Posterior cruciate-retaining total knee arthroplasty exhibits small kinematic changes in the first postoperative year

Abstract

Purpose Fluoroscopic knee kinematics have historically been quantiied at least 1 year after total knee arthroplasty (TKA). The purpose of this study was to longitudinally assess knee kinematics at 6-12 weeks, 6 months, and 1 year after TKA to determine if earlier evaluation may be justiied. Methods Twenty-one patients participated after undergoing TKA with a posterior cruciate ligament-retaining ixed-bearing prosthesis. Fluoroscopic examinations of lunge, kneel, and step-up activities were performed at 12 ± 4 weeks (V1), 7 ± 2 months (V2), and 13 ± 2 months (V3) postoperatively. Images were analyzed using a three-dimensional to two-dimensional image registration technique. Maximum lexion poses for lunging and kneeling were compared between visits with repeated-measures statistical tests. For the step-up activity, mixed-efects linear models were constructed for condylar anteroposterior (AP) contact points and tibial internal rotation throughout lexion. Estimated marginal means of itted values were plotted with 95% conidence intervals and used to compare mean kinematics between visits. Results There were no signiicant changes in maximum lunging lexion over time (p = 0.405), though signiicant increases in maximum kneeling lexion were observed between V1 (106 ± 8°) and V2 (110 ± 9°) (p = 0.006), and V1 and V3 (113 ± 9°) (p = 0.0003). While statistical diferences were calculated for lunging medial condyle AP translation and kneeling tibial internal rotation, absolute diferences in condylar AP contact locations were less than ~ 2 mm between all visits during both movements. For the step-up activity, tibial internal rotation increased with lexion, and there were pair-wise signiicant diferences at all lexion angles between V1-V2 (p < 0.001) and V1-V3 (p < 0.001). Anterior medial condylar translation was observed with lexion, with pair-wise signiicant diferences present for V1-V3 (p = 0.005) and V2-V3 (p < 0.001). The lateral condyle exhibited initial posterior translation followed by anterior translation with increasing lexion, with pair-wise diferences between all visits (p < 0.005 for all comparisons). Conclusion Though statistical diferences were observed between visits for all activities, variations in estimated mean condylar positions were within ~ 2 mm from ~ 12 weeks to 1 year. Considering measurement error averages approximately 1 mm for sagittal plane translations, these results indicate that knee kinematics during kneel, lunge, and step-up activities may be sustained from as early as 12 weeks after TKA.