Kinematics Of Total Knee Arthroplasty Research Articles

Clinical Results of Kinematic Total Knee Arthroplasty in Rheumatoid Arthritis

Clinical Results of Kinematic Total Knee Arthroplasty in Rheumatoid Arthritis

Correlation between preoperative and postoperative knee kinematics in total knee arthroplasty using cruciate retaining designs

The authors evaluated the relationships between preoperative and postoperative kinematics in 50 osteoarthritic knees scheduled for cruciate retaining total knee arthroplasty with regards to posterior femoral roll back and external femoral rotation using a navigation system from 10° to 120° of knee flexion. Although posterior femoral roll back was maintained, external femoral rotation was significantly decreased compared to those of the preoperative knee after total knee arthroplasty. However, the amount of posterior roll back and external femoral rotation after total knee arthroplasty were found to be significantly positively related to those measured preoperatively (r = 0.62 and 0.57, respectively). These significant kinematic correlations may explain why preoperative range of knee motion influences range of motion after total knee arthroplasty.

Can Patellar Tendon Angle reveal sagittal kinematics in total knee arthroplasty?

The Patellar Tendon Angle is strongly correlated with both patello-femoral and tibio-femoral joint kinematics. Thus, the Patellar Tendon Angle might be regarded as a concise indicator of the antero-posterior translation of the femur with respect to the tibia. Twelve subjects, who had undergone total knee arthroplasty, were investigated by video-fluoroscopy during step-up/down. The kinematics at the replaced knee was reconstructed by means of 3D fluoroscopy. The Patellar Tendon Angle and the knee-flexion angle were measured on sagittal fluoroscopic images with software designed for the purpose. The slope of the linear trend of the Patellar Tendon Angle versus knee-flexion angle relationship correlated significantly with the mean (p = 0.001), most anterior (p = 0.001), and most posterior (p = 0.016) position reached by the femur over the tibia. The Patellar Tendon Angle versus knee-flexion angle relationship provides relevant information about the anterior or posterior positioning of the femur over the tibia, but it cannot be interpreted as quantification of the actual antero-posterior translation of the femur over the tibia.

Assessment of the Radii of the Medial and Lateral Femoral Condyles in Varus and Valgus Knees with Osteoarthritis

Understanding the relationship between the radii of the medial and lateral femoral condyles in varus and valgus knees is important for aligning the femoral component and for restoring kinematics in total knee arthroplasty. The purpose of this study was to test the hypothesis that the asymmetry between the radii of the medial and lateral femoral condyles in varus and valgus knees with osteoarthritis is small enough to be clinically unimportant. A magnetic resonance imaging scan was obtained with use of a biplanar, rotational alignment protocol in a consecutive series of subjects with end-stage osteoarthritis prior to total knee arthroplasty. The alignment protocol oriented the scanning plane so that both condyles were imaged in a plane perpendicular to the primary femoral axis of the knee about which the tibia flexes and extends. The study included 155 varus knees and forty-four valgus knees. Radii were calculated from the area of the best-fit circle overlaid from 10 degrees to 160 degrees on the subchondral corticocancellous bone interface of the medial and lateral femoral condyles. The radius of a condyle was the average of the radii on four adjacent images that showed the femoral condyle with the largest curvature. In the 155 varus knees, the radius of the lateral condyle was an average of 0.1 mm larger than that of the medial condyle (p = 0.003). In the forty-four valgus knees, the radius of the lateral condyle was an average of 0.2 mm larger than that of the medial condyle (p < 0.006). There was a strong association between the radii of the medial and lateral femoral condyles in both the varus (r(2) = 0.9210) and the valgus (r(2) = 0.9129) knees. As determined by imaging of the femoral condyles perpendicular to the primary femoral axis of the knee, the asymmetry between the radii of the medial and lateral femoral condyles in varus and valgus knees with end-stage osteoarthritis was < or =0.2 mm, which is small enough to be considered clinically unimportant when aligning a total knee prosthesis.

