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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December 2017
Research-Article
Replication and Substitution of Anatomic Stabilizing Mechanisms in a Total Knee Design
Peter S. Walker,
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
Hospital for Joint Diseases,
New York University Langone Medical Center,
301 East 17th Street,
New York, NY 10003
e-mail: Peter.walker@nyumc.org
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Ilya Borukhov
Ilya Borukhov
Department of Orthopaedics,
Hospital for Joint Diseases,
New York University Langone Medical Center,
301 East 17th Street,
New York, NY 10003
Hospital for Joint Diseases,
New York University Langone Medical Center,
301 East 17th Street,
New York, NY 10003
Search for other works by this author on:
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
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
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. Dec 2017, 11(4): 041005 (5 pages)
Published Online: September 22, 2017
Article history
Received:
April 14, 2017
Revised:
June 22, 2017
Citation
Walker, P. S., and Borukhov, I. (September 22, 2017). "Replication and Substitution of Anatomic Stabilizing Mechanisms in a Total Knee Design." ASME. J. Med. Devices. December 2017; 11(4): 041005. https://doi.org/10.1115/1.4037261
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