title: In vivo kneeling biomechanics after posterior stabilized total knee arthroplasty.
abstract: BACKGROUND
  Kneeling is one of the activities sought by patients after total knee arthroplasty (TKA). This study investigated the six degrees of freedom (DOF) kinematics and three-dimensional (3D) contact during weight-bearing kneeling.
  
  
  METHODS
  A total of 16 South Korean female patients (22 knees) after posteriorly stabilized (PS) TKA (LPS-Flex) were randomly recruited and had the same surgeon. The patients were imaged using a dual fluoroscopic technique while they kneeled from initial to maximum flexion. The acquired images and 3D models were then used to recreate the in vivo pose of the components. Contact was determined by locating the surface intersections in the tibiofemoral and cam/post (between the femoral cam and tibial post) articular compartments.
  
  
  RESULTS
  Patients flexed, on average, from 107.3 degrees to 128.0 degrees during the kneeling activity. Changes in kinematics included 1.0 mm of proximal, 0.9 mm of medial, and 7.6 mm of posterior translation and 1.7 degrees of varus rotation (P < 0.04). A difference in internal tibial rotation was not detected. Articular contact moved posteriorly by 5.9 mm and 6.4 mm in the medial and lateral compartments, respectively. Contact also moved medially by 3.2 mm and 5.8 mm in the medial and lateral compartments. A decrease in articular contact was observed in both condyles, and lateral condylar lift-off increased with flexion (P = 0.0001). More than 80% of the patients demonstrated cam/post engagement, which always occurred in the distal portion of the post.
  
  
  CONCLUSIONS
  In this patient cohort, the knee joint was constrained during the weight-bearing activity such that femoral subluxation and dislocation were not observed. Furthermore, posterior cam/post engagement occurred only in the distal portion of the tibial post, which may improve the longevity of the post. The tibiofemoral and cam/post articular contact data presented in this study further suggest that kneeling may be performed by patients after clinically successful PS TKA who feel comfortable with the activity and are free of pain.
authors.affiliation: Department of Orthopaedic Surgery, Massachusetts General Hospital and Harvard Medical School, 55 Fruit Street, GRJ 1215, Boston, MA 02114, USA.
authors.forename: George R
authors.initials: GR
authors.lastname: Hanson
authors.forename: Sang E
authors.initials: SE
authors.lastname: Park
authors.forename: Jeremy F
authors.initials: JF
authors.lastname: Suggs
authors.forename: Angela L
authors.initials: AL
authors.lastname: Moynihan
authors.forename: Kyung W
authors.initials: KW
authors.lastname: Nha
authors.forename: Andrew A
authors.initials: AA
authors.lastname: Freiberg
authors.forename: Guoan
authors.initials: G
authors.lastname: Li
mesh_terms: D000368:Aged; D019645:Arthroplasty, Replacement, Knee; D005260:Female; D006801:Humans; D007719:Knee Joint / Q000502:physiology* / Q000601:surgery; D007720:Knee Prosthesis; D011312:Pressure; D016059:Range of Motion, Articular / Q000502:physiology*; D020127:Recovery of Function; D016474:Weight-Bearing / Q000502:physiology