Accuracy of soft tissue balancing in TKA: comparison between navigation-assisted gap balancing and conventional measured resection

Equalized rectangular extension and flexion gaps are considered desirable to ensure proper kinematics in total knee arthroplasty (TKA). We compared soft tissue balancing in TKAs performed using navigation-assisted gap-balancing (60 knees) and conventional measured resection (56 knees). The outlier of soft tissue balancing was defined as a gap difference >3 mm between the medial and lateral sides in 90 degrees flexion and extension. Medial or lateral outliers in extension or flexion were observed in 12% (7 of 60) navigation TKAs and 25% (14 of 56) conventional TKAs (p = 0.028). There were more outliers in flexion-extension gap difference on the medial side in the conventional (23%) than in the navigation-assisted (5%) group (p = 0.025). However, the proportion of flexion gap difference, extension gap difference, and lateral gap difference outliers did not differ significantly between the two groups (n.s.). Additionally, clinicoradiologic outcomes were similar for the two groups except for the postoperative mechanical axis outlier (p = 0.012). Navigation-assisted soft tissue balancing in TKA reduced not only the postoperative alignment outlier, but also the medial gap difference and achieved a more rectangular flexion and extension gap compared with conventional TKA.

Kinematics of a cementless mobile bearing posterior cruciate ligament-retaining total knee arthroplasty

Mobile bearing (MB) total knee arthroplasty (TKA) was developed to provide low contact stress and unconstrained joint motion. We studied a consecutive series of 41 knees with mobile-bearing, posterior cruciate-retaining (CR) TKAs to determine if kinematics resembled normal knees or if kinematics changed over time. Patients were studied at 3 and 21 months average follow-up with weight-bearing radiographs at full extension, 30° flexion and maximum flexion. Shape-matching techniques were used to measure TKA kinematics. Implant hyperextension, maximum flexion and total ROM increased with follow-up. Tibial rotation and condylar translations did not change with time. The medial condyle did not translate from extension to 30°, but translated 5 mm anteriorly from 30° to maximum flexion. Lateral condylar translation was 3 mm posterior from extension to 30°, with no translation from 30° to maximum flexion. Tibiofemoral kinematics in CR-MB-TKAs were stable over time, but did not replicate motions observed in healthy knees. The mobile tibial insert showed rotation and translation at both follow-up examinations, but the patterns of translation were not predictable.

The Influence of Contemporary Knee Design on High Flexion: A Kinematic Comparison with the Normal Knee

Although >90% of total knee arthroplasties are associated with a good-to-excellent outcome, some patients have difficulty adjusting their gait to accommodate the new articulations inherent in contemporary implant designs. Paradoxical motions inclusive of anterior sliding and lateral pivot are examples of aberrant kinematics in total knee arthroplasty. A computational kinematic simulator measured the motion attained by six contemporary total knee arthroplasty designs. Results were compared with the in vivo kinematic data from healthy knees (i.e., knees with no history of surgery) in deep flexion1. Three designs employing a tibial post and a femoral cam as the motion control mechanism were evaluated, including the Legacy LPS-Flex Fixed Bearing (Zimmer, Warsaw, Indiana), the Journey (Smith and Nephew, Memphis, Tennessee), and the Vanguard PS (Biomet, Warsaw, Indiana). Three designs that did not employ a tibial post and femoral cam mechanism were also evaluated, including the MRK (Finsbury, Leatherhead, United Kingdom), the Duracon (Stryker Orthopaedics, Mahwah, New Jersey), and the Triathlon (Stryker Orthopaedics). All six designs have a fixed plateau and are currently available for clinical use in the United States. LifeMOD/KneeSIM (LifeModeler, San Clemente, California), a dynamic, validated musculoskeletal modeling system, was utilized in this study. KneeSIM provides a musculoskeletal modeling environment of the left leg of a nominal-size patient in which activities such as walking gait, lunge, stair ascent and descent, and deep-knee bend may be simulated. Activities are propelled by muscle forces and constrained by the soft tissues. Solid models of scanned geometries of the total knee arthroplasty component are arranged in the joint space to reflect a successful virtual surgery (Fig. 1). A specified activity is then simulated, and animations and plots of component and soft-tissue positions, forces, and moments are generated. Factors influencing kinematic function and stability of the knee joint, including surgical technique, component placement and …

Sagittal Laxity After Posterior Cruciate Ligament-Retaining Mobile-Bearing Total Knee Arthroplasty

Posterior cruciate ligament stretching after posterior cruciate ligament-retaining (CR) total knee arthroplasty (TKA) can lead to an increase in sagittal laxity, knee dysfunction, or accelerated damage to the tibial bearing surface. We conducted a prospective study on 74 consecutive mobile-bearing CR TKA to determine if knee laxity changed with time or if knees with large initial laxity experienced greater increases in laxity. Patients were studied with radiographic posterior and anterior drawer examinations at 3 and 23 months. Model-based shape-matching techniques were used to measure TKA kinematics. We found a 1-mm increase in posterior drawer. Knees with large postoperative drawers did not exhibit increased laxity at last follow-up. The use of a mobile-bearing CR TKA did not significantly modify the midterm knee sagittal laxity.

