The wear and kinematics of two medially stabilised total knee replacement systems

Abstract

Background: Medially stabilised total knee replacement systems aim to provide a more natural feeling knee replacement by providing increased stability through flexion. The aim of this study was to compare the kinematics and wear of two different medially stabilised total knee replacement systems in an experimental simulation study. The Medial Rotation Knee™ system (MRK) is an early medially stabilised knee (>20 years clinical success); the SAIPH® knee system being a more modern and refined, bone conserving evolution of the original design with a larger size range.

Methods: Three SAIPH and three MRK total knee replacements (MatOrtho Ltd, UK) were investigated. The study was performed on a knee simulator with load controlled input kinematic conditions (ISO 14243-1). 6 million cycles of simulation were carried out with the wear of the UHMWPE tibial components assessed gravimetrically. The resulting anterior-posterior translation and tibial rotation position was measured throughout the study.

Results: The mean UHMWPE wear rate was 0.57 ± 0.71 and 1.24 ± 2.0 mm³/million cycles for SAIPH and MRK total knee replacement systems respectively with no significant difference in wear (p = 0.24). Analysis of simulator output kinematics showed a larger range of anterior-posterior motion for SAIPH total knee replacements compared to MRK. The magnitude of tibial rotation was low for both knee replacement systems.

Conclusion: The small magnitude of anterior-posterior displacement and tibial rotation motion demonstrates the inherent stability of this knee system design offered by the constrained medial compartment. This study shows the potential for medially stabilised knee systems as a low polyethylene surface wear solution.

Keywords: Biomechanics; Experimental simulation; Medially stabilised; Total knee replacement; UHMWPE; Wear.