BIOMECHANIC

S
OF
NORMAL
&
REPLACED KNEE
 BIOMECHANICS

KNEE :Force closed

mechanism
HIP :Self closed
mechanism
 The Axis Of Lower
Limb
•Vertical Axis
•Mechanical Axis
•Anatomical Axis of Femur
•Anatomical Axis of Tibia
Tibio-Femoral
Motion
•Flexion –
Extension
•Abduction –
Adduction
•Internal –
External
Rotation
 FLEXION -
EXTENSION

Instantaneous centre of
motion
 FLEXION -
EXTENSION

Instantaneous
Instantaneous center
center
pathway
pathway
Sliding/Rocking
 FLEXION -
EXTENSION

Sliding/Rocking of femur
Gliding/Rolling
 FLEXION -
EXTENSION

Gliding/Rolling of femur
 FLEXION -
EXTENSION

Knee glides & Slides

Rocks & Rolls!
ROTATION OF KNEE
••Screw
Screw home
home
movement
movement
••Rotation
Rotation increases
increases as
as
knee
knee is
is flexed
flexed
••Arc
Arc ranges
ranges 30
30 –– 60
60
Abduction - Adduction
• Normal angulation
of 7 Degrees with
knee extended
• Motion permitted
by cruciate and
collaterals
• No movement in
flexion
 F TO
F
Flexion
40

Extensi 40
on
HS HO
Flexion -
Extension

• Sit & Rise

from a chair
90 -110
degrees
 Flexion -
Extension

• Descending stairs 90 degrees

 Flexion -
Extension

• Ascending stairs 82 degrees

Int – Ext Rotation
•• Normal
Normal 30-60
30-60 Degrees
Degrees
•• 13
13 degrees
degrees inin normal
normal
walking
walking
•• More
More in
in stair
stair walking
walking
•• More
More on
on rough
rough ground
ground
walking
walking
 Loads Applied to
Knee

• 3X - in Level Walking
• 4X – in Stair Climbing
• Area of Contact is less in Flexion
• Medial side bears
bears more
more weight
STABILITY
• Surface
geometry
• Muscles crossing
the joint
• Ligaments and
capsule
• Menisci
 SURFACE
GEOMETRY

Femur
Femur is is convex
convex
Tibia
Tibia is
is concave
concave medially
medially
Tibia
Tibia is
is convex
convex laterally
laterally
Tibial
Tibial eminence
eminence aidsaids in
in stability
stability
 MUSCLE
S

••Resists
Resists deforming
deforming force
force
••Resists
Resists slow
slow forces
forces
••Increase
Increase joint
joint
compression
compression
••Increase
Increase stability
stability
LIGAMENTS

•Resists motion
•Resists translatory
movement
•Resists excessive rotation
MENISCUS

•Joint conformity
•Varus valgus
stability
•Resists translation
 IDEAL KNEE
•• Extends
Extends fully
fully &
& achieves
achieves excellent
excellent stability
stability

•• Flexes
Flexes beyond
beyond 110
110 &
& still
still retains
retains stability
stability

•• Gliding
Gliding and
and sliding
sliding occurs
occurs simultaneously
simultaneously

•• Allows
Allows more
more rotation
rotation as
as knee
knee flexes
flexes

•• Articular
Articular contact
contact maximum
maximum throughout
throughout range
range
 IDEAL KNEE
• Reduplicate the function of menisci
• Reduplicate the function of cruciates
• Achieve excellent ligament balance
• Have anatomic femur & tibial surface
RESTORATION OF
MECHANICAL AXIS
RESTORATION
RESTORATION OF
MECHANICAL
MECHANICAL AXIS
AXIS

Perpendicular
to the
Mechanical &
Anatomical
axis of the
BIOMECHANICS OF
TKR

Should
none, one or
both
cruciate
ligaments be
 ACL & PCL
SACRIFICED
• Conforming
concave surface of
tibia producing
inherent stability
• Long term results
from HSS still
remains the gold
standard
 TOTAL CONDYLAR
DESIGNS

• Limited knee motion

• Tibial component
subluxated posteriorly
• Stair climbing was
difficult
TOTAL CONDYLAR
DESIGNS
 RETAIN THE PCL
•• PCL
PCL roll
roll back
back in
in flexion
flexion

•• Roll
Roll back
back needs
needs flat
flat tibial
tibial surface
surface
ROLL BACK WITH PCL
 RETAIN THE PCL
 More arc of
motion
 Intact PCL
prevents post
subluxation of
tibia
 Stability is
increased
 Decreased
 RETAIN THE PCL

• Proprioception is better

• Retention of PCL helps in

maintaining the joint line
Why surgeon sacrifices
PCL?

• Minimum tibial resection

• Easier surgical technique
• Easier correction of
deformity
PCL
SUBSTITUTI
NG KNEE

• Spine & Cam mechanism

• Produces roll back
• Prevents posterior subluxation
PCL
SUBSTITUTING
KNEE• Anterior tibial subluxation
not prevented
• Does not substitute
collaterals
• Posterior slope in tibia
necessary
PCL
SUBSTITUTING
KNEE
PCL
SUBSTITUTING
KNEE
•• Bad
Bad for
for valgus
valgus knee
knee
•• Wear
Wear of
of spine
spine
•• Bone
Bone loss
loss
PCL SUBSTITUTING
KNEE

Can we substitute the PCL by

ultra congruent insert ?
PCL SUBSTITUTING
KNEE
• Patellectomy
• Old PCL injury
• Over release of PCL
• Inflammatory
conditions ?
MENISCAL BEARING
KNEE

•• ACL,
ACL, PCL
PCL retaining
retaining
•• PCL
PCL retaining
retaining
ROTATING PLATFORM
KNEE
• Cruciate sacrificing

• Spin off

• Undersurface wear
 FEMUR
• Anatomic
• Decrease
radius of
curvature
posteriorly
EXTERNAL ROTATION OF
FEMUR
EXTERNAL ROTATION OF
FEMUR
EXTERNAL ROTATION OF
FEMUR
TIBIAL
TRAY
• Concave conforming
• No rotation in extension
• Intercondylar eminence to prevent
translocation
• Anterior Posterior margin equal
height
TIBIAL
TRAY

• Anatomic
PATELLA
PATELLA
Recent thoughts…
•• Adductor
Adductor moment
moment
•• Rotatory
Rotatory arthritis
arthritis of
of
knee
knee (RAK)
(RAK)
•• Does
Does tibia
tibia really
really slope
slope
posteriorly?
posteriorly?
Adductor Moment
Rotatory Arthritis of Knee

• Deformities in Knee are

triplanar – frontal,
saggital & coronal
• ACL ‘s role
• Soft tissue involvement
Posterior slope of tibia