title: Kinematics of posterior cruciate ligament-retaining and -sacrificing mobile bearing total knee arthroplasties. An in vitro comparison of the New Jersey LCS meniscal bearing and rotating platform prostheses.
abstract: The posterior cruciate ligament (PCL)-retaining, meniscal bearing and the PCL-sacrificing rotating platform designs of the LCS prosthesis (DePuy, Warsaw, IN) were designed to minimally constrain knee kinematics while minimizing bone-cement-prosthesis interface stresses and polyethylene wear. The kinematics and stability of the knee following arthroplasty with these devices rely on adequate tensioning of the remaining soft tissues by management of the flexion/extension gaps at the time of surgery. In this in vitro study, the knee kinematics of the function of the quadriceps mechanism for 8 cadaveric knees were measured quantitatively before and after implantation of these 2 prosthesis designs. Following implantation of the PCL-retaining, meniscal bearing prosthesis, anterior translations during anterior drawer testing were significantly greater (P < .05) than those seen in the intact knee. Implantation of the PCL-retaining, meniscal bearing prosthesis resulted in an increase in the extension gap of 2 mm. Quadriceps force needed to achieve full extension was increased by 30% over that needed in the intact knee. The PCL-sacrificing, rotating platform prosthesis constrained anterior translation such that nearly normal anterior knee stability was reestablished; however, the extension gap was increased by 4 mm and the quadriceps force needed to achieve full extension was 50% greater than that needed in the intact knee. Attempts to achieve joint stability by increases in the thickness of the tibial component to widen the flexion/extension gaps results in compromises of quadriceps efficiency, particularly in the absence of a functioning PCL, as demonstrated in this in vitro model. Patients receiving the PCL-sacrificing prosthesis may experience difficulty in those activities requiring quadriceps power near full extension, such as rising from a chair or ascending or descending stairs.
authors.affiliation: Department of Orthopaedic Surgery, Summa Health System, Akron, OH 44310, USA.
authors.forename: P J
authors.initials: PJ
authors.lastname: Lewandowski
authors.forename: M J
authors.initials: MJ
authors.lastname: Askew
authors.forename: D F
authors.initials: DF
authors.lastname: Lin
authors.forename: F W
authors.initials: FW
authors.lastname: Hurst
authors.forename: A
authors.initials: A
authors.lastname: Melby
mesh_terms: D019645:Arthroplasty, Replacement, Knee; D002102:Cadaver; D006801:Humans; D007720:Knee Prosthesis; D018482:Muscle, Skeletal / Q000502:physiology; D016119:Posterior Cruciate Ligament; D011474:Prosthesis Design; D012399:Rotation; D013848:Thigh