Mechanism of Anterior Impingement Damage in Total Knee Arthroplasty by Scott A. Banks, Melinda K. Harman, and W. Andrew Hodge J Bone Joint Surg Am Volume.

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Mechanism of Anterior Impingement Damage in Total Knee Arthroplasty by Scott A. Banks, Melinda K. Harman, and W. Andrew Hodge J Bone Joint Surg Am Volume 84(suppl 2):S37-S42 November 1, 2002 ©2002 by The Journal of Bone and Joint Surgery, Inc.

Damage on the anterior part of the post of a retrieved PCL-substituting polyethylene tibial insert. Scott A. Banks et al. J Bone Joint Surg Am 2002;84:S37- S42 ©2002 by The Journal of Bone and Joint Surgery, Inc.

Both PCL-retaining (Fig. 2-A and 2-B) and PCL-substituting (Fig. 2-C and 2-D) designs from many different implant manufacturers show symmetrical deformation (arrows) on the tibial spine or anterior part of the post at retrieval. Scott A. Banks et al. J Bone Joint Surg Am 2002;84:S37- S42 ©2002 by The Journal of Bone and Joint Surgery, Inc.

Femoral component impingement can cause delamination, forming a shallow groove on the anterior part of the tibial post. Scott A. Banks et al. J Bone Joint Surg Am 2002;84:S37- S42 ©2002 by The Journal of Bone and Joint Surgery, Inc.

Fig. 4-A With knee flexion, there is no contact between the femoral component and the anterior part of the tibial eminence. Scott A. Banks et al. J Bone Joint Surg Am 2002;84:S37- S42 ©2002 by The Journal of Bone and Joint Surgery, Inc.

Implant flexion angle exceeded 0° (hyperextension) during the gait cycle in some patients, independent of the prosthesis design implanted. Scott A. Banks et al. J Bone Joint Surg Am 2002;84:S37- S42 ©2002 by The Journal of Bone and Joint Surgery, Inc.

Fig. 6-A Fluorscopic image, made at heel-strike, of a knee with a mobile-bearing translating and rotating cruciate-retaining prosthesis. Scott A. Banks et al. J Bone Joint Surg Am 2002;84:S37- S42 ©2002 by The Journal of Bone and Joint Surgery, Inc.

Fig. 7-A Prostheses are not aligned perpendicular to the mechanical axis of the bones. Scott A. Banks et al. J Bone Joint Surg Am 2002;84:S37- S42 ©2002 by The Journal of Bone and Joint Surgery, Inc.

Fig. 8-A External goniometric measurements of the knee angle reflect the bone alignment, not the implant alignment. Scott A. Banks et al. J Bone Joint Surg Am 2002;84:S37- S42 ©2002 by The Journal of Bone and Joint Surgery, Inc.

An external marker-based tracking system measured bone position, and a fluoroscopy system tracked the position of the implants as the patients walked on a treadmill. Scott A. Banks et al. J Bone Joint Surg Am 2002;84:S37- S42 ©2002 by The Journal of Bone and Joint Surgery, Inc.

The knee flexion angle was 10° more extended throughout the entire gait cycle when measured with use of the implant position compared with the bone position. Scott A. Banks et al. J Bone Joint Surg Am 2002;84:S37- S42 ©2002 by The Journal of Bone and Joint Surgery, Inc.

External goniometry of the skeletal landmarks and fluoroscopic images of the implant position were used to measure knee flexion during kneeling. Scott A. Banks et al. J Bone Joint Surg Am 2002;84:S37- S42 ©2002 by The Journal of Bone and Joint Surgery, Inc.