Representing the effect of variation in soft tissue constraints in experimental simulation of total knee replacements

As life expectancy and activity levels of patients increase so does the demand on total knee replacements (TKRs). Abnormal mechanics and wear of TKRs can lead to implant loosening and early failure. Polyethylene inserts of varying design and conformity have been introduced in the past decade to improve stability and patient's confidence in the replaced knee, particularly in cases where soft tissue support around the knee is sub optimal. This study experimentally investigated the effect of variation in the soft tissues on the kinematics and wear of a TKR on three different tibial insert designs. DePuy Sigma fixed bearing TKRs with moderately cross-linked UHMWPE and the ISO force control inputs were used. Different soft tissue constraints were simulated using virtual springs in an ISO force controlled simulation system. The spring gaps and stiffness' were varied and their effect on the output kinematics and wear rates assessed. The lower conformity inserts resulted in significantly higher displacements and more variation between the stations on the simulator. They were also more sensitive to changes in the soft tissue constraints than the high conformity insert. The wear rate for the high tension springs was significantly lower than for the lower tension springs tested. Tibial insert geometry and soft tissue constraints significantly affected kinematics and wear in these experimental simulations. Soft tissue constraints and the variability in patients are important considerations in the stratified design of TKRs and approach to patient selection.