Differences in kinematics and kinetics during gait between total knee arthroplasty implant designs

Background: Implant design is important for achieving proper knee biomechanics during gait following knee arthroplasty. Bicruciate-stabilized total knee arthroplasty attempts to replicate anterior stability and rotational facilitation. However, its detailed gait biomechanics compared with other implant designs have not been analyzed. The purpose of this study is to compare knee kinematics and kinetics between bicruciate-stabilized total knee arthroplasty, posterior-stabilized total knee arthroplasty, unicompartmental knee arthroplasty, and normal knees. Methods: Ten healthy subjects, 16 who underwent posterior stabilized total knee arthroplasty, 12 who underwent bicruciate-stabilized total knee arthroplasty, and 13 who underwent unicompartmental knee arthroplasty were recruited. The mean follow-up period after arthroplasty was 11.0 months. Three-dimensional kinematics and kinetics were assessed using a motion capture system with subjects walking on a 5-m walkway. Comparisons between groups were conducted using the Kruskal-Wallis test, and post hoc analysis was performed for those parameters that differed significantly. Findings: The bicruciate-stabilized total knee arthroplasty group showed decreased internal rotation compared to the unicompartmental knee arthroplasty group. Compared to the control group, the posterior-stabilized total knee arthroplasty group exhibited reduced knee extension and internal rotation moment. Interpretation: Bicruciate-stabilized total knee arthroplasties exhibited different biomechanical characteristics compared to unicompartmental knee arthroplasties during terminal stance. Postoperative total knee arthroplasty rehabilitation should focus on relieving stiffness owing to insufficient knee flexion-extension motion observed in both bicruciate-stabilized and posterior-stabilized total knee arthroplasties compared with unicompartmental knee arthroplasty, which may be due to a lack of knee rotational motion during gait.