Improved quadriceps efficiency with a medial pivot in comparison to a cruciate-retaining design in total knee arthroplasty.

Purpose: The posterior cruciate-retaining (CR) design offers rotational freedom but risks abnormal kinematics and instability. The medial pivot (MP) design mimics native joint motion with a high-conformity medial and flat lateral interface. Within clinical studies, the MP design outclassed the CR design, but biomechanical studies are lacking. This study investigates the tibiofemoral and patellofemoral kinematics of both implant designs compared to native kinematics.

Methods: Eight fresh-frozen cadaveric knee specimens underwent total knee arthroplasty using MP and CR designs. Testing was performed in a dynamic knee rig simulating active knee flexion (30-130°) under muscle load. Biomechanical assessments included tibial rotation, tibiofemoral translation, patellar tilt/shift, patellofemoral contact/pressure patterns and quadriceps force. Functional regressions were used to analyse the effects of the component designs on the native situation.

Results: The MP design exhibited increased tibial rotation (130° flexion: MP 9.4° vs. CR 6.6°) and lateral anterior tibial translation during flexion (130° flexion: MP 25.8 mm vs. CR 22.6 mm). Both designs showed no significant differences in patellar tilt or shift and similar patellofemoral pressure (CR 3.2 MPa, MP 3.4 MPa) and contact patterns (CR 213.8 mm vs. MP 230.4 mm). The MP design required lower quadriceps force, particularly in deep flexion (NS 452.6 N, CR 407.8 N and MP 367.3 N).

Conclusion: The MP design provides a more native-like knee kinematic profile than the CR design, with a more pronounced MP motion pattern and reduced quadriceps loading.

Level Of Evidence: Not applicable.