The biomechanical effect of tibiofemoral conformity design for patient-specific cruciate retainging total knee arthroplasty using computational simulation

Yong-Gon Koh,Kyoung-Tak Kang,Kyoung-Mi Park

doi:10.1186/s40634-019-0192-6

Yong-Gon Koh, Kyoung-Tak Kang + Show 1 more

Open Access

https://doi.org/10.1186/s40634-019-0192-6

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Abstract

BackgroundAlterations to normal knee kinematics performed during conventional total knee arthroplasty (TKA) focus on the nonanatomic articular surface. Patient-specific TKA was introduced to provide better normal knee kinematics than conventional TKA. However, no study on tibiofemoral conformity has been performed after patient-specific TKA. The purpose of this study was to compare the biomechanical effect of cruciate-retaining (CR) implants after patient-specific TKA and conventional TKA under gait and deep-knee-bend conditions.MethodsThe examples of patient-specific TKA were categorized into conforming patient-specific TKA, medial pivot patient-specific TKA and anatomy mimetic articular surface patient-specific TKA. We investigated kinematics and quadriceps force of three patient-specific TKA and conventional TKA using validated computational model. The femoral component designs in patient specific TKA were all identical.ResultsThe anatomy mimetic articular surface patient-specific TKA provided knee kinematics that was closer to normal than the others under the gait and deep-knee-bend conditions. However, the other two patient-specific TKA designs could not preserve the normal knee kinematics. In addition, the closest normal quadriceps force was found for the anatomic articular surface patient-specific TKA.ConclusionsOur results showed that the anatomy mimetic articular surface patient-specific TKA provided close-to-normal knee mechanics. Other clinical and biomechanical studies are required to determine whether anatomy mimetic articular surface patient-specific TKA restores more normal knee mechanics and provides improved patient satisfaction.

Highlights

Alterations to normal knee kinematics performed during conventional total knee arthroplasty (TKA) focus on the nonanatomic articular surface
We investigated the kinematics and quadriceps force to evaluate how effectively the generation of normal knee mechanics was achieved for different conformity after patient specific TKA compared to conventional TKA
The kinematics of the articular surface patient-specific TKA (APS TKA) design was visually closer to the normal AP and IE motions compared to the TKA devices implanted using the other designs

Summary

Introduction

Alterations to normal knee kinematics performed during conventional total knee arthroplasty (TKA) focus on the nonanatomic articular surface. Patient-specific TKA was introduced to provide better normal knee kinematics than conventional TKA. Current patientspecific related studies have only customized the femoral component of a patient’s anatomy, followed by conforming the design of the tibial insert to that femoral component (ConforMIS). These patient-specific TKA procedures have shown more normal femoral rollback in in-vitro study, but there has been no study that investigated the effect of the tibial articular surface in relation to the postoperative kinematics (Patil et al 2015)

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