3D in vivo femoro-tibial kinematics of tri-condylar total knee arthroplasty during kneeling activities.
BACKGROUND
Kneeling position can serve as an important posture, providing stability and balance from a standing position to sitting on the floor or vice-versa. The purpose of the current study was to determine the kinematics during kneeling activities after subjects were implanted with a tri-condylar total knee arthroplasty.


METHODS
Kinematics was evaluated in 54 knees using fluoroscopy and a three-dimensional model fitting approach.


RESULTS
The average knee flexion at before contact status, at complete contact and at maximum flexion was 98.1±9.0°, 107.2±6.7°, and 139.6±12.3°, respectively. On average, there was no gross anterior displacement from before contact status to complete contact. Only slight posterior rollback motion of both condyles from complete contact to maximum flexion was observed. Three of 39 (7.7%) knees experienced anterior movement of both condyles more than 2mm from before contact status to complete contact. Reverse rotation pattern from before contact status to complete contact and then normal rotation pattern from complete contact to maximum flexion were observed. Condylar lift-off greater than 1.0 mm was observed in 45 knees (83.3%).


CONCLUSIONS
The presence of the ball-and-socket joint articulation provides sufficient antero-posterior stability in these designs to enable the patients to kneel safely without the incidence of any dislocation.


CONCLUSIONS
This study suggests a safe implant design for kneeling.
Center for Musculoskeletal Research, University of Tennessee, Knoxville, TN, USA; Department of Orthopedic Surgery, Kyoto University, Graduate School of Medicine, Kyoto, Japan. Electronic address: shnk@kuhp.kyoto-u.ac.jp.
Shinichiro
S
Nakamura
Center for Musculoskeletal Research, University of Tennessee, Knoxville, TN, USA.
Adrija
A
Sharma
Department of Orthopedic Surgery, Kyoto University, Graduate School of Medicine, Kyoto, Japan.
Masahiko
M
Kobayashi
Department of Orthopedic Surgery, Kyoto University, Graduate School of Medicine, Kyoto, Japan.
Hiromu
H
Ito
Department of Orthopedic Surgery, Tamatsukuri-Koseinenkin Hospital, Matsue, Shimane, Japan.
Kenji
K
Nakamura
Center for Musculoskeletal Research, University of Tennessee, Knoxville, TN, USA.
Sumesh M
SM
Zingde
Department of Orthopedic Surgery, Kyoto University, Graduate School of Medicine, Kyoto, Japan.
Takashi
T
Nakamura
Center for Musculoskeletal Research, University of Tennessee, Knoxville, TN, USA.
Richard D
RD
Komistek
D000368:Aged; D000369:Aged, 80 and over; D019645:Arthroplasty, Replacement, Knee; D001696:Biomechanical Phenomena / Q000502:physiology; D005260:Female; D005269:Femur / Q000502:physiology; D005471:Fluoroscopy; D006801:Humans; D007091:Image Processing, Computer-Assisted; D021621:Imaging, Three-Dimensional; D007719:Knee Joint / Q000502:physiology*; D007720:Knee Prosthesis; D008297:Male; D008875:Middle Aged; D011187:Posture / Q000502:physiology*; D011474:Prosthesis Design; D016059:Range of Motion, Articular / Q000502:physiology; D013977:Tibia / Q000502:physiology
Deep flexion; Kinematics; Kneeling; Total knee arthroplasty; Tri-condylar knee