Symmetrical vs asymmetrical total knee replacement--a medium term comparative analysis

Modifications of established implants can result in deleterious effects, as with the Capitol and the matt coated Exeter hips. In 1991 the Kinemax plus modification of the Kinematic knee was introduced in Bristol, the design changes having been made to reduce patello-femoral complications. We carried out a comparative analysis of the prospective recorded data on a consecutive series of 182 total knee replacements (95 Kinematic and 87 Kinemax plus knees) performed between 1991 and 1993. The same instrumentation and surgical technique was used. Since the design had introduced a broader trochlear, offset patella and had changed from an asymmetrical to a symmetrical femoral component, particular attention was paid to tracking and range of movement. All patients were reviewed at 5 years using the Bristol knee score and radiographs. There was no difference in the overall score (both prosthesis scoring 85-86) but the Kinemax plus group with a symmetrical trochlear had a significantly greater improvement in the range of movement (14 degrees as opposed to 4 degrees; P<0.05). In addition, secondary intervention for mal-tracking was significantly less in the Kinemax group. No deleterious effect of the changed geometry was observed. It is concluded that the introduction of a symmetrical femoral component with an offset patella reduced patello-femoral complications without detectable disadvantages.