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Research Papers

Replication and Substitution of Anatomic Stabilizing Mechanisms in a Total Knee Design

[+] Author and Article Information
Peter S. Walker

Department of Orthopaedics,
Hospital for Joint Diseases,
New York University Langone Medical Center,
301 East 17th Street,
New York, NY 10003
e-mail: Peter.walker@nyumc.org

Ilya Borukhov

Department of Orthopaedics,
Hospital for Joint Diseases,
New York University Langone Medical Center,
301 East 17th Street,
New York, NY 10003

1Corresponding author.

Manuscript received April 14, 2017; final manuscript received June 22, 2017; published online September 22, 2017. Assoc. Editor: Rita M. Patterson.

J. Med. Devices 11(4), 041005 (Sep 22, 2017) (5 pages) Paper No: MED-17-1205; doi: 10.1115/1.4037261 History: Received April 14, 2017; Revised June 22, 2017

While the majority of the total knees used today are of the cruciate retaining (CR) and cruciate substituting (PS) types, the results are not ideal in terms of satisfaction, function, and biomechanical parameters. It is proposed that a design which specifically substituted for the structures which provided stability could produce normal laxity behavior, which may be a path forward to improved outcomes. Stabilizing structures of the anatomic knee were identified under conditions of low and high axial loading. The upward slope of the anterior medial tibial plateau and the anterior cruciate was particularly important under all loading conditions. A guided motion design was formulated based on this data, and then tested in a simulating machine which performed an enhanced ASTM constraint test to determine stability and laxity. The guided motion design showed much closer neutral path of motion and laxity in anterior–posterior (AP) and internal–external rotation, compared with the PS design. Particular features included absence of paradoxical anterior sliding in early flexion, and lateral rollback in higher flexion. A total knee design which replicated the stabilizing structures of the anatomical knee is likely to provide more anatomical motion and may result in improved clinical outcomes.

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Copyright © 2017 by ASME
Topics: Design , Knee
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Figures

Grahic Jump Location
Fig. 1

Design of the replica-guided motion knee with three separate bearing surfaces, lateral, medial, and intercondylar. In combination, the bearings are intended to replicate the stabilizing mechanisms of the anatomic knee.

Grahic Jump Location
Fig. 2

Sections through the femoral and tibial bearing surfaces; lateral, intercondylar, and medial; at different flexion angles. The changing contact points with flexion are shown. The sequence is the intended neutral path of motion for only an axial compressive force acting.

Grahic Jump Location
Fig. 3

The models of the two total knee designs, made in a polymeric material by 3D printing, which were tested for kinematics in the knee testing machine

Grahic Jump Location
Fig. 4

The knee testing machine used for the kinematic analysis. The test total knee components were 3D printed and mounted on 3D printed bones. A metal rod AX was fixed in line with the circular axis of the femur. AC, axial compression forces; ST, horizontal forces to apply shear or torque to the femur. The medial collateral ligament (MCL) and lateral collateral ligament (LCL) consisted of elastic cables anatomically positioned and pretensioned to 75 N. FL, femur flexed using cables; T, targets to track motion with digital camera.

Grahic Jump Location
Fig. 5

The neutral path of motion and the laxity about the neutral path, plotted against angle of flexion. The anatomic data is the benchmark against which the PS knee and the replica guided motion knees were compared. The fine dashed horizontal line is the “corrected” neutral path curve of the lowest point on the medial femoral condyle. The overhead images show the locations of the femoral circular axis for discrete flexion angles, together with the femoral–tibial contact patches.

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