Deep Flexion-Oriented Bisurface-Type Knee Joint and Its Tibial Rotation That Attributes Its High Performance of Flexion

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Abstract

In 1989, we developed an artificial knee prosthesis that could accommodate the oriental lifestyle where people would sit more often on the floor than on a chair. The knee had a bisurface feature with an auxiliary joint of a ball and socket at the center of the posterior part aiming at an improved flexional function. The auxiliary joint functions not only to facilitate a rollback movement but also to add a rotational movement. It was investigated whether this knee prosthesis could show an internal rotation of the tibia during flexion such as the physiologic movement of the knee. The internal rotation of the tibia was evaluated for the patients who could sit on legs in the oriental style after total knee arthroplasty. The average flexion angle of patients who achieved this style of sitting was 144.1°, and the average internal rotation was estimated as 14.3° by a pattern matching method using a computer-assisted design system.

Section snippets

Development of BS Knee

We considered that the idea of conventional knee prostheses with just replicating the anatomy of the natural knee joint would not be good enough when a deep flexional function is pursued with a knee prosthesis of new design. After extensive consideration, we determined to add the prosthesis a structure that specifically functions for flexion. We divided the function of the femorotibial articulation into 2 parts and made these 2 parts to have 2 separate functions, weight bearing and extra

Case Material and Method

As typical cases of deep flexion, 30 knees of 23 patients who could sit on legs in oriental sitting position (seiza) were selected of 946 joints operated between July 1997 and August 2008 for the prosthetic kinematics study of this knee. The knees were examined by lateral view of x-ray. Because there is no practical method to directly measure the prosthetic kinematics in vivo, indirect techniques have been applied. There have been various reported techniques concerning with a 3-dimensional

Results

The average flexion angles of the 946 joints operated between July 1997 and August 2008 were 132.2° before operation and 138.5° 1 month after operation. Joints with more than 130° of maximum flexion accounts for 67% before operation, and the number considerably increased to 86% 1 month after operation.

The good flexion quality of the BS knee was analyzed from the point of kinematics. Although informal sitting that shifts the feet just off to the side (Fig. 3) or cross-legged sitting (Fig. 4) was

Discussion

It has been widely accepted that deep flexion of the knee could be achieved with internal rotation of the tibia. It was affirmed that the BS knee could achieve the flexion function that was the initial objective of the development. However, the 3-dimensional presentation of kinematics, simultaneous movement of flexion, and rotation were difficult. Through the development of computer technology, this proposition found a solution using a pattern matching method. There is a concern about early

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