Joint stability is a primary concern in total knee joint replacement. The GMK Sphere prosthesis was specifically designed to provide medial compartment anterior-posterior (A-P) stability, while permitting rotational freedom of the joint through a flat lateral tibial surface. The objective of this study was to establish the changes in joint kinematics introduced by the GMK Sphere prosthesis during gait activities in comparison to conventional posterior-stabilized (PS) fixed-bearing and ultra-congruent (UC) mobile-bearing geometries. The A-P translation and internal/external rotation of three cohorts, each with 10 good outcome subjects (2.9 ± 1.6 years postop), with a GMK Sphere, GMK PS or GMK UC implant were analysed throughout complete cycles of gait activities using dynamic videofluoroscopy. The GMK Sphere showed the smallest range of medial compartment A-P translation for level walking, downhill walking, and stair descent (3.6 ± 0.9 mm, 3.1 ± 0.8 mm, 3.9 ± 1.3 mm), followed by the GMK UC (5.7 ± 1.0 mm, 8.0 ± 1.7 mm, 8.7 ± 1.9 mm) and the GMK PS (10.3 ± 2.2 mm, 10.1 ± 2.6 mm, 11.6 ± 1.6 mm) geometries. The GMK Sphere exhibited the largest range of lateral compartment A-P translation (12.1 ± 2.2 mm), and the largest range of tibial internal/external rotation (13.2 ± 2.2°), both during stair descent. This study has shown that the GMK Sphere clearly restricts A-P motion of the medial condyle during gait activities while still allowing a large range of axial rotation. The additional comparison against the conventional GMK PS and UC geometries, not only demonstrates that implant geometry is a key factor in governing tibio-femoral kinematics, but also that the geometry itself probably plays a more dominant role for joint movement than the type of gait activity. © 2019 The Authors. Journal of Orthopaedic Research® published by Wiley Periodicals, Inc. on behalf of Orthopaedic Research Society. J Orthop Res 37:2337-2347, 2019.

1st Orthopaedic Clinic Faculty of Medicine Charles University Prague Czech Republic

Institute for Biomechanics D HEST ETH Zurich Zurich Switzerland

Klinik für Orthopädie und Traumatologie Winterthur Cantonal Hospital Winterthur Switzerland

Orthopaedics Balgrist University Hospital Zürich Switzerland

The Royal London Hospital London United Kingdom

J Orthop Res. 2020 Sep;38(9):2083. doi: 10.1002/jor.24703. PubMed

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Dennis DA, Komistek RD, Mahfouz MR. 2003. In vivo fluoroscopic analysis of fixed‐bearing total knee replacements. Clin Orthop Relat Res 410:114–130. PubMed

Blaha JD. 2004. The rationale for a total knee implant that confers anteroposterior stability throughout range of motion. J Arthroplasty 19:22–26. PubMed

Pritchett JW. 2011. Patients prefer a bicruciate‐retaining or the medial pivot total knee prosthesis. J Arthroplasty 26:224–228. PubMed

Pitta M, Esposito CI, Li Z, et al. 2017. Failure after modern total knee arthroplasty: a prospective study of 18,065 knees. J Arthroplasty 33:407–414. PubMed PMC

Iwaki H, Pinskerova V, Freeman MA. 2000. Tibiofemoral movement 1: the shapes and relative movements of the femur and tibia in the unloaded cadaver knee. J Bone Joint Surg Br 82:1189–1195. PubMed

Scott G, Imam MA, Eifert A, et al. 2016. Can a total knee arthroplasty be both rotationally unconstrained and anteroposteriorly stabilised? A pulsed fluoroscopic investigation. Bone Joint Res 5:80–86. PubMed PMC

Andriacchi TP, Galante JO, Fermier RW. 1982. The influence of total knee‐replacement design on walking and stair‐climbing. J Bone Joint Surg Am 64:1328–1335. PubMed

Stacoff A, Diezi C, Luder G, et al. 2005. Ground reaction forces on stairs: effects of stair inclination and age. Gait Posture 21:24–38. PubMed

McIntosh AS, Beatty KT, Dwan LN, et al. 2006. Gait dynamics on an inclined walkway. J Biomech 39:2491–2502. PubMed

Taylor WR, Ehrig RM, Duda GN, et al. 2005. On the influence of soft tissue coverage in the determination of bone kinematics using skin markers. J Orthop Res 23:726–734. PubMed

Andriacchi TP, Alexander EJ, Toney MK, et al. 1998. A point cluster method for in vivo motion analysis: applied to a study of knee kinematics. J Biomech Eng 120:743–749. PubMed

Capozzo A, Della Croce U, Leardini A, et al. 2005. Human movement analysis using stereophotogrammetry Part 1: theoretical background. Gait Posture 21:186–196. PubMed

Hill PF, Vedi V, Williams A, et al. 2000. Tibiofemoral movement 2: the loaded and unloaded living knee studied by MRI. J Bone Joint Surg Br 82:1196–1198. PubMed

Freeman MA, Pinskerova V. 2003. The movement of the knee studied by magnetic resonance imaging. Clin Orthop Relat Res 410:35–43. PubMed

Johal P, Williams A, Wragg P, et al. 2005. Tibio‐femoral movement in the living knee. A study of weight bearing and non‐weight bearing knee kinematics using ‘interventional’ MRI. J Biomech 38:269–276. PubMed

