Skip to main content
SpringerLink
Log in

Tibiofemoral conformity variation offers changed kinematics and wear performance of customized posterior-stabilized total knee arthroplasty

  • Knee
  • Published:
Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Purpose

Posterior-stabilized (PS)-total knee arthroplasty (TKA) can be applied in any of several variations in terms of the tibiofemoral conformity and post-cam mechanism. However, previous studies have not evaluated the effect of the condylar surface radii (tibiofemoral conformity) on wear in a customized PS-TKA. The present study involved evaluating the wear performance with respect to three different conformities of the tibiofemoral articular surface in a customized PS-TKA by means of a computational simulation.

Methods

An adaptive computational simulation method was developed that conduct wear simulation for tibial insert to predict kinematics, weight loss due to wear, and wear contours to results. Wear predictions using computational simulation were performed for 5 million gait cycles with force-controlled inputs. Customized PS-TKA designs were developed and categorized as conventional conformity (CPS-TKA), medial pivot conformity (MPS-TKA), and anatomical conformity (APS-TKA). The post-cam design in the customized PS-TKA is identical. We compared the kinematics, contact mechanics, and wear performance.

Results

The findings revealed that APS-TKA exhibited the highest internal tibial rotation relative to other TKA designs. Additionally, the higher contact area led to there being less contact stress although it did not directly affect the wear performance. Specifically, MPS-TKA exhibited the lowest volumetric wear.

Conclusions

The results of the present study showed that tibiofemoral articular surface conformity should be considered carefully in customized PS-TKA design. Different wear performances were observed with respect to different tibiofemoral conformities. Even though APS-TKA exhibited an inferior wear performance compared to MPS-TKA, it proved to be better in terms of kinematics so its functionality may be improved through the optimization of the tibiofemoral articular surface conformity. Additionally, it should be carefully designed since any changes may affect the post-cam mechanism.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6
Fig. 7

Similar content being viewed by others

References

  1. Abdelgaied A, Liu F, Brockett C, Jennings L, Fisher J, Jin Z (2011) Computational wear prediction of artificial knee joints based on a new wear law and formulation. J Biomech 44:1108–1116

    Article  PubMed  Google Scholar 

  2. Archard JF (1953) Contact and rubbing of flat surfaces. J Appl Phys 24:981–988

    Article  Google Scholar 

  3. Ardestani MM, Moazen M, Jin Z (2015) Contribution of geometric design parameters to knee implant performance: conflicting impact of conformity on kinematics and contact mechanics. Knee 22:217–224

    Article  PubMed  Google Scholar 

  4. Ardestani MM, Moazen M, Maniei E, Jin Z (2015) Posterior stabilized versus cruciate retaining total knee arthroplasty designs: conformity affects the performance reliability of the design over the patient population. Med Eng Phys 37:350–360

    Article  PubMed  Google Scholar 

  5. Arnout N, Vanlommel L, Vanlommel J, Luyckx JP, Labey L, Innocenti B, Victor J, Bellemans J (2015) Post-cam mechanics and tibiofemoral kinematics: a dynamic in vitro analysis of eight posterior-stabilized total knee designs. Knee Surg Sports Traumatol Arthrosc 23:3343–3353

    Article  CAS  PubMed  Google Scholar 

  6. Baker PN, van der Meulen JH, Lewsey J, Gregg PJ (2007) The role of pain and function in determining patient satisfaction after total knee replacement. Data from the National Joint Registry for England and Wales. J Bone Joint Surg Br 89:893–900

    Article  CAS  PubMed  Google Scholar 

  7. Bellemans J, Carpentier K, Vandenneucker H, Vanlauwe J, Victor J (2010) The John Insall Award: Both morphotype and gender influence the shape of the knee in patients undergoing TKA. Clin Orthop Relat Res 468:29–36

    Article  PubMed  Google Scholar 

  8. Blaha JD (2004) The rationale for a total knee implant that confers anteroposterior stability throughout range of motion. J Arthroplasty 19:22–26

