Research Article| Volume 27, ISSUE 8, P1460-1468.e1, September 2012

Assessment of a Medial Pivot Total Knee Arthroplasty Design in a Cadaveric Knee Extension Test Model


      A total knee has been designed to mimic less-compliant medial and more-compliant lateral behavior. In vivo testing compared open-kinematic chain behaviors of cadaver knees in their normal state and after implantation of the knee prosthesis. Specimen's limbs were computed tomography scanned, and infrared arrays on tibia and femur were registered to bone markers. Motion of the joint and quadriceps force were reported from 90° flexion to full extension. Less medial and more lateral anterior-posterior motion was seen in both the intact and the implanted knees. Tibiofemoral rotation and translation were similar in direction but were reduced in magnitude for the prosthetic knees. Quadriceps force, defined as that applied force required to extend the knee, required after implantation was variable between specimens but not statistically different from the intact condition. The prosthesis tested exhibits kinematic behavior similar to that in their normal state, with no difference in quadriceps force required for extension.


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        • Blaha J.D.
        A medial pivot geometry.
        Orthopedics. 2002; : 963
        • Freeman M.A.
        • Pinskerova V.
        The movement of the knee studied by magnetic resonance imaging.
        Clin Orthop Relat Res. 2003; : 35
        • Komistek R.D.
        • Dennis D.A.
        • Mahfouz M.
        In vivo fluoroscopic analysis of the normal human knee.
        Clin Orthop Relat Res. 2003; : 69
        • Ahmed A.M.
        • Burke D.L.
        • Hyder A.
        Force analysis of the patellar mechanism.
        J Orthop Res. 1987; : 69
        • Grood E.S.
        • Suntay W.J.
        • Noyes F.R.
        • et al.
        Biomechanics of the knee-extension exercise. Effect of cutting the anterior cruciate ligament.
        J Bone Joint Surg Am. 1984; : 725
        • Kaufer H.
        Mechanical function of the patella.
        J Bone Joint Surg Am. 1971; : 1551
        • Mahoney O.M.
        • McClung C.D.
        • dela Rosa M.A.
        • et al.
        The effect of total knee arthroplasty design on extensor mechanism function.
        J Arthroplasty. 2002; : 416
        • Dunbar MJ
        • Amirault JD
        • Gross M
        • et al.
        Migration of medial-pivot and posterior stabilized knee implants.
        in: Paper presented at: 73rd Annual Meeting of the AAOS; New Orleans, LA2006
        • Karachalios T.
        • Roidis N.
        • Giotikas D.
        • et al.
        A mid-term clinical outcome study of the Advance Medial Pivot knee arthroplasty.
        Knee. 2009; : 484
        • Minoda Y.
        • Kobayashi A.
        • Iwaki H.
        • et al.
        Polyethylene wear particles in synovial fluid after total knee arthroplasty.
        Clin Orthop Relat Res. 2003; : 165
        • Pritchett J.W.
        Patient preferences in knee prostheses.
        J Bone Joint Surg Br. 2004; : 979
        • Schmidt R.
        • Komistek R.D.
        • Blaha J.D.
        • et al.
        Fluoroscopic analyses of cruciate-retaining and medial pivot knee implants.
        Clin Orthop Relat Res. 2003; : 139
        • Shakespeare D.
        • Ledger M.
        • Kinzel V.
        Flexion after total knee replacement. A comparison between the Medial Pivot knee and a posterior stabilised implant.
        Knee. 2006; : 371
        • Blaha J.D.
        • Mancinelli C.A.
        • Simons W.H.
        • et al.
        Kinematics of the human knee using an open chain cadaver model.
        Clin Orthop Relat Res. 2003; : 25
        • Yoshioka Y.
        • Siu D.
        • Cooke T.D.
        The anatomy and functional axes of the femur.
        J Bone Joint Surg Am. 1987; : 873
        • Yoshioka Y.
        • Siu D.W.
        • Scudamore R.A.
        • et al.
        Tibial anatomy and functional axes.
        J Orthop Res. 1989; : 132
        • Feinstein W.K.
        • Noble P.C.
        • Kamaric E.
        • et al.
