Abstract
A new CR TKA design with concave medial and convex lateral tibial polyethylene bearing components was introduced recently to improve functional outcomes. This study aimed to investigate in-vivo articular contact kinematics in unilateral asymmetrical tibial polyethylene geometry CR TKA patients during strenuous knee flexion activities. Fifteen unilateral CR TKA patients (68.4 ± 5.8years; 6 male/9 female) were evaluated for both knees during sit-to-stand, single-leg deep lunges and step-ups using validated combined computer tomography and dual fluoroscopic imaging system. Medial and lateral condylar contact positions were quantified during weight-bearing flexion activities. The Wilcoxon signed-rank test was performed to determine if there is a significant difference in articular contact kinematics during strenuous flexion activities between CR TKA and the non-operated knees. Contact excursions of the lateral condyle in CR TKAs were significantly more anteriorly located than the contralateral non-operated knee during sit-to-stand (3.7 ± 4.8mm vs - 7.8 ± 4.3mm) and step-ups (- 1.5 ± 3.2mm vs - 6.3 ± 5.8mm). Contact excursions of the lateral condyle in CR TKAs were significantly less laterally located than the contralateral non-operated knee during sit-to-stand (21.4 ± 2.8mm vs 24.5 ± 4.7mm) and single-leg deep lunges (22.6 ± 4.4mm vs 26.2 ± 5.7mm, p < 0.05). Lateral condyle posterior rollback was not fully restored in CR TKA patients during sit-to-stand (9.8 ± 6.7mm vs 12.9 ± 8.3mm) and step-ups (8.1 ± 4.8mm vs 12.2 ± 6.4mm). Lateral pivoting patterns were observed in 80%, 73% and 69% of patients during sit-to-stand, step-ups and single-leg deep lunges respectively. Although lateral femoral rollback and lateral pivoting patterns were observed during strenuous functional daily activities, asymmetric contact kinematics still persisted in unilateral CR TKA patients. This suggests the specific investigated contemporary asymmetrical tibial polyethylene geometry CR TKA design evaluated in this study does not fully replicate healthy knee contact kinematics during strenuous functional daily activities. III.
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