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The Influence of Contemporary Knee Design on High Flexion: A Kinematic Comparison with the Normal Knee
Edward A. Morra, MSME1; Mircea Rosca, MSME1; Jonathan F.I. Greenwald, MFA1; A. Seth Greenwald, DPhil(Oxon)1
1 Orthopaedic Research Laboratories, Lutheran Hospital, 1730 West 25th Street, Cleveland, OH 44113. E-mail address: info@orl-inc.com
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Disclosure: In support of the research for or preparation of this work, the laboratory at which the authors work received, in any one year, equal grants in excess of $10,000 from Finsbury, Biomet, and Smith and Nephew. Neither they nor a member of their immediate families received payments or other benefits or a commitment or agreement to provide such benefits from a commercial entity. No commercial entity paid or directed, or agreed to pay or direct, any benefits to any research fund, foundation, division, center, clinical practice, or other charitable or nonprofit organization with which the authors, or a member of their immediate families, are affiliated or associated.
Note: The authors acknowledge the efforts of Melinda Harman, PhD, and Scott A. Banks, PhD, for their contribution of validation data to this project; they also thank Bernard N. Stulberg, MD, Peter J. Brooks, MD, FRCS(C), and Adolph V. Lombardi Jr., MD, for their virtual surgical reviews and clinical insights.

The Journal of Bone and Joint Surgery, Incorporated
J Bone Joint Surg Am, 2008 Nov 01;90(Supplement 4):195-201. doi: 10.2106/JBJS.H.00817
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Although >90% of total knee arthroplasties are associated with a good-to-excellent outcome, some patients have difficulty adjusting their gait to accommodate the new articulations inherent in contemporary implant designs. Paradoxical motions inclusive of anterior sliding and lateral pivot are examples of aberrant kinematics in total knee arthroplasty. A computational kinematic simulator measured the motion attained by six contemporary total knee arthroplasty designs. Results were compared with the in vivo kinematic data from healthy knees (i.e., knees with no history of surgery) in deep flexion1. Three designs employing a tibial post and a femoral cam as the motion control mechanism were evaluated, including the Legacy LPS-Flex Fixed Bearing (Zimmer, Warsaw, Indiana), the Journey (Smith and Nephew, Memphis, Tennessee), and the Vanguard PS (Biomet, Warsaw, Indiana). Three designs that did not employ a tibial post and femoral cam mechanism were also evaluated, including the MRK (Finsbury, Leatherhead, United Kingdom), the Duracon (Stryker Orthopaedics, Mahwah, New Jersey), and the Triathlon (Stryker Orthopaedics). All six designs have a fixed plateau and are currently available for clinical use in the United States.
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    These activities have been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint sponsorship of the American Academy of Orthopaedic Surgeons and The Journal of Bone and Joint Surgery, Inc. The American Academy of Orthopaedic Surgeons is accredited by the ACCME to provide continuing medical education for physicians.
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