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J Knee Surg 2019; 32(08): 710-713
DOI: 10.1055/s-0039-1681030
Special Focus Section
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

A Cam–Post Mechanism Is No Longer Necessary in Modern Primary Total Knee Arthroplasty

R. Michael Meneghini
1   Department of Orthopaedic Surgery, Indiana University Hip & Knee Center, Indiana University School of Medicine, Fishers, Indiana
,
Michael D. Stefl
1   Department of Orthopaedic Surgery, Indiana University Hip & Knee Center, Indiana University School of Medicine, Fishers, Indiana
,
W. Andrew Hodge
2   Department of Orthopaedic Surgery, Institute for Mobility and Longevity, Phoenix, Arizona
,
Scott A. Banks
3   Department of Mechanical and Aerospace Engineering, University of Florida, Gainesville, Florida
› Author Affiliations
Further Information

Publication History

23 December 2018

10 January 2019

Publication Date:
01 March 2019 (online)

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Abstract

Conclusive evidence supporting a clinical difference between posterior-stabilized (PS) and cruciate-retaining (CR) designs in total knee arthroplasty (TKA) does not currently exist, despite both designs being used for decades. Proponents of PS designs that employ a cam-and-post mechanism cite in vivo fluoroscopic data that demonstrate improved posterior rollback; however, optimal rollback has never been correlated to superior clinical outcomes. Recently, anterior-lipped and more conforming CR bearings, such as ultracongruent, medial pivot, and dual-pivot designs, have been used to substitute for the posterior cruciate ligament and obviate the need for the cam–post mechanism of a traditional PS design. Advantages of avoiding a PS TKA include eliminating the risk of box cut induced femoral condylar fracture, improving operative efficiency by removing procedural steps, removing the articulation that is a source of wear, postdeformation, breakage, or dislocation, and eliminating patellar clunk. Health care reform efforts mandate cost reduction, and procedural efficiencies and minimizing inventory through the removal of unnecessary bearing options foster that initiative.

Keywords

knee kinematics - cam–post - total knee arthroplasty - posterior-stabilized articulations
 

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