A Dual-Pivot Pattern Simulating Native Knee Kinematics Optimizes Functional Outcomes After Total Knee Arthroplasty

Abstract

Background: Few studies on kinematics correlate patterns to functional outcomes after total knee arthroplasty (TKA). The purpose of this study was to determine if lateral pivot motion in early flexion and medial pivot in high flexion, simulating native knee kinematics, produces superior clinical outcomes. A second objective was to determine if specific kinematic patterns produce superior outcomes.

Methods: One hundred twenty consecutive TKAs were performed using sensor trials to record intraoperative knee kinematics. Lateral and medial pivot pattern designations were based on the center of rotation within 3 flexion zones: 0°-45° (early), 45°-90°, and 90° to full flexion (late). Knee Society Scores, pain scores, and patient satisfaction were analyzed in relation to kinematic patterns.

Results: Knee Society function scores were higher in TKAs with early lateral pivot/late medial pivot intraoperative kinematics compared to all other kinematic patterns (P = .018), and there was a greater decrease in the proportion who reported that their knee never feels normal (P = .011). Early lateral/late medial pivot had greater function scores at 1-year (P < .001) and improvement from preoperative baseline (P = .008) compared to those with the least ideal pattern. All patients with the most ideal pattern compared to none of the least ideal pattern reported they were very satisfied (P = .003).

Conclusion: Patients with an intraoperative early lateral pivot pattern followed by medial pivot motion in later flexion, reported higher functional outcome scores along with higher overall patient satisfaction. Replicating the dual-pivot kinematic pattern observed in native knees may improve function and satisfaction after TKA.

Keywords: kinematics; lateral-pivot; medial-pivot; patient-reported outcomes; sensors; total knee arthroplasty.