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Posterior stabilized total knee arthroplasty reproduces natural joint laxity compared to normal in kinematically aligned total knee arthroplasty: a matched pair cadaveric study

  • Knee Arthroplasty
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Abstract

Purpose

As the goal of kinematic aligned (KA) total knee arthroplasty (TKA) is to preserve soft tissue tension to the native knee, many KA surgeons recommend cruciate-retaining (CR) prosthesis. However, how a posterior-stabilizing (PS) prosthesis affects the biomechanics of a KA TKA remains unclear. This cadaveric study tested the hypothesis that a PS prosthesis in KA TKA would produce biomechanics similar to CR prosthesis and KA TKA with a PS prosthesis would produce more native knee biomechanics than mechanical aligned (MA) TKA with PA prosthesis.

Methods

Fourteen cadaver knees (7 pairs) were mounted on a knee-testing system to measure knee motion during flexion. For each pair, 1 knee was assigned to KA TKA and the other to MA TKA. In the KA TKA group, the native knee, CR TKA, and PS TKA were tested sequentially. MA TKA was performed using conventional measured resection techniques with a PS prosthesis. All kinematics were measured and compared with the native knee before and after surgery.

Results

A PS prosthesis restored femoral rollback similar to a CR prosthesis. CR TKA showed less lateral rollback at knee flexion ≤ 60° than the native knee. There were no differences in soft tissue tensions among the native knee, CR, and PS prosthesis, except in varus tension at 30° of flexion. Varus tension of CR TKA was larger than those of PS TKA and the native knee after KA TKA with < 1 degree difference. Meanwhile, KA TKA achieved knee motion that was closer to the native knee than did MA TKA at ≥ 60° of flexion when using a PS prosthesis. There were no differences in soft tissue tension between KA-PS and MA-PS TKA.

Conclusions

After KA TKA, a PS prosthesis affords similar femoral rollback and soft tissue tension when compared with a CR prosthesis. A PS TKA may be a feasible strategy for patients requiring a PS prosthesis when performing KA TKA.

Level of evidence

Therapeutic Laboratory study, I.

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Acknowledgements

The authors wish to acknowledge the financial support of the Catholic Medical Center Research Foundation made in the program year of 2019 and partial funding provided by Veterans Affairs Rehabilitation Research and Development Merit Review and the John C. Griswold Foundation. All implants and surgical instruments were donated by Corentec Co. Ltd (Seoul, Republic of Korea). We thank Il Jung Park MD, PhD of Bucheon St. Mary’s Hospital, Republic of Korea, Ji Hyun Ahn MD, PhD of Dongguk University Ilsan Hospital, Republic of Korea, Mauro Maniglio MD of Inselspital Bern, Switzerland, Nilay A. Patel, MD of University of California, Irvine, USA and Adam Kantor BA, of the Orthopedic Biomechanical Laboratory, USA for assistance in testing. We also thank the donors and their families.

Funding

This study was funded by the Catholic Medical Center Research Foundation made in the program year of 2019. (No. 5-2018-B0001-00247).

Author information

Authors and Affiliations

  1. Joint Replacement Center, Eunpyeong St. Mary’s Hospital, Seoul, 03312, Republic of Korea

    In Jun Koh & Soo Bin Park

  2. Department of Orthopaedic Surgery, College of Medicine, The Catholic University of Korea, 1021, Tongil-ro, Eunpyeong-gu, Seoul, 06591, Republic of Korea

    In Jun Koh

  3. School of Medicine, University of California, Irvine, Irvine, CA, 92697, USA

    Christen E. Chalmers

  4. Department of Orthopaedic Surgery, NYU Langone Orthopedic Hospital, NY 301 East 17th Street, New York, NY, 10003, USA

    Charles C. Lin

  5. Orthopaedic Biomechanics Laboratory, Congress Medical Foundation, 800 South Raymond Avenue, Pasadena, CA, 91105, USA

    Michelle H. McGarry & Thay Q. Lee

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  1. In Jun Koh
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Corresponding author

Correspondence to In Jun Koh.

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Conflict of interest

On behalf of all authors, the corresponding authors identify the following possible conflict of interest: Corentec Co. Ltd. donated all prostheses used in this study. The company had no input into the study design, or data collection or interpretation. The company was not involved in manuscript preparation or the decision to submit the article to this journal.

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Koh, I.J., Chalmers, C.E., Lin, C.C. et al. Posterior stabilized total knee arthroplasty reproduces natural joint laxity compared to normal in kinematically aligned total knee arthroplasty: a matched pair cadaveric study. Arch Orthop Trauma Surg 141, 119–127 (2021). https://doi.org/10.1007/s00402-020-03624-y

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