        Anatomic alignment of the patellar groove.
        Clin Orthop Relat Res. 1996; : 64
        • Grelsamer R.P.
        • Dubey A.
        • Weinstein C.H.
        Men and women have similar Q angles: a clinical and trigonometric evaluation.
        J Bone Joint Surg Br. 2005; : 1498
        • Lee S.
        • Fichtinger G.
        • Chirikjian G.S.
        Numerical algorithms for spatial registration of line fiducials from cross-sectional images.
        Med Phys. 2002; : 1881
        • Grood E.S.
        • Suntay W.J.
        A joint coordinate system for the clinical description of three dimensional motions: application to the knee.
        J Biomech Eng. 1983; : 136
        • Iwaki H.
        • Pinskerova V.
        • Freeman M.A.
        Tibiofemoralmovement1: the shapes and relative movements of the femur and tibia in the unloaded cadaver knee.
        J Bone Joint Surg Br. 2000; : 1189
        • Hill P.F.
        • Vedi V.
        • Williams A.
        • et al.
        Tibiofemoralmovement2: the loaded and unloaded living knee studied by MRI.
        J Bone Joint Surg Br. 2000; : 1196
        • Dennis D.A.
        • Komistek R.D.
        • Mahfouz M.R.
        • et al.
        Multicenter determination of in vivo kinematics after total knee arthroplasty.
        Clin Orthop Relat Res. 2003; : 37
        • Walker P.S.
        • Heller Y.
        • Cleary D.J.
        • et al.
        Preclinical evaluation method for total knees designed to restore normal knee mechanics.
        J Arthroplasty. 2011; : 152
        • Bartel D.L.
        • Bicknell V.L.
        • Wright T.M.
        The effect of conformity, thickness, and material on stresses in ultra-high molecular weight components for total joint replacement.
        J Bone Joint Surg Am. 1986; : 1041
        • Yildirim G.
        • Walker P.S.
        • Boyer J.
        Total knees designed for normal kinematics evaluated in an up-and-down crouching machine.
        J Orthop Res. 2009; : 1022
        • Bull A.M.
        • Kessler O.
        • Alam M.
        • et al.
        Changes in knee kinematics reflect the articular geometry after arthroplasty.
        Clin Orthop Relat Res. 2008; : 2491
        • Victor J.
        • Labey L.
        • Wong P.
        • et al.
        The influence of muscle load on tibiofemoral knee kinematics.
        J Orthop Res. 2010; : 419
        • Hollman J.H.
        • Deusinger R.H.
        • Van Dillen L.R.
        • et al.
        Gender differences in surface rolling and gliding kinematics of the knee.
        Clin Orthop Relat Res. 2003; : 208
        • Kvist J.
        • Gillquist J.
        Sagittal plane knee translation and electromyographic activity during closed and open kinetic chain exercises in anterior cruciate ligament-deficient patients and control subjects.
        Am J Sports Med. 2001; : 72
        • Wilk K.E.
        • Escamilla R.F.
        • Fleisig G.S.
        • et al.
        A comparison of tibiofemoral joint forces and electromyographic activity during open and closed kinetic chain exercises.
        Am J Sports Med. 1996; : 518
        • Varadarajan K.M.
        • Harry R.E.
        • Johnson T.
        • et al.
        Can in vitro systems capture the characteristic differences between the flexion-extension kinematics of the healthy and TKA knee?.
        Med Eng Phys. 2009; : 899
        • Okamoto N.
        • Breslauer L.
        • Hedley A.K.
        • et al.
        In vivo knee kinematics in patients with bilateral total knee arthroplasty of 2 designs.
        J Arthroplasty. 2011; : 914
        • Barnes C.L.
        • Sharma A.
        • Blaha J.D.
        • et al.
        Kneeling is safe for patients implanted with medial pivot total knee arthroplasty designs.
        J Arthroplasty. 2011; : 549
        • Goodfellow J.
        • O'Connor J.
        The mechanics of the knee and prosthesis design.
        J Bone Joint Surg Br. 1978; : 358
        • Dennis D.A.
        • Mahfouz M.R.
        • Komistek R.D.
        • et al.
        In vivo determination of normal and anterior cruciate ligament-deficient knee kinematics.
        J Biomech. 2005; : 241