The normal knee joint maintains stable motion during activities of daily living. After total knee arthroplasty (TKA), stability is achieved by the conformity of the bearing surfaces of the implant components, ligaments, and constraint structures incorporated in the implant design. The large, rectangular tibial post in constrained condylar knee (CCK) arthroplasty, often used in revision surgery, provides added stability, but increases susceptibility to polyethylene wear as it contacts the intercondylar box on the femoral component. We examined coronal plane stability to understand the relative contributions of the mechanisms that act to stabilize the CCK knee under varus–valgus loading, namely, load distribution between the medial and lateral condyles, contact of the tibial post with the femoral intercondylar box, and elongation of the collateral ligaments. A robot testing system was used to determine the joint stability in human cadaveric knees as described by the moment versus angular rotation behavior under varus–valgus moments at 0 deg, 30 deg, and 90 deg of flexion. The angular rotation of the CCK knee in response to the physiological moments was limited to ≤1.5 deg. The primary stabilizing mechanism was the redistribution of the contact force on the bearing surfaces. Contact between the tibial post and the femoral box provided a secondary stabilizing mechanism after lift-off of a condyle had occurred. Collateral ligaments provide limited stability because little ligament elongation occurred under such small angular rotations. Compressive loads applied across the knee joint, such as would occur with the application of muscle forces, enhanced the ability of the bearing surfaces to provide resisting internal varus–valgus moment and, thus, reduced the exposure of the tibial post to the external varus–valgus loads. Our results suggest that the CCK stability can be refined by considering both the geometry of the bearing surfaces and the contacting geometry between the tibial post and femoral box.
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August 2016
Research-Article
Load Sharing Among Collateral Ligaments, Articular Surfaces, and the Tibial Post in Constrained Condylar Knee Arthroplasty Available to Purchase
Xiaonan Wang,
Xiaonan Wang
Physiology, Biophysics, and
Systems Biology Program,
Weill Cornell Graduate School
of Medical Sciences,
New York, NY 10065
Systems Biology Program,
Weill Cornell Graduate School
of Medical Sciences,
New York, NY 10065
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Aamer Malik,
Aamer Malik
Department of Orthopaedic Surgery,
Hospital for Special Surgery,
New York, NY 10021
Hospital for Special Surgery,
New York, NY 10021
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Donald L. Bartel,
Donald L. Bartel
Department of Biomechanics,
Hospital for Special Surgery,
New York, NY 10021
Hospital for Special Surgery,
New York, NY 10021
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Timothy M. Wright,
Timothy M. Wright
Department of Biomechanics,
Hospital for Special Surgery,
New York, NY 10021
Hospital for Special Surgery,
New York, NY 10021
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Douglas E. Padgett
Douglas E. Padgett
Department of Orthopaedic Surgery,
Hospital for Special Surgery,
535 East 70th Street,
New York, NY 10021
e-mail: [email protected]
Hospital for Special Surgery,
535 East 70th Street,
New York, NY 10021
e-mail: [email protected]
Search for other works by this author on:
Xiaonan Wang
Physiology, Biophysics, and
Systems Biology Program,
Weill Cornell Graduate School
of Medical Sciences,
New York, NY 10065
Systems Biology Program,
Weill Cornell Graduate School
of Medical Sciences,
New York, NY 10065
Aamer Malik
Department of Orthopaedic Surgery,
Hospital for Special Surgery,
New York, NY 10021
Hospital for Special Surgery,
New York, NY 10021
Donald L. Bartel
Department of Biomechanics,
Hospital for Special Surgery,
New York, NY 10021
Hospital for Special Surgery,
New York, NY 10021
Timothy M. Wright
Department of Biomechanics,
Hospital for Special Surgery,
New York, NY 10021
Hospital for Special Surgery,
New York, NY 10021
Douglas E. Padgett
Department of Orthopaedic Surgery,
Hospital for Special Surgery,
535 East 70th Street,
New York, NY 10021
e-mail: [email protected]
Hospital for Special Surgery,
535 East 70th Street,
New York, NY 10021
e-mail: [email protected]
1Corresponding author.
Manuscript received October 29, 2014; final manuscript received May 2, 2016; published online June 16, 2016. Assoc. Editor: Paul Rullkoetter.
J Biomech Eng. Aug 2016, 138(8): 081002 (8 pages)
Published Online: June 16, 2016
Article history
Received:
October 29, 2014
Revised:
May 2, 2016
Citation
Wang, X., Malik, A., Bartel, D. L., Wright, T. M., and Padgett, D. E. (June 16, 2016). "Load Sharing Among Collateral Ligaments, Articular Surfaces, and the Tibial Post in Constrained Condylar Knee Arthroplasty." ASME. J Biomech Eng. August 2016; 138(8): 081002. https://doi.org/10.1115/1.4033678
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