Rotational Constraint in Posterior-Stabilized Total Knee Prostheses

Rotational stresses from box-post impingement have been implicated in the loosening of posterior-stabilized total knee prostheses. A bench model was constructed to assess the forces generated by tibiofemoral rotation. Rotational torque under load was measured in two different posteriorstabilized total knee prostheses using an axial-torsion load cell at 0°, 20°, and 40° flexion over 20° internal and external rotation. The Sigma posterior-stabilized prosthesis generated little torque through 5° internal and external rotation. An increase in torque then occurred because of box-post impingement, generating peak torques of 17 to 18 N-m at 12° to 14° rotation. The bench model produced the same deformation of the polyethylene post as seen on retrieved specimens. The Scorpio posterior-stabilized prosthesis had a relatively continuous rise in generated torque from tibiofemoral conformity. Box-post impingement did not occur resulting in 32% lower torque between 12° and 14° rotation. Peak rotational torques of 15 to 16 N-m were reached at 19° to 20° rotation. Tibiofemoral conformity is the primary source of rotational constraint. Box-post impingement can be a source of additional rotational constraint. Depending on specific design features, small changes in relative tibiofemoral component rotation can more than double the generated torque. Axial rotation of the knee in vivo can generate substantial torque. Relative tibiofemoral rotational position is an important factor influencing component function and fixation.