Karrholm J, Brandsson S, Freeman MA. 2000. Tibiofemoral movement 4: changes of axial tibial rotation caused by forced rotation at the weight‐bearing knee studied by RSA. J Bone Joint Surg Br 82:1201–1203. PubMed

Wolterbeek N, Garling EH, Mertens BJ, et al. 2012. Kinematics and early migration in single‐radius mobile‐ and fixed‐bearing total knee prostheses. Clin Biomech (Bristol, Avon) 27:398–402. PubMed

Komistek RD, Dennis DA, Mahfouz M. 2003. In vivo fluoroscopic analysis of the normal human knee. Clin Orthop Relat Res 410:69–81. PubMed

Hamai S, Moro‐oka TA, Dunbar NJ, et al. 2013. In vivo healthy knee kinematics during dynamic full flexion. BioMed Res Int 2013:717546. PubMed PMC

Grieco TF, Sharma A, Dessinger GM, et al. 2017. In vivo kinematic comparison of a bicruciate stabilized total knee arthroplasty and the normal knee using fluoroscopy. J Arthroplasty 33:565–571. PubMed

Banks SA, Hodge WA. 1996. Accurate measurement of three‐dimensional knee replacement kinematics using single‐plane fluoroscopy. IEEE Trans Biomed Eng 43:638–649. PubMed

Lafortune MA, Cavanagh PR, Sommer HJ, et al. 1992. 3‐Dimensional Kinematics of the Human Knee During Walking. J Biomech 25:347–357. PubMed

Lafortune MA. 1984. The use of intra‐cortical pins to measure the motion of the knee joint during walking (PhD thesis). Pennsylvania: The Pennsylvania State University.

Reinschmidt C, vandenBogert AJ, Lundberg A, et al. 1997. Tibiofemoral and tibiocalcaneal motion during walking: external vs. skeletal markers. Gait Posture 6:98–109.

Guan S, Gray HA, Keynejad F, et al. 2016. Mobile biplane X‐ray imaging system for measuring 3D dynamic joint motion during overground gait. IEEE Trans Med Imaging 35:326–336. PubMed

List R, Postolka B, Schutz P, et al. 2017. A moving fluoroscope to capture tibiofemoral kinematics during complete cycles of free level and downhill walking as well as stair descent. PLoS ONE 12:e0185952. PubMed PMC

Schütz P, Postolka B, Gerber H, et al. 2019. Knee implant kinematics are task‐dependent. J R Soc Interface 16:20180678. PubMed PMC

Guan S, Gray HA, Schache AG, et al. 2017. In vivo six‐degree‐of‐freedom knee‐joint kinematics in overground and treadmill walking following total knee arthroplasty. J Orthop Res 35:1634–1643. PubMed

Taylor WR, Schutz P, Bergmann G, et al. 2017. A comprehensive assessment of the musculoskeletal system: The CAMS‐Knee data set. J Biomech 65:32–39. PubMed

List R, Gerber H, Foresti M, et al. 2012. A functional outcome study comparing total ankle arthroplasty (TAA) subjects with pain to subjects with absent level of pain by means of videofluoroscopy. Foot Ankle Surg 18:270–276. PubMed

Foresti M. 2009. In vivo measurement of total knee joint replacement kinematics and kinetics during stair descent (PhD thesis). Zurich: ETH Zurich.

Gerber H, Foresti M, Zihlmann M, et al. 2007. Method to simultaneously measure kinetic and 3D kinematic data during normal level walking using KISTLER force plates, VICON System and video‐fluoroscopy. J Biomech 40:S405–S405.

Zihlmann MS, Gerber H, Stacoff A, et al. 2006. Three‐dimensional kinematics and kinetics of total knee arthroplasty during level walking using single plane video‐fluoroscopy and force plates: a pilot study. Gait Posture 24:475–481. PubMed

List R, Foresti M, Gerber H, et al. 2012. Three‐dimensional kinematics of an unconstrained ankle arthroplasty: a preliminary in vivo videofluoroscopic feasibility study. Foot Ankle Int 33:883–892. PubMed

Burckhardt K, Szekely G, Notzli H, et al. 2005. Submillimeter measurement of cup migration in clinical standard radiographs. IEEE Trans Med Imaging 24:676–688. PubMed

Grood ES, Suntay WJ. 1983. A joint coordinate system for the clinical description of three‐dimensional motions: application to the knee. J Biomech Eng 105:136–144. PubMed

Kozanek M, Hosseini A, Liu F, et al. 2009. Tibiofemoral kinematics and condylar motion during the stance phase of gait. J Biomech 42:1877–1884. PubMed PMC

Dennis D, Komistek R, Scuderi G, et al. 2001. In vivo three‐dimensional determination of kinematics for subjects with a normal knee or a unicompartmental or total knee replacement. J Bone Joint Surg Am 83:104–115. PubMed

Pinskerova V, Johal P, Nakagawa S, et al. 2004. Does the femur roll‐back with flexion? J Bone Joint Surg Br 86:925–931. PubMed

Hitz M, Schutz P, Angst M, et al. 2018. Influence of the moving fluoroscope on gait patterns. PLoS ONE 13:e0200608. PubMed PMC