Knee rotation during a weightbearing activity: Influence of turning

Kinematic studies, in which mobile- and fixed-bearing total knee arthroplasty (TKA) were compared, showed controversial results with respect to axial femorotibial rotation. However, all studies focused only on straight ahead tasks, which may underestimate possible differences in freedom of rotation. The purpose of this study was to investigate the influence of turning on normal axial knee rotation. If large differences across tasks were to be found, this would support the use of this task in the evaluation of in-vivo TKA kinematics. In 15 healthy persons, crossover and sidestep turns were added to a standardized chair rise. Three-dimensional knee angles were recorded using an optoelectronic motion analysis system, and a noninvasive epicondylar frame was developed to track the femur. Compared to knee rotation during the straight ahead task, average peak tibial internal rotation increased during a crossover turn ( p < 0.001), as did peak external tibia rotation during a sidestep turn ( p < 0.001). The combined range of axial rotation for both turning tasks together was 20.9°, versus 13.5° for the straight ahead task ( p < 0.001). The turning maneuvers in this study induced a large range of axial knee rotation, so they could be important in studies comparing freedom of rotation in mobile- and fixed-bearing TKA.

Intraoperative vs. weightbearing patellar kinematics in total knee arthroplasty: A cadaveric study

During knee replacement surgery, surgeons optimize intraoperative patellar tracking with the aim of optimizing postoperative tracking. This link has not been investigated to date. Our research questions were: (1) How well do patellar kinematics correlate between passive and weightbearing flexion across numerous changes in component placement? (2) How do the kinematics differ between the two loading configurations? Eight cadaveric knee joints with modified knee components that allowed 11 different femoral, tibial and patellar placements were tested in two experimental rigs simulating intraoperative and weightbearing dynamic flexion. Baseline placement had all components in neutral position. Pearson correlation coefficients were calculated for absolute baseline kinematics and for relative kinematics due to changes in component position (i.e., the 10 altered positions vs. baseline). Correlations between intraoperative and weightbearing rigs for absolute baseline kinematics were unpredictable, ranging from poor to excellent (mean 0.56 for tilt and mean 0.50 for shift). Correlations between rigs for changes in tilt and shift, i.e. relative kinematics, were strong (>0.8) or very strong (>0.9), with the exception of shift in early flexion (0.54). Differences in relative kinematics, which averaged 2.2 degrees in tilt (standard deviation 1.8 degrees ) and 1.6mm in shift (standard deviation 1.7mm), were notably smaller and less variable than differences in absolute kinematics, which averaged 4.2 degrees in tilt (standard deviation 3.6 degrees ) and 4.3mm in shift (standard deviation 3.9mm). The results of this study suggest that, while absolute kinematics may differ between conditions, if a surgeon adjusts a component position to improve patellar kinematics intraoperatively, the effects of such a geometric change will likely carry through to the postoperative joint.

In Vivo Determination of Total Knee Arthroplasty Kinematics: A Multicenter Analysis of an Asymmetrical Posterior Cruciate Retaining Total Knee Arthroplasty

The objective of this study was to determine if consistent posterior femoral rollback of an asymmetrical posterior cruciate retaining (PCR) total knee arthroplasty was mostly influenced by the implant design, surgical technique, or presence of a well-functioning posterior cruciate ligament (PCL). Three-dimensional femorotibial kinematics was determined for 80 subjects implanted by 3 surgeons, and each subject was evaluated under fluoroscopic surveillance during a deep knee bend. All subjects in this present study having an intact PCL had a well-functioning PCR knee and experienced normal kinematic patterns, although less in magnitude than the normal knee. In addition, a surprising finding was that, on average, subjects without a PCL still achieved posterior femoral rollback from full extension to maximum knee flexion. The findings in this study revealed that implant design did contribute to the normal kinematics demonstrated by subjects having this asymmetrical PCR total knee arthroplasty.

