Kinematic changes after bicondylar resurfacing knee arthroplasty

Abstract

Knee joint motion appears as a hinge movement around the flexion - extension axis. But corresponding to the rolling-sliding-mechanism and alternative models of knee joint kinematics an instant center pathway must be expected. Objective of the study was the comparison of this pathway when assessed in the sagittal plane in patients with preoperative varus or valgus deformity. A total of 40 patients either with varus or valgus deformity (20 in each group) were examined before and 6 months after implantation of PFC(R)-SIGMA prostheses. Apart from the influence of knee joint deformity (35 degrees varus to 24 degrees valgus), a so called soft tissue ratio was investigated. Therefore the relation of thigh and femur as well as lower limb and tibia diameters was calculated and combined in one value. The examination by means of photogrammetry consisted of a standardized chair with passive knee joint movement (90 degrees to 0 degrees flexion) supported by an electric motor. The position of defined skin markers was assessed by digital camara with online transmission to PC. The instant center pathway was then evaluated applying the Reuleaux-technique based on the changes of skin marker positions. Results showed a dependence of the course and dimension of the instant center pathway on the extent of soft tissue ratio as well as knee joint deformity. Small values of the ratio (W = 2.9) were represented by round or oval courses of the pathway whereas increasing ratios (W = 4.0) led to triangular and slightly increased dimensions of the courses. Varus deformitywas primarily combined with an increase of the pathways dimension and in contrast, valgus deformity showed decreased pathways. In each case, dimension normalized after prostheses implantation. The instant center pathway of knee joint motion showed for both patient groups characteristic phenomen. They were clearly combined with constitutional and clinical features of each patient.