    Article  PubMed  Google Scholar 

  9. Bourne RB, Chesworth BM, Davis AM, Mahomed NN, Charron KD (2010) Patient satisfaction after total knee arthroplasty: who is satisfied and who is not? Clin Orthop Relat Res 468:57–63

    Article  PubMed  Google Scholar 

  10. Bourne RB, McCalden RW, MacDonald SJ, Mokete L, Guerin J (2007) Influence of patient factors on TKA outcomes at 5 to 11 years followup. Clin Orthop Relat Res 464:27–31

    PubMed  Google Scholar 

  11. Collins MJ (2014) The impact patient-specific instrumentation has had on my practice in the last 5 years. Am J Orthop (Belle Mead NJ) 43:S14–S16

    Google Scholar 

  12. DesJardins JD, Burnikel B, LaBerge M (2008) UHMWPE wear against roughened oxidized zirconium and CoCr femoral knee components during force-controlled simulation. Wear 264:245–256

    Article  CAS  Google Scholar 

  13. DesJardins JD, Walker PS, Haider H, Perry J (2000) The use of a force-controlled dynamic knee simulator to quantify the mechanical performance of total knee replacement designs during functional activity. J Biomech 33:1231–1242

    Article  CAS  PubMed  Google Scholar 

  14. Galloway F, Worsley P, Stokes M, Nair P, Taylor M (2012) Development of a statistical model of knee kinetics for applications in pre-clinical testing. J Biomech 45:191–195

    Article  PubMed  Google Scholar 

  15. Galvin AL, Kang L, Udofia I, Jennings LM, McEwen HM, Jin Z, Fisher J (2009) Effect of conformity and contact stress on wear in fixed-bearing total knee prostheses. J Biomech 42:1898–1902

    Article  PubMed  Google Scholar 

  16. Godest AC, Beaugonin M, Haug E, Taylor M, Gregson PJ (2002) Simulation of a knee joint replacement during a gait cycle using explicit finite element analysis. J Biomech 35:267–275

    Article  CAS  PubMed  Google Scholar 

  17. Halloran JP, Easley SK, Petrella AJ, Rullkoetter PJ (2005) Comparison of deformable and elastic foundation finite element simulations for predicting knee replacement mechanics. J Biomech Eng 127:813–818

    Article  PubMed  Google Scholar 

  18. Innocenti B, Labey L, Kamali A, Pascale W, Pianigiani S (2014) Development and validation of a wear model to predict polyethylene wear in a total knee arthroplasty: a finite element analysis. Lubricants 2:193–205

    Article  Google Scholar 

  19. Johal P, Williams A, Wragg P, Hunt D, Gedroyc W (2005) Tibio-femoral movement in the living knee. A study of weight bearing and non-weight bearing knee kinematics using ‘interventional’ MRI. J Biomech 38:269–276

    Article  CAS  PubMed  Google Scholar 

  20. Johnson T, Laurent M, Yao J, Gilbertson L (2001) The effect of displacement control input parameters on tibiofemoral prosthetic knee wear. Wear 250:222–226

    Article  Google Scholar 

  21. Kang KT, Kwon SK, Son J, Kwon OR, Lee JS, Koh YG (2018) The increase in posterior tibial slope provides a positive biomechanical effect in posterior-stabilized total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc. https://doi.org/10.1007/s00167-018-4925-3

    Article  PubMed  Google Scholar 

  22. Kang KT, Son J, Kim HJ, Baek C, Kwon OR, Koh YG (2017) Wear predictions for UHMWPE material with various surface properties used on the femoral component in total knee arthroplasty: a computational simulation study. J Mater Sci Mater Med 28:105

    Article  CAS  PubMed  Google Scholar 

  23. Kang KT, Son J, Kwon OR, Baek C, Heo DB, Park KM, Kim HJ, Koh YG (2016) Morphometry of femoral rotation for total knee prosthesis according to gender in a Korean population using three-dimensional magnetic resonance imaging. Knee 23:975–980

    Article  PubMed  Google Scholar 

  24. Kang KT, Son J, Suh DS, Kwon SK, Kwon OR, Koh YG (2018) Patient-specific medial unicompartmental knee arthroplasty has a greater protective effect on articular cartilage in the lateral compartment: a finite element analysis. Bone Joint Res 7:20–27

