ArticleKnee surgery, sports traumatology, arthroscopy : official journal of the ESSKA2019
Asymmetric polyethylene inserts promote favorable kinematics and better clinical outcome compared to symmetric inserts in a mobile bearing total knee arthroplasty.
Article in Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA, 2019. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 15 papers.
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15 citing papers in PubMed, 28 citations in OpenAlex.
- Increased varus deformity requires greater personalisation of alignment: A finite element biomechanical study.Journal of experimental orthopaedics · 2025Article
- Effect of design and surgical parameters variations in mobile-bearing versus fixed-bearing unicompartmental knee arthroplasty: A finite element analysis.Journal of experimental orthopaedics · 2024Article
- A new gap balancing technique with functional alignment in total knee arthroplasty using the MAKO robotic arm system: a preliminary study.BMC surgery · 2024Article
- Biomechanical analysis of patient specific cone vs conventional stem in revision total knee arthroplasty.Journal of orthopaedic surgery and research · 2024Article
- Article
- Biomechanical analysis of different levels of constraint in TKA during daily activities.Arthroplasty (London, England) · 2023Article
- Application strategy of finite element analysis in artificial knee arthroplasty.Frontiers in bioengineering and biotechnology · 2023Review
- Mobile medial pivot (lateral slide) type total knee arthroplasty exhibits a medial pivot pattern: three-dimensional motion analysis using cadaveric knees.Journal of experimental orthopaedics · 2022Article
- Evaluation of double-high insert mid-term outcomes in cruciate-retaining medial-pivotal total knee arthroplasty - a propensity score-matched analysis with averaged 8-year follow-up.BMC musculoskeletal disorders · 2022Article
- Mid-term clinical outcomes and survivorship of medial-pivot total knee arthroplasty-a mean five year follow-up based on one thousand, one hundred and twenty eight cases.International orthopaedics · 2021Article
- Assessment of paradoxical anterior translation in a CR total knee prosthesis coupling dynamic RSA and FE techniques.Journal of experimental orthopaedics · 2021Article
- High congruency MB insert design: stabilizing knee joint even with PCL deficiency.Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA · 2020Article
- The effect of different insert design congruencies on the kinematics of a mobile bearing TKA: A cadaveric study.Journal of orthopaedicsArticle
- Experimental and clinical analysis of the use of asymmetric vs symmetric polyethylene inserts in a mobile bearing total knee arthroplasty.Journal of orthopaedicsArticle
- Change in knee biomechanics during squat and walking induced by a modification in TKA size.Journal of orthopaedicsArticle
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Authors and funding
3 authors at 1 institution in 1 country.
Funding
Abstract
purposeThis study aims at comparing the effects of symmetric and asymmetric designs for the polyethylene insert currently available and also for mobile bearing total knee arthroplasty (TKA). The investigation was performed both clinically and biomechanically through finite element analysis.
methods303 patients, with a mobile bearing TKA, were analyzed retrospectively. All patients received the same femoral and tibial components; for the insert, 151 patients received a symmetric design (SD) and 152 an asymmetric design (AD). Additionally, a 3D finite element model of a lower leg was developed, resurfaced with the same TKAs and analysed during gait and squat activities. TKA kinematics, and bone-stresses were investigated for the two insert solutions.
resultsAfter surgery, patients' average flexion improved from 105°, with 5° of preoperative extension deficit, to 120° (AD-group) and 115° (SD-group) at the latest follow-up. There was no postoperative extension deficit. No pain affected the AD-group, while an antero-lateral pain was reported in some patients of the SD-group. Patients of the AD-group presented a better ability to perform certain physical routines. Biomechanically, the SD induced higher tibial-bone stresses than the AD. Both designs replicated similar kinematics, comparable to literature. However, SD rotates more on the tray, reducing the motion between femoral and polyethylene components, while AD permits greater insert rotation.
conclusionThe biomechanical analysis justifies the clinical findings. TKA kinematics is similar for the two designs, although the asymmetric solution shows less bone stress, thus resulting as more suitable to be cemented, avoiding lift-off issues, inducing less pain. Clinically, and biomechanically, an asymmetric mobile bearing insert could be a valid alternative to symmetric mobile bearing insert. LEVEL OF EVIDENCE: Case-control study retrospective comparative study, III.
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