboratory, Radboud University Medical Centre, PO Box 9101, 6500 HB Nijmegen, The Netherlands
- Laboratory for Biomechanical Engineering, University of Twente, Enschede, The Netherlands
S.A. Banks
- Department of Mechanical and Aerospace Engineering, University of Florida, 318 MAE-A, Mail Stop 116250, Gainesville, Florida 32611, USA

Received 7 April 2009; received in revised form 23 September 2009; accepted 24 September 2009. published online 30 October 2009.

Abstract

The aim of this study was to investigate anteroposterior instability in the CKS and the PFC total knee arthroplasty (TKA) designs. Physical examinations, including VAS, IKS and WOMAC were performed in combination with a detailed fluoroscopic measurement technique for three-dimensional kinematic assessment of TKA design function. Anteroposterior instability rated with the IKS was not significantly different (p=0.34), but patients with a CKS design showed more limitations according to the WOMAC joint stiffness total score, and for items regarding higher flexion activities in the WOMAC score for knee disability. Kinematic analyses showed that the CKS design tended to have more anterior sliding of the femur on the tibia during mid- and deep flexion activities. The sliding distance was larger at the medial than at the lateral side. This phenomenon has also been described for posterior cruciate ligament deficient knees. Furthermore, the CKS design showed a significantly lower range of tibial rotation (p<0.05) from maximum extension to maximum flexion during deep knee bend activities. Kinematic differences can be ascribed to posterior cruciate ligament deficiency/laxity or differences in TKA designs.