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Medial congruent polyethylene design show different tibiofemoral kinematics and enhanced congruency compared to a standard symmetrical cruciate retaining design for total knee arthroplasty—an in vivo randomized controlled study of gait using dynamic radiostereometry

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Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Purpose

New total knee arthroplasty implant designs attempt to normalize kinematics patterns that may improve functional performance and patient satisfaction. It was hypothesized that a more medial congruent (MC) anatomic bearing design (1) influences the tibiofemoral kinematics and (2) enhances articular congruency compared to a standard symmetrical cruciate retaining (CR) bearing design.

Methods

In this double-blinded randomized study, 66 patients with knee osteoarthritis were randomly included in two groups: MC (n = 31) and CR (n = 33). Clinical characteristics such as knee ligament lesions and knee osteoarthritis scores were graded on preoperative magnetic resonance imaging and radiography. At the 1-year follow-up, dynamic radiostereometric analysis was used to assess tibiofemoral joint kinematics and articulation congruency. Patient-reported outcome measures, Oxford Knee Score, the Forgotten Joint Score, and the Knee Osteoarthritis Outcome Score, were assessed preoperatively and at the 1-year follow-up.

Results

Compared to the CR bearing, the MC bearing displayed an offset with approximately 3 mm greater anterior tibial drawer (p < 0.001) during the entire motion, and up to approximately 3.5 degrees more tibial external rotation (p = 0.004) from mid-swing to the end of the gait cycle at the 1-year follow-up. Furthermore, the congruency area in the joint articulation was larger during approximately 80% of the gait cycle for the MC bearing compared to the CR. The patient-reported outcome measures improved (p < 0.001), but there were no differences between groups. In addition, there were no differences in clinical characteristics and there were no knee revisions or recognized deep infections during follow-up.

Conclusion

The study demonstrates that the MC-bearing design changes tibiofemoral kinematics and increases the area of congruency towards more native knee kinematics than the CR bearing. In perspective this may contribute to a more stabilized knee motion, restoring the patient’s confidence in knee function during daily activities.

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Acknowledgements

We thank for the financial support we received from: Aarhus University, The Danish Rheumatism Association, Toyota-Fonden, Købmand Sven Hansen og Hustru Ina Hansens Fond, Søster og Verner Lipperts Fond. Furthermore, Zimmer Biomet provided financial support for dynamic radiostereometric analysis investigations but had no role in collection, evaluation, or interpretation of the study data. The study sponsors have no conflicts of interest to declare.

Funding

Aarhus University, The Danish Rheumatism Association, Toyota-Fonden, Købmand Sven Hansen og Hustru Ina Hansens Fond, and Søster og Verner Lipperts Fond. Furthermore, Zimmer Biomet provided financial support for dynamic radiostereometric analysis investigations but had no role in collection, evaluation, or interpretation of the study data. The study sponsors have no conflicts of interest to declare.

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Authors and Affiliations

  1. University Clinic for Hand, Hip and Knee Surgery, Holstebro Central Hospital, Holstebro, Denmark

    Emil Toft Petersen, Daan Koppens, Jesper Dalsgaard & Torben Bæk Hansen

  2. Department of Clinical Medicine, Aarhus University, Aarhus N, Denmark

    Emil Toft Petersen, Søren Rytter, Torben Bæk Hansen & Maiken Stilling

  3. AutoRSA Research Group, Orthopaedic Research Unit, Aarhus University Hospital, Aarhus N, Denmark

    Emil Toft Petersen, Søren Rytter & Maiken Stilling

  4. Department of Orthopaedic Surgery, Aarhus University Hospital, Aarhus N, Denmark

    Søren Rytter, Daan Koppens & Maiken Stilling

  5. Department of Materials and Production, Aalborg University, Aalborg, Denmark

    Michael Skipper Andersen

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Contributions

ETP was involved in all aspects of the study including patient tests, analysis, and drafted the manuscript. SR, DK, and JD operated the patients. SR examined and labelled the clinical characteristics. SR, TBH, MSA, and MS had an essential role in the study design, interpretation, and presentation of data. All authors contributed to data interpretation and manuscript revision.

Corresponding author

Correspondence to Emil Toft Petersen.

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Conflict of interest

The authors have no conflicts of interest to declare.

Ethical approval

The study was approved by the Committee on Biomedical Research Ethics of the Central Denmark Region (1-10-72-303-16, issued 28 February 2017) and registered with the Danish Data Protection Agency (1-16-02-582-16, issued 31 October 2016).

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All patients gave written informed consent.

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Petersen, E.T., Rytter, S., Koppens, D. et al. Medial congruent polyethylene design show different tibiofemoral kinematics and enhanced congruency compared to a standard symmetrical cruciate retaining design for total knee arthroplasty—an in vivo randomized controlled study of gait using dynamic radiostereometry. Knee Surg Sports Traumatol Arthrosc 31, 933–945 (2023). https://doi.org/10.1007/s00167-022-07036-w

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