In vivo kinematic analysis of total knee arthroplasty with four different polyethylene designs

The femorotibial contact point on the sagittal plane was measured under weight-bearing conditions in 45 subjects with implanted and nonimplanted knees. They consisted of 11 knees with flat bearing inserts, 16 knees with shallow dished inserts, 10 knees with posterior lipped inserts, 10 knees with posterior stabilized bearing inserts, and 8 normal knees selected as controls. The average amount of anterior translation of the knee with a flat bearing insert was significantly larger than that of the other implanted knees. The average femorotibial contact point did not differ significantly among knees with shallow dished, posterior lipped, and posterior stabilized bearing inserts, but posterior stabilized knees exhibited most frequently a normal posterior movement. Based on our results, it may be safer to use more anteroposterior constrained bearing inserts in total knee arthroplasty, particularly when the posterior cruciate ligament is loose.