Single Versus Multiple-Radii Cruciate-Retaining Total Knee Arthroplasty: An In Vivo Mobile Fluoroscopy Study

Previous fluoroscopic studies, using static C-arm systems, have shown nonnormal kinematic patterns in cruciate-retaining (CR) total knee arthroplasty (TKA). This study compares in vivo the kinematic differences in subjects implanted with single sagittal radius (SR) vs multiradii (MR) CR TKA for various activities using a novel mobile fluoroscopic system.

Using mobile fluoroscopy and 3D to 2D registration, tibiofemoral kinematics were analyzed for 25 subjects with an SR, symmetrical condylar CR TKA and 25 subjects with an MR, asymmetric condylar CR TKA for three dynamic weight-bearing activities: (1) deep knee bend (DKB), (2) walking up a ramp, and (3) walking down a ramp.

During DKB, from full extension to maximum knee flexion, the SR (-0.43 ± 3.43 mm) and MR (-1.00 ± 3.23 mm) groups experienced statistically similar anterior/posterior (AP) motion in the lateral condyle. The SR (3.51 ± 2.68 mm) group had significant anterior movement compared to the MR (-0.42 ± 2.20 mm) group in the medial condyle. This resulted in a significantly larger amount of normal axial rotation experienced by the SR (5.20 ± 3.93°) group compared to the MR (0.75 ± 5.12°) group. During ramp activities, the SR TKA consistently exhibited a significantly more posterior position of both condyles compared to the MR TKA.

Although the SR TKA exhibited larger amounts of axial rotation compared to the MR TKA in DKB, neither design exhibited weight-bearing kinematics as previously reported for the normal knee. Additional research on the normal knee for ramp activities is required to understand the importance of condylar position during these activities.