Effect of increased posterior tibial slope or partial posterior cruciate ligament release on knee kinematics of total knee arthroplasty

To compare the effects of increased posterior tibial slope or partial posterior cruciate ligament (PCL) release on knee kinematics of total knee arthroplasty (TKA). Anteroposterior laxity, rotational laxity, varus and valgus laxity and maximum flexion angle were evaluated in 6 normal cadaver knees and the knees after TKA at flexion 0 degrees , 30 degrees , 60 degrees , 90 degrees and 120 degrees . Then the femoral prosthesis was shifted 5 mm posteriorly to simulate the tightly implanted knee. The same tests were performed on the tightly implanted knees. After that, the posterior tibial slope was increased 4 degrees or the PCL was partially released, and the same tests were made as in the normal knees respectively. Statistical analysis of the results was made using student's t test. Anteroposterior laxity, rotational laxity and varus and valgus laxity of the tightly implanted knees at flexion 30 degrees , 60 degrees , 90 degrees and 120 degrees were significantly less than those of the normal TKA knees (P < 0.05). Compared with the tightly implanted knees, anteroposterior laxity, rotational laxity and varus and valgus laxity at flexion 30 degrees , 60 degrees , 90 degrees and 120 degrees significantly improved after increased 4 degrees posterior tibial slope (P < 0.05); in the partial PCL released group, anteroposterior laxity at flexion 30 degrees , 60 degrees , 90 degrees and 120 degrees was significantly improved (P < 0.05), varus and valgus laxity was significantly improved only at flexion 90 degrees (P < 0.05), and rotational laxity was significantly improved at flexion 30 degrees , 60 degrees and 90 degrees (P < 0.05). Compared with PCL released group, varus and valgus laxity at flexion 30 degrees , 60 degrees and 90 degrees and rotational laxity at flexion 0 degrees , 30 degrees , 60 degrees and 90 degrees were significantly improved in the group of increased 4 degrees posterior tibial slope (P < 0.05). Maximum flexion angle of the tightly implanted knee (120.4 degrees ) was less than that of the normal TKA knees (130.3 degrees , P < 0.05) and that of increased 4 degrees posterior tibial slope group (131.1 degrees , P < 0.05). There was no significant difference at the maximum flexion angle between the increased 4 degrees posterior tibial slope group and the PCL released group (131.1 degrees vs 124.0 degrees , P = 0.0816). Anteroposterior laxity, varus and valgus laxity, rotational laxity and maximum flexion angle of the tightly implanted knees are less than those of the normal TKA knees. After increased 4 degrees posterior tibial slope, these indexes are improved significantly. Partial PCL released can significantly improve the anteroposterior laxity and had less effect on the varus and valgus laxity, rotational laxity and maximum flexion angle. So, a knee that is tight in flexion can be more likely to be corrected by increasing posterior tibial slope than by partially releasing PCL.

Influence of intra-operative joint gap on post-operative flexion angle in osteoarthritis patients undergoing posterior-stabilized total knee arthroplasty

Recently, we developed a new tensor for total knee arthroplasty (TKA) procedures enabling soft tissue balance assessment throughout the range of motion while reproducing post-operative joint alignment with the patello-femoral (PF) joint reduced and the tibiofemoral joint aligned. Using the tensor with a computer-assisted navigation system, we investigated the relationship between various intra-operative joint gap values and their post-operative flexion angles. An increased value during the extension to flexion gap and a decreased value during the flexion to deep flexion gap with PF joint reduced, not everted, showed an inverse correlation with post-operative knee flexion angle, not pre-operative flexion angle. In conclusion, understanding the characteristics of joint gap kinematics in posterior-stabilized TKA under physiological and reproducible joint conditions may enable the prediction of the post-operative flexion angle and help to determine the appropriate intra-operative joint gap.

A new in vivo technique for determination of femoro-tibial and femoro-patellar 3D kinematics in total knee arthroplasty

