Lack of Axial Rotation in Mobile-bearing Knee Designs

It has often been assumed rotational kinematics are improved with mobile-bearing TKA designs as the terms mobile-bearing and rotating platform imply. We tested this assumption by assessing the in vivo axial rotation magnitudes and patterns of 527 knees implanted with 12 different mobile-bearing TKA designs. Implants were grouped and compared by type—posterior stabilized (PS), posterior cruciate retaining (PCR), and posterior cruciate sacrificing (PCS)—and by specific design. We hypothesized all three mobile-bearing types (PS, PCR, and PCS) would achieve greater than 10° average axial rotation and we would find no differences in axial rotation between types. Only 14% of PS knees, 3% of PCS knees, and 17% of PCR knees attained greater than 10° axial rotation when measured from 0° to 90°. The percentage of PCS knees with greater than 10° axial rotation was less compared with the other two groups. Axial rotation averaged 4.3°, 2.5°, and 3.8° for the PS, PCS, and PCR knees, respectively. Incidences of reverse rotation were observed in 17% of PS knees, 32% of PCS knees, and 28% of PCR knees. Compared with the PCS group, the PS group achieved greater average axial rotation and had a lower percentage of knees displaying incidences of reverse rotation. The data refuted the hypotheses.