Kinematics and fixation of total knee arthroplasties : a clinical, radiographic, scintimetric, and roentgen stereophotogrammetric evaluation

Abstract: Aseptic loosening of the tibial component is an important cause of failure after total knee arthroplasty. Bone destruction often claimed to be caused by the cement makes the revision difficult. In order to treat younger patients, uncemented fixation has been introduced, but the etiology to loosening is multifactorial and only partly known. Early detection of implant migration facilitates research in this field but is difficult using conventional techniques. In this study modified versions of roentgen stereophotogrammetric analysis (RSA) were developed to obtain accurate and standardized evaluations facilitating comparison between prosthetic designs. The method was used to record the efficacy of cemented and uncemented fixation of different designs of the tibial component, to determine the accuracy of scintimetry in the detection of early aseptic loosening, and to analyse the in vivo kinematics of knee arthroplasties with different design and stability between the joint surfaces.Forty-three arthroplasties with comparatively high inherent stability of the joint surfaces were randomized to cemented or uncemented fixation of the tibial component. In all groups micromovements were rather large, but with no differences between the cemented and uncemented components. The preoperative diagnosis (arthrosis OA, n=25; rheumatoid arthritis RA, n=18) did not influence the magnitude of micromotion.20 arthroplasties with the same design as above but equipped with an intramedullary stem, were randomized to cemented or uncemented fixation in patients with RA. Cement improved the fixation. Uncemented stemmed components displayed micromovements seemingly larger than unstemmed ones.34 arthroplasties with an unconstrained design of the joint area and fixed to the tibia with four pegs were randomized to cemented or uncemented fixation in patients with OA. When used uncemented 4 screws were added. Compared with previously investigated designs small micromotions were recorded, and especially in the cemented cases. Uncemented components with thin polyethylene inserts displayed larger initial micromotions. The preoperative deformity influenced the direction of the micromotion.33 knees were followed prospectively with RSA and scintimetry to evaluate any correlation between these methods. Low activity under the tibial component at 2 years implied prosthetic stability, whereas high activity indicated instability or high bone remodelling caused by the preoperative malalignment.The in vivo kinematics in three different designs of knee arthroplasties were analyzed during active flexion and extension without weight-bearing. Each type of prosthesis displayed design-specific abnormalities when compared with a normal material. Pronounced posterior tibial translations were recorded during flexion regardless whether the posterior cruciate ligament had been sacrificed or not. Data from the kinematic and the fixation studies suggest that movements restricted by the design of the joint area are transmitted to the bony interface with design-specific micromotions as the result.Analysis of knee joint kinematics during extension and weight-bearing revealed small alterations compared with non-weight-bearing. Evaluation of the three-dimensional movements in terms of helical axis rotations and translations confirmed the constrained or unconstrained in vivo behaviour of the designs under study. This analysis also facilitated the interpretation of the kinematic behaviour of the prosthetic knees and may be of value in the evaluation of new designs.