The effect of tibial insert design on rising from a chair; motion analysis after total knee replacement

Background. There are few previous studies of sit-to-stand movement following total knee arthroplasty. Aim of the study was to test the hypotheses that total knee replacement alters the maximum trunk, hip, knee and ankle flexion–extension movements during chair rising, and that the design of the tibial plateau has small influence on the kinematics. Methods. A motion analysis system was used to evaluate kinematics of the trunk, hip, knee and ankle when rising from one chair and sitting down on another. Patients with 5° varus/valgus alignment or less received either a flat or a concave tibial insert with retention of the posterior cruciate ligament. Patients who had more malalignment and /or extension defect of 10° or more were randomized to receive the concave or a posterior-stabilized tibial component with resection of the posterior cruciate ligament. The two groups of patients operated with and without resection of the posterior cruciate ligament were analysed separately and compared with a control group. 28 patients (29 knees) and 16 controls were in the final analysis. Findings. Decreased hip and knee extension compared to the controls was seen, but there were no statistically significant differences in kinematics between the designs. Interpretation. Choice of implant design in total knee arthroplasty had no detectable effects on kinematics of hip and knee joints during sit-to-stand movement.