title: Endurance sports after total knee replacement: a biomechanical investigation.
abstract: OBJECTIVE
  No biomechanical evaluation of total knee designs exists for loads occurring during sports activities. It was the purpose of the present study to evaluate the contact stress distribution and contact area of different knee joint designs for loads that occur during four common recreational endurance activities.
  
  
  METHODS
  Three different total knee designs were evaluated for loads occurring during cycling (1.2 body weight (BW) at 80 degrees of knee flexion), power walking (4 BW at 20 degrees), hiking (8 BW at 40 degrees), and jogging (9 BW at 50 degrees) using Fuji pressure-sensitive film. The designs consisted of a flat tibial inlay, a curved inlay, and an inlay with mobile bearings. Five measurements were conducted for each load. The pressure sensitive films were scanned and analyzed using an image analysis program.
  
  
  RESULTS
  During cycling, the area with stress levels above the yield point of polyethylene (overloaded area) was below 15 mm2 for each design. During power walking, the mobile bearing design showed no overloaded area, whereas it was below 50 mm2 for the flat and curved design. During downhill walking and jogging, more than 140 mm2 were overloaded for each design.
  
  
  CONCLUSIONS
  It was concluded that patients after total knee replacement should alternate activities such as power walking and cycling. For mountain hiking, patients are advised to avoid descents or at least use ski poles. Jogging or sports involving running should be discouraged after total knee replacement.
authors.affiliation: Klinik für Orthopädische Chirurgie, Kantonsspital, St. Gallen, Switzerland. mskuster@bluewin.ch
authors.forename: M S
authors.initials: MS
authors.lastname: Kuster
authors.forename: E
authors.initials: E
authors.lastname: Spalinger
authors.forename: B A
authors.initials: BA
authors.lastname: Blanksby
authors.forename: A
authors.initials: A
authors.lastname: Gächter
mesh_terms: D001696:Biomechanical Phenomena; D006801:Humans; D007720:Knee Prosthesis; D010807:Physical Endurance; D013177:Sports