    Article  PubMed  PubMed Central  Google Scholar 

  25. Knight LA, Pal S, Coleman JC, Bronson F, Haider H, Levine DL, Taylor M, Rullkoetter PJ (2007) Comparison of long-term numerical and experimental total knee replacement wear during simulated gait loading. J Biomech 40:1550–1558

    Article  PubMed  Google Scholar 

  26. Koh YG, Son J, Kwon SK, Kim HJ, Kwon OR, Kang KT (2017) Preservation of kinematics with posterior cruciate-, bicruciate- and patient-specific bicruciate-retaining prostheses in total knee arthroplasty by using computational simulation with normal knee model. Bone Joint Res 6:557–565

    Article  PubMed  PubMed Central  Google Scholar 

  27. Kurtz WB, Slamin JE, Doody SW (2016) Bone preservation in a novel patient specific total knee replacement. Reconstr Rev 6:23–29

    Google Scholar 

  28. Kwon OR, Kang KT, Son J, Kwon SK, Jo SB, Suh DS, Choi YJ, Kim HJ, Koh YG (2014) Biomechanical comparison of fixed- and mobile-bearing for unicompartmental knee arthroplasty using finite element analysis. J Orthop Res 32:338–345

    Article  PubMed  Google Scholar 

  29. Li G, Papannagari R, Most E, Park SE, Johnson T, Tanamal L, Rubash HE (2005) Anterior tibial post impingement in a posterior stabilized total knee arthroplasty. J Orthop Res 23:536–541

    Article  PubMed  Google Scholar 

  30. McGloughlin TM, Murphy DM, Kavanagh AG (2004) A machine for the preliminary investigation of design features influencing the wear behaviour of knee prostheses. Proc Inst Mech Eng H 218:51–62

    Article  CAS  PubMed  Google Scholar 

  31. Padua R, Ceccarelli E, Bondi R, Campi A, Padua L (2007) Range of motion correlates with patient perception of TKA outcome. Clin Orthop Relat Res 460:174–177

    CAS  PubMed  Google Scholar 

  32. Pal S, Haider H, Laz PJ, Knight LA, Rullkoetter PJ (2008) Probabilistic computational modeling of total knee replacement wear. Wear 264:701–707

    Article  CAS  Google Scholar 

  33. Patil S, Bunn A, Bugbee WD, Colwell CW Jr, D’Lima DD (2015) Patient-specific implants with custom cutting blocks better approximate natural knee kinematics than standard TKA without custom cutting blocks. Knee 22:624–629

    Article  PubMed  Google Scholar 

  34. Pritchett JW (2011) Patients prefer a bicruciate-retaining or the medial pivot total knee prosthesis. J Arthroplasty 26:224–228

    Article  PubMed  Google Scholar 

  35. Robertsson O, Dunbar MJ (2001) Patient satisfaction compared with general health and disease-specific questionnaires in knee arthroplasty patients. J Arthroplasty 16:476–482

    Article  CAS  PubMed  Google Scholar 

  36. Roh YW, Jang J, Choi WC, Lee JK, Chun SH, Lee S, Seong SC, Lee MC (2013) Preservation of the posterior cruciate ligament is not helpful in highly conforming mobile-bearing total knee arthroplasty: a randomized controlled study. Knee Surg Sports Traumatol Arthrosc 21:2850–2859

    Article  PubMed  Google Scholar 

  37. Sharkey PF, Hozack WJ, Rothman RH, Shastri S, Jacoby SM (2002) Insall Award paper. Why are total knee arthroplasties failing today? Clin Orthop Relat Res 404:7–13

    Article  Google Scholar 

  38. Slamin J, Parsley B (2012) Evolution of customization design for total knee arthroplasty. Curr Rev Musculoskelet Med 5:290–295

    Article  PubMed  PubMed Central  Google Scholar 

  39. Steklov N, Slamin J, Srivastav S, D’Lima D (2010) Unicompartmental knee resurfacing: enlarged tibio-femoral contact area and reduced contact stress using novel patient-derived geometries. Open Biomed Eng J 4:85–92

