In vivo kinematics of cruciate-retaining and -substituting knee arthroplasties

A fluoroscopic measurement technique has been used to provide detailed three-dimensional kinematic assessment of knee arthroplasty function during a step-up activity. Three groups of knee arthroplasty subjects with excellent clinical outcomes and similar ranges of motion were evaluated. Each group received different prosthetic components and surgical treatments of the posterior cruciate ligament (PCL). Group 1 had relatively flat articular surfaces with retention of the bony insertion of the PCL, group 2 had similar articular geometry but recessed the PCL without retaining the bony insertion, and group 3 had prostheses with greater sagittal conformity and post/cam substitution of the sacrificed PCL. Although none of the knees exhibited normal knee kinematics, the ranges of axial rotation and condylar translation for group 1 were similar to ranges previously reported for normal and anterior cruciate-deficient knees. Axial rotations and condylar translations decreased when the PCL was surgically recessed or substituted. The smallest kinematic ranges were observed in group 3. The results indicate that both prosthetic component selection and surgical technique have a significant effect on prosthetic knee kinematics during functional activities.