Aim was to develop an in vivo technique which allows determination of femoro-tibial and of femoro-patellar 3D-kinematics in TKA simultaneously. The knees of 20 healthy volunteers and of eight patients with TKA (PCR, rotating platform) were investigated. Kinematics analysis was performed in an open MR-system at different flexion angles with external loads being applied. The TKA components were identified using a 3D-fitting technique, which allows an automated 3D-3D-registration of the TKA. Femoro-patellar and femoro-tibial 3D-kinematics were analyzed by image postprocessing. The validity of the postprocessing technique demonstrated a coefficient of determination of 0.98 for translation and of 0.97 for rotation. The reproducibility yielded a coefficient of variation (CV%) for patella kinematics between 0.17% (patello-femoral angle) and 6.8% (patella tilt). The femoro-tibial displacement also showed a high reproducibility with CV% of 4.0% for translation and of 7.1% for rotation. While in the healthy knees the typical screw-home mechanism was observed, a paradoxical anterior translation of the femur relative to the tibia combined with an external rotation occurred after TKA. Fifty percent of the TKA's experienced a condylar lift-off of >1 mm predominately on the medial side. Regarding patellar kinematics significant changes were found in both planes in TKA with an increased patella height in the sagittal plane and patella tilt and shift in the transversal plane. The results demonstrate that the presented 3D MR-open based method is highly reproducible and valid for image acquisition and postprocessing and provides—for the first time—in vivo data of 3D-kinematics of the tibio-femoral and simultaneously of the patello-femoral joint during knee flexion.

Joint Gap Kinematics in Posterior-Stabilized Total Knee Arthroplasty Measured by a New Tensor With the Navigation System

The management of soft tissue balance during surgery is essential for the success of total knee arthroplasty (TKA) but remains difficult, leaving it much to the surgeon's feel. Previous assessments for soft tissue balance have been performed under unphysiological joint conditions, with patellar eversion and without the prosthesis only at extension and 90 deg of flexion. We therefore developed a new tensor for TKA procedures, enabling soft tissue balance assessment throughout the range of motion while reproducing postoperative joint alignment with the patellofemoral (PF) joint reduced and the tibiofemoral joint aligned. Our purpose in the present study was to clarify joint gap kinematics using the tensor with the CT-free computer assisted navigation system. Joint gap kinematics, defined as joint gap change during knee motion, was evaluated during 30 consecutive, primary posterior-stabilized (PS) TKA with the navigation system in 30 osteoarthritic patients. Measurements were performed using a newly developed tensor, which enabled the measurement of the joint gap throughout the range of motion, including the joint conditions relevant after TKA with PF joint reduced and trial femoral component in place. Joint gap was assessed by the tensor at full extension, 5 deg, 10 deg, 15 deg, 30 deg, 45 deg, 60 deg, 90 deg, and 135 deg of flexion with the patella both everted and reduced. The navigation system was used to obtain the accuracy of implantations and to measure an accurate flexion angle of the knee during the intraoperative joint gap measurement. Results showed that the joint gap varied depending on the knee flexion angle. Joint gap showed an accelerated decrease during full knee extension. With the PF joint everted, the joint gap increased throughout knee flexion. In contrast, the joint gap with the PF joint reduced increased with knee flexion but decreased after 60 deg of flexion. We clarified the characteristics of joint gap kinematics in PS TKA under physiological and reproducible joint conditions. Our findings can provide useful information for prosthetic design and selection and allow evaluation of surgical technique throughout the range of knee motion that may lead to consistent clinical outcomes after TKA.

Three-dimensional kinematics and kinetics of total knee arthroplasty during level walking using single plane video-fluoroscopy and force plates: A pilot study

The goal of the study was to simultaneously obtain accurate kinematic and kinetic data from a total knee arthroplasty (TKA) during level walking, by coupling force plate data with the kinematics of TKA measured by a movable video-fluoroscopic system. Kinematic and kinetic information of a TKA is crucial for the improvement of implant designs and for the increased longevity of the implant components. Instrumented gait analysis, with skin mounted marker tracking and force plates, is a well-established method for the acquisition of kinematic and kinetic data of TKA in vivo and for non-invasive estimation of joint function. However, resultant moments at the knee joint are inaccurate with this method, due to skin movement artifacts. Video-fluoroscopy reduces these inaccuracies by means of the direct tracking of the implant components with X-ray. However this measuring technique carries disadvantages: it provides only kinematic data, and the image intensifier covers a limited field of view. This paper presents a newly developed measuring technique, which enables a more accurate resultant moments calculation for level walking than could be achieved by conventional instrumented gait analysis.

