Posterior stabilized design of a new generation total knee arthroplasty shows wider medial pivoting compared to the cruciate retaining design during chair raising
ESSKA Academy. Zaffagnini S. Nov 8, 2019; 284389; epEKA-58 Topic: Joint Replacement
Prof. Dr. Stefano Zaffagnini
Prof. Dr. Stefano Zaffagnini
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Posterior stabilized design of a new generation total knee arthroplasty shows wider medial pivoting compared to the cruciate retaining design during chair raising

ePoster - epEKA-58

Topic: TKA

Bontempi M.1, Roberti Di Sarsina T.2, Marcheggiani Muccioli G.M.2, Pizza N.2, Cardinale U.1, Bragonzoni L.1, Zaffagnini S.2
1Università di Bologna, Bologna, Italy, 2IRCCS Istituto Ortopedico Rizzoli, II Orthopaedic and Traumatologic Clinic, Bologna, Italy

Introduction: Long debate is still ongoing to establish which TKA design represent the better solution to restore a correct knee biomechanics. The role of PCL and the level of constraint given by the polyethylene insert appear to be the most crucial topic. The aim of this study was to compare PS and CR design of the same TKA by the use of model-based dynamic RSA.
Objectives: The hypothesis was that the two designs influence differently in vivo knee kinematic.
Aims: Compare kinematics of TKAs design in order to understand the specific biomechanical behavior attempting to better understand the impact of the design on the clinical results.
Methods: A cohort of 16 randomly selected patients were recruited after signing an informed consent validated by Rizzoli Institute IRB and were prospectively evaluated at minimum 9 months after surgery. A new design TKA was implanted, 8 with CR design and 8 with PS design. The kinematic evaluations were performed using a Dynamic RSA developed in our Institute, during the execution of the sit-to-stand motor task.The motion parameters were obtained using the Grood and Suntay decomposition and the low-point kinematics methods.
Results: PS TKA lateral femoral compartment had a wider anterior translation (16.47 ± 0.2mm)than the medial one (10.73 ± 0.2mm), while the two compartments of CR TKA showed a similar anterior translation (medial: 9.51 ± 0.2mm/ lateral: 10.87± 0.2mm).
T-test for comparison between CR and PS TKA of AP translation showed a statistically significant difference (p< 0.05) in the flexion range between 15° and 40°. The CR prosthesis did not anteriorly translate during flexion. The PS design translated anteriorly showing a roll-forward mechanism during extension from 80° to 18° of flexion and a posterior translation from 18° to 0°.
The same significant differences (p< 0.05) between the PS and CR groups were found comparing the low-point positions of the femoral condyles in the range of flexion between 25° and 40° for the medial compartment and between 15° and 25° for the lateral compartment.
Conclusion: Dynamic RSA was able to compare the kinematic behaviour of two different TKA designs. PS TKA showed a medial-pivot during sit-to-stand motion task, while the CR TKA showed a cylindrical movement. The clinical relevance of the present study is that evaluating the biomechanics of different TKA designs, we could better understand the impact of the design on the clinical results and forecast pattern of long-term survivorship.
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