Quadriceps force during knee extension after non-hinged and hinged TKA: An in vitro study

Abstract

Background and purpose Problems during knee extension, due to kinematic alterations, are not uncommon after total knee arthroplasty. Hinged prostheses provide higher stability than non-hinged designs and may minimize these alterations. Thus, in this in vitro study we investigated the quadriceps force required to extend the knee during an isokinetic extension cycle generating a constant extension moment after non-hinged and hinged total knee arthroplasty.

Methods Human knee specimens were tested in a kinematic knee simulator under physiological conditions, after implantation of two types of non-hinged cruciate retaining prosthesis (Gemini; Link, Germany and Interax I.S.A.; Stryker, Ireland) and a hinged prosthesis (Rotations-Knie; Link, Germany). During simulation of an extension cycle from 120° knee flexion to full extension, the change in quadriceps force to produce the constant extension moment of 31 Nm was dynamically measured using a load cell attached to the quadriceps tendon.

Results After implantation of the non-hinged pros-theses, there was no alteration in maximum quadriceps force in knee flexion compared to physiological conditions, but alteration occurred at lower flexion angle (p=0.002) and increased up to 1,257 (SD 273) N (p=0.04) in knee extension. Following implantation of the hinged prosthesis, there was no alteration in quadriceps extension force in flexion but it decreased to 690 (SD 81) N (p=0.003) in extension.

Interpretation Hinged knee prostheses restore the quadriceps lever arm in knee flexion and improve the lever arm in knee extension due to higher constraint and knee joint stability. This would offer a potential advantage for patients with weak quadriceps strength by making it easier to stabilize the knee in full extension during walking.

Contributions of authors

SO performed the test set-up, observed the test cycles, and did the biomechanical and statistical analysis. He also wrote the draft manuscript and revisions. CF initiated the study and performed implantation of the prosthetic systems. SF prepared the knee specimens and performed the test cycles. CH helped with the biomechanical and statistical analyses and revised the manuscript. CSC designed the test set-up and helped with the clinical background.