title: Total knees designed for normal kinematics evaluated in an up-and-down crouching machine.
abstract: We constructed a crouching machine to study the motion of the knee joint, in which a motor was used to wind the quadriceps tendon so as to move the knee from high flexion to extension and back into flexion, while springs simulated hamstrings forces. Seven human cadaveric knees were tested intact and then after anterior cruciate ligament (ACL) resection. Motions of the femur, tibia, and patella were recorded by an optical tracking system. We then inserted plastic models representing commonly used total condylar and posterior stabilized knee replacement designs. Femoral motion was described by successive positions of the transverse axis of the femur projected onto the tibial surface. In the knee replacements, motions were similar to that of an ACL-deficient knee. We then tested two new designs with features intended to prevent anterior paradoxical sliding and to promote a medial pivot motion with femoral rollback primarily on the lateral side. The motion path more closely followed that of the normal intact knee. We concluded that motion guiding features in a total knee replacement could reproduce a normal neutral path that might result in functional improvements for the patient.
authors.affiliation: Department of Orthopaedic Surgery, NYU Hospital for Joint Diseases, c/o Veterans Administration Medical Center, 423 East 23rd Street, Annex Building #2, Room 206A, New York, New York 10010, USA.
authors.forename: Gokce
authors.initials: G
authors.lastname: Yildirim
authors.forename: Peter S
authors.initials: PS
authors.lastname: Walker
authors.forename: Jason
authors.initials: J
authors.lastname: Boyer
mesh_terms: D016118:Anterior Cruciate Ligament / Q000502:physiology / Q000601:surgery; D019645:Arthroplasty, Replacement, Knee / Q000295:instrumentation*; D001696:Biomechanical Phenomena; D002102:Cadaver; D019937:Diagnostic Techniques and Procedures / Q000295:instrumentation; D004867:Equipment Design / Q000379:methods; D005269:Femur / Q000503:physiopathology; D006801:Humans; D007719:Knee Joint / Q000503:physiopathology*; D010329:Patella / Q000503:physiopathology; D013977:Tibia / Q000503:physiopathology