In Vivo Determination of Cam-Post Engagement in Fixed and Mobile-bearing TKA

Kinematics vary, sometimes in important ways, among the different types of total knee arthroplasty (TKA) designs, yet differences between the in vivo mechanisms of cam-post engagement in rotating-platform posterior-stabilized (PS) TKA, bicruciate-stabilized TKA, and fixed-bearing PS TKA designs remain largely uncharacterized. The objective of this study was to determine the cam-post mechanism interaction for subjects implanted with three different TKA designs. In vivo, analysis was conducted for patients implanted with nine rotating-platform PS TKAs, five knees with a fixed-bearing PS TKA, and 10 knees with a bicruciate-stabilized TKA while performing a deep knee bend. Three-dimensional kinematics of the implant components were determined by analysis of fluoroscopic images during flexion. The distances between the interacting surfaces were measured throughout flexion and instances and locations of contact were identified. Seven of the 10 bicruciate-stabilized knees analyzed had the femoral component engaged with the anterior aspect of the tibial post at full extension. Posterior cam-post engagement occurred at 34A degrees for the bicruciate-stabilized (range, 17A degrees-68A degrees), 93A degrees for the fixed-bearing PS (range, 88A degrees-100A degrees), and at 97A degrees (range, 90A degrees-104A degrees) for rotating-platform PS TKA. In bicruciate-stabilized and fixed-bearing PS knees, the contact initially occurred on the medial aspect of the posterior surface of the tibial post and then moved centrally and superiorly with increasing flexion. For rotating-platform PS TKA, it was located centrally on the posterior surface of the post at all times. This study suggests that mobility of the polyethylene might play an important role in ensuring central cam-post interaction in PS TKA. The polyethylene insert rotates axially in accordance with the rotating femur, maintaining central cam-post contact. This phenomenon was not observed in the fixed-bearing PS TKAs analyzed in this study. We speculate that this centralized symmetrical contact between the cam and posterior surface of the post could be beneficial clinically in terms of reducing wear of the posterior surface and particularly at the medial extremes of it. Level III, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.