title: In vivo kinematic effects of ball and socket third condyle as a post-cam mechanism in tri-condylar knee implants.
abstract: BACKGROUND
  Tri-condylar implants containing a ball and socket third condyle as a post-cam mechanism were developed to accommodate a lifestyle requiring frequent deep flexion activities. The purpose of the current study was to examine the kinematic effects of the ball and socket third condyle during a deep knee bend activity, and to confirm the contact status of the ball and socket joint.
  
  
  METHODS
  Seventeen knees implanted with tri-condylar implants were analyzed using a 3D to 2D registration approach. A distance of less than 1mm denoted ball and socket contact. Medial and lateral contact positions and axial rotation were compared before and after contact. Moreover, the contact position at the third condyle and the center of the ball joint were analyzed.
  
  
  RESULTS
  After the third condyle contact, posterior translation of the medial and lateral contact positions increased considerably. Meanwhile, the angular rotation remained still. The center of the third condyle did not move after contact, and the contact position at the third condyle remained low.
  
  
  CONCLUSIONS
  The third condyle induced intensive posterior translation of both condyles, and did not prevent axial rotation, which was proved to work properly as a posterior stabilizing post-cam mechanism.
authors.affiliation: Center for Musculoskeletal Research, University of Tennessee, Knoxville, TN, USA. Electronic address: shnk@kuhp.kyoto-u.ac.jp.
authors.forename: Shinichiro
authors.initials: S
authors.lastname: Nakamura
authors.affiliation: Center for Musculoskeletal Research, University of Tennessee, Knoxville, TN, USA.
authors.forename: Adrija
authors.initials: A
authors.lastname: Sharma
authors.affiliation: Department of Orthopedic Surgery, Tamatsukuri-Koseinenkin Hospital, Matsue, Shimane, Japan.
authors.forename: Kenji
authors.initials: K
authors.lastname: Nakamura
authors.affiliation: Department of Orthopedic Surgery, Tamatsukuri-Koseinenkin Hospital, Matsue, Shimane, Japan.
authors.forename: Noboru
authors.initials: N
authors.lastname: Ikeda
authors.affiliation: Department of Orthopedic Surgery, Tamatsukuri-Koseinenkin Hospital, Matsue, Shimane, Japan.
authors.forename: Jun
authors.initials: J
authors.lastname: Kawai
authors.affiliation: Center for Musculoskeletal Research, University of Tennessee, Knoxville, TN, USA.
authors.forename: Sumesh M
authors.initials: SM
authors.lastname: Zingde
authors.affiliation: Center for Musculoskeletal Research, University of Tennessee, Knoxville, TN, USA.
authors.forename: Richard D
authors.initials: RD
authors.lastname: Komistek
mesh_terms: D000368:Aged; D019645:Arthroplasty, Replacement, Knee / Q000379:methods*; D001696:Biomechanical Phenomena; D005260:Female; D005269:Femur / Q000000981:diagnostic imaging / Q000601:surgery; D006801:Humans; D021621:Imaging, Three-Dimensional; D007719:Knee Joint / Q000000981:diagnostic imaging / Q000503:physiopathology* / Q000601:surgery; D007720:Knee Prosthesis; D008297:Male; D020370:Osteoarthritis, Knee / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery; D011474:Prosthesis Design; D011859:Radiography; D016059:Range of Motion, Articular / Q000502:physiology*; D012399:Rotation; D013977:Tibia / Q000000981:diagnostic imaging / Q000601:surgery
keywords: Deep knee bend activity; Kinematics; Post-cam mechanism; Total knee arthroplasty; Tri-condylar knee implant