Knee kinematics are not different between asymmetrical and symmetrical tibial baseplates in total knee arthroplasty: A fluoroscopic analysis of step‐up and lunge motions

Abstract

AbstractPurposeThis clinical fluoroscopy study investigated knee kinematics of two different cemented fixed‐bearing, posterior‐stabilised (PS) total knee arthroplasty (TKA) designs: an asymmetric tibial component including an asymmetric insert designed to optimise personalised balance and fit and its precursor symmetrical design with symmetric insert.MethodsA consecutive series of patients (16 TKAs from each treatment group) participating in a randomised controlled trial comparing TKA migration was included. The exclusion criterion was the use of walking aids. Flat‐panel fluoroscopic recordings of step‐up and lunge motions were acquired 1‐year postoperatively. Medial and lateral contact points (CPs) were determined to calculate CP displacement, femoral axial rotation and pivot position. Using linear mixed‐effects modelling techniques, kinematics between TKA designs were compared.ResultsDuring knee extension between 20° flexion and full extension, the CPs moved anteriorly combined with a small internal femoral rotation (a screw‐home mechanism). Whereas CP movement was reversed: femoral rollback, external femoral rotation while flexing the knee between full extension and 20° knee flexion, At larger flexion angles, femoral axial rotation (FAR) occurred around a lateral pivot point both during step‐up and lunge. The symmetric design had a 2.3° larger range of FAR compared to the asymmetric design during lunge (p = 0.02). All other kinematics were comparable.ConclusionDespite the differences in design, this study showed that the asymmetric and symmetric PS TKA designs had mostly comparable knee kinematics during step‐up and lunge motions. It is therefore expected that the functionality of the successor TKA design is similar to that of its precursor design.Level of EvidenceLevel II, prospective comparative study.