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J Knee Surg 2020; 33(03): 284-293
DOI: 10.1055/s-0039-1677846
Original Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Kinematic Alignment in Cruciate Retaining Implants Improves the Biomechanical Function in Total Knee Arthroplasty during Gait and Deep Knee Bend

Kyoung-Tak Kang   *
1   Department of Mechanical Engineering, Yonsei University, Seodaemun-gu, Seoul, Republic of Korea
,
Yong-Gon Koh   *
2   Department of Orthopaedic Surgery, Joint Reconstruction Center, Yonsei Sarang Hospital, Seocho-gu, Seoul, Republic of Korea
,
Ji Hoon Nam
2   Department of Orthopaedic Surgery, Joint Reconstruction Center, Yonsei Sarang Hospital, Seocho-gu, Seoul, Republic of Korea
,
Sae Kwang Kwon
2   Department of Orthopaedic Surgery, Joint Reconstruction Center, Yonsei Sarang Hospital, Seocho-gu, Seoul, Republic of Korea
,
Kwan Kyu Park
3   Department of Orthopedic Surgery, Yonsei University College of Medicine, Seodaemun-gu, Seoul, Republic of Korea
› Author Affiliations
Further Information

Publication History

15 January 2018

16 December 2018

Publication Date:
06 February 2019 (online)

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Abstract

Kinematic alignment (KA), which co-aligns the rotational axes of the components with three kinematic axes of the knee by aligning the components to the prearthritic joint lines, has been a recently introduced surgical technique. However, whether KA and cruciate retaining (CR) implants provide better biomechanical function during activities than mechanical alignment (MA) in posterior stabilized (PS) implants is unclear. We evaluated the biomechanical functions during the stance phase gait and deep knee bend, with a computer simulation and measured forces in the medial and lateral collateral ligaments and medial and lateral contact stresses in the polyethylene insert and patellar button. The forces on the medial collateral ligament in KA were lower than those in MA in both CR and PS TKA in the stance phase gait and deep knee bend conditions, whereas those on the lateral collateral ligament did not show any difference between the two surgical alignment techniques in the stance phase gait condition. The maximum contact stresses on the medial PE inserts in KA were lower than those in MA in both CR and PS TKA in the stance phase gait and deep knee bend conditions. However, the maximum contact stresses on the lateral PE inserts and the patellar button did not differ between MA and KA. The biomechanical function was superior in KA TKA than in MA TKA, and KA was more effective in CR TKA. This comparison could be used as a reference by surgeons to reduce the failure rates by using KA TKA instead of MA TKA.

Keywords

total knee arthroplasty - kinematic alignment - mechanical alignment - finite element analysis

* Kyoung-Tak Kang and Young-Gon Koh contributed equally to this work and should be considered co-first authors.