An Optimized Image Matching Method for Determining In-Vivo TKA Kinematics with a Dual-Orthogonal Fluoroscopic Imaging System

This study presents an optimized matching algorithm for a dual-orthogonal fluoroscopic image system used to determine six degrees-of-freedom total knee arthroplasty (TKA) kinematics in-vivo. The algorithm was evaluated using controlled conditions and standard geometries. Results of the validation demonstrate the algorithm's robustness and capability of realizing a pose from a variety of initial poses. Under idealized conditions, poses of a TKA system were recreated to within 0.02+/-0.01 mm and 0.02+/-0.03 deg for the femoral component and 0.07+/-0.09 mm and 0.16+/-0.18 deg for the tibial component. By employing a standardized geometry with spheres, the translational accuracy and repeatability under actual conditions was found to be 0.01+/-0.06 mm. Application of the optimized matching algorithm to a TKA patient showed that the pose of in-vivo TKA components can be repeatedly located, with standard deviations less than +/-0.12 mm and +/-0.12 deg for the femoral component and +/-0.29 mm and +/-0.25 deg for the tibial component. This methodology presents a useful tool that can be readily applied to the investigation of in-vivo motion of TKA kinematics.

Magnetic resonance imaging of in vivo kinematics after total knee arthroplasty

To improve the quality of magnetic resonance imaging (MRI) on knees after total knee arthroplasty (TKA) by minimizing image artifacts caused by metallic implants, and to establish a method determining in vivo kinematics of TKA knees using MRI. Two knee implants made of cobalt-chrome and oxidized zirconium were tested with different pulse sequences and imaging parameters. Then, in vivo kinematic MRI was performed on five well-functioning TKAs under simulated weight-bearing conditions. Kinematic measurements were made and a linear correlation test was run between the tibio- and patellofemoral measurements. The best images with minimum metallic artifacts were observed using oxidized zirconium implants, a fast spin echo sequence (FSE), thin slice thickness, and high readout gradient. TKA kinematics exhibited a large deviation from the normal kinematics and considerable patient-to-patient variability. However, significant linear correlations between tibiofemoral and patellofemoral kinematics were observed (R = -0.96, 0.92, 0.88). Metallic artifacts due to orthopedic implants can be reduced in MR images for some materials, appropriate pulse sequence, and imaging parameters selection, enabling MR quantification of knee kinematics. Tibiofemoral kinematics appears to affect patellofemoral position after total knee arthroplasty.

Correlation of compartment pressure data from an intraoperative sensing device with postoperative fluoroscopic kinematic results in TKA patients

Fluoroscopy has recently been used to analyze postoperative kinematics in total knee arthroplasty (TKA). These analyses have reported varying results even in patients with similar implant design. In addition, patterns of wear in retrieved tibial polyethylene inserts of similar design have been found to vary substantially. These findings suggest that surgical technique, especially soft tissue balancing, may play a role in postoperative kinematics and implant failure. Accurate soft-tissue balancing is hypothesized to result in similar pressures within the medial and lateral compartments of the knee. However, a method of easily measuring these pressures at TKA has not been developed. In the present study, 32 patients were implanted with a mobile-bearing LCS TKA utilizing the balanced gap technique. An electronic pressure sensor, developed specifically to record pressure magnitude and distribution in the medial and lateral compartments, was incorporated into the implant trials. The knee was then passively taken through a range of motion while pressure data was recorded via computer. Postoperatively, 16 patients underwent active fluoroscopic kinematic analysis to assess for condylar liftoff and femorotibial translation. We found that abnormal compartment pressures and distributions as recorded by the intraoperative pressure sensor were correlated with inappropriate or paradoxical postoperative kinematics. In addition, subjects having similar pressures in both compartments throughout a range of motion did not experience condylar liftoff values greater than 1.0 mm. These data suggest that surgical technique influences the magnitude and distribution of forces at the articulation, postoperative kinematics, and likely, implant longevity.

15-year follow-up study of total knee arthroplasty in patients with rheumatoid arthritis

In 25 patients with rheumatoid arthritis, 36 cases of cemented Kinematic total knee arthroplasty were reviewed clinically and radiographically at 13 to 19 years after surgery. The mean age at the time of surgery was 51.6 ± 8.9 years. According to the follow-up results evaluated with the Hospital for Special Surgery knee scoring system, 28 knees (77.7%) were classified as good or excellent. The mean flexion angle at follow-up evaluation was 99° ± 24° (10°–140°). At the tibial or femoral bone-cement interfaces, a radiolucent line was seen in 10 of 36 knees (27.8%) at follow-up evaluation. The survival rate of prostheses with revision as the endpoint was estimated to be 93.7% at 15 years. Kinematic total knee arthroplasty in rheumatoid arthritis patients provided a good long-term outcome.