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  40. Tsumori Y, Yoshiya S, Kurosaka M, Kobashi S, Shibanuma N, Yamaguchi M (2011) Analysis of weight-bearing kinematics of posterior-stabilized total knee arthroplasty with novel helical post-cam design. J Arthroplasty 26:1556–1561

    Article  PubMed  Google Scholar 

  41. van den Heever DJ, Scheffer C, Erasmus P, Dillon E (2011) Contact stresses in a patient-specific unicompartmental knee replacement. Clin Biomech (Bristol Avon) 26:159–166

    Article  Google Scholar 

  42. Varadarajan KM, Harry RE, Johnson T, Li G (2009) Can in vitro systems capture the characteristic differences between the flexion–extension kinematics of the healthy and TKA knee? Med Eng Phys 31:899–906

    Article  PubMed  Google Scholar 

  43. Varadarajan KM, Zumbrunn T, Rubash HE, Malchau H, Li G, Muratoglu OK (2015) Cruciate retaining implant with biomimetic articular surface to reproduce activity dependent kinematics of the normal knee. J Arthroplasty 30:2149–2153.e2142

    Article  PubMed  Google Scholar 

  44. Varadarajan KM, Zumbrunn T, Rubash HE, Malchau H, Muratoglu OK, Li G (2015) Reverse engineering nature to design biomimetic total knee implants. J Knee Surg 28:363–369

    Article  PubMed  Google Scholar 

  45. Walker PS, Lowry MT, Kumar A (2014) The effect of geometric variations in posterior-stabilized knee designs on motion characteristics measured in a knee loading machine. Clin Orthop Relat Res 472:238–247

    Article  PubMed  Google Scholar 

  46. Wang H, Foster J, Franksen N, Estes J, Rolston L (2017) Gait analysis of patients with an off-the-shelf total knee replacement versus customized bi-compartmental knee replacement. Int Orthop 42:805–810

    Article  PubMed  Google Scholar 

  47. White PB, Ranawat AS (2016) Patient-specific total knees demonstrate a higher manipulation rate compared to “Off-the-shelf implants”. J Arthroplasty 31:107–111

    Article  PubMed  Google Scholar 

  48. Zeller IM, Dessinger GM, Kurtz WB, Sharma A, Komistek RD (2017) In-vivo kinematics for traditional and patient-specific posterior stabilized total knee arthroplasty during activities of daily living. British association for surgery of the knee meeting #0105

  49. Zeller IM, Sharma A, Kurtz WB, Anderle MR, Komistek RD (2017) Customized versus patient-sized cruciate-retaining total knee arthroplasty: an in vivo kinematics study using mobile fluoroscopy. J Arthroplasty 32:1344–1350

    Article  PubMed  Google Scholar 

Download references

Funding

There was no funding for this study.

Author information

Author notes

  1. Yong-Gon Koh and Juhyun Son contributed equally to this work and should be considered co-first authors.

Authors and Affiliations

  1. Joint Reconstruction Center, Department of Orthopaedic Surgery, Yonsei Sarang Hospital, 10 Hyoryeong-ro, Seocho-gu, Seoul, 06698, Republic of Korea

    Yong-Gon Koh, Oh-Ryong Kwon & Sae Kwang Kwon

  2. Department of Mechanical Engineering, Yonsei University, 50 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea

    Juhyun Son & Kyoung-Tak Kang

Authors
  1. Yong-Gon Koh
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Juhyun Son
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Oh-Ryong Kwon
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Sae Kwang Kwon
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Kyoung-Tak Kang
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Kyoung-Tak Kang.

Ethics declarations

Conflict of interest

The authors declare no conflict of interest.

Ethical approval

Approval was not required, as neither human participants nor animals were involved in this study.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Koh, YG., Son, J., Kwon, OR. et al. Tibiofemoral conformity variation offers changed kinematics and wear performance of customized posterior-stabilized total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 27, 1213–1223 (2019). https://doi.org/10.1007/s00167-018-5045-9

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00167-018-5045-9

Keywords

Search

Navigation