{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,23]],"date-time":"2026-03-23T11:11:20Z","timestamp":1774264280381,"version":"3.50.1"},"reference-count":26,"publisher":"Wiley","issue":"4","license":[{"start":{"date-parts":[[2024,10,24]],"date-time":"2024-10-24T00:00:00Z","timestamp":1729728000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["esskajournals.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Knee surg. sports traumatol. arthrosc."],"published-print":{"date-parts":[[2025,4]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Purpose<\/jats:title><jats:p>This work developed a novel preclinical test of total knee replacements (TKRs) in order to explain TKR instability linked to patient dissatisfaction. It was hypothesized that stability tests on the isolated moving prostheses would provide novel comparative data on the stability and kinematics among TKR designs.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Three TKR designs, DePuy Synthes Attune MS, Stryker Triathlon and Zimmer Biomet Persona MC, were assessed using a robotic arm while flexing\u2013extending 0\u2013140\u00b0. Tests imposed 710\u2009N body weight combined with three tibial loads: no anterior\u2013posterior (AP) force, 90\u2009N anterior or 90\u2009N posterior force. Other load effects were minimized and the kinematics was recorded. Each implant was tested six times to investigate the repeatability of the method. Data were analysed using statistical parametric mapping with one\u2010way analysis of variance (ANOVA). If significance was found (<jats:italic>p<\/jats:italic>\u2009&lt;\u20090.05), post hoc <jats:italic>t<\/jats:italic> tests with Bonferroni correction were used to contrast groups.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Significant differences were found throughout flexion\u2013extension. Femoral rollback, AP stability, coupled internal\u2013external rotation and AP position (roll\u2010back) were all influenced by implant design. AP stability of the TKRs reduced with flexion reaching Attune 15\u2009mm, Persona 13\u2009mm and Triathlon 21\u2009mm at 140\u00b0 flexion. Tractive rolling significantly affected kinematics in the less congruent Triathlon design, with 6\u2009mm different paths between flexion and extension motion (<jats:italic>p<\/jats:italic>\u2009&lt;\u20090.05 across 5\u2013100\u00b0). Paradoxical anterior femoral sliding in early flexion (0\u201340\u00b0) occurred in Persona and Triathlon designs.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>The novel testing technique provides, for the first time, comparative data on the inherent stability and kinematics of the TKR implants themselves across the arc of flexion\u2013extension, independent of variables including soft tissue behaviour and surgical technique. The data show how much each prosthesis can contribute to the stability and motion of the implanted knee. Similar data from a wider range of designs will enable more informed decisions regarding implant design choice, aiming to reduce the prevalence of TKR instability in patients.<\/jats:p><\/jats:sec><jats:sec><jats:title>Level of Evidence<\/jats:title><jats:p>Controlled laboratory study.<\/jats:p><\/jats:sec>","DOI":"10.1002\/ksa.12516","type":"journal-article","created":{"date-parts":[[2024,10,24]],"date-time":"2024-10-24T07:02:04Z","timestamp":1729753324000},"page":"1387-1396","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Evaluation of a novel robotic testing method for stability and kinematics of total knee arthroplasty"],"prefix":"10.1002","volume":"33","author":[{"given":"Sander R.","family":"Holthof","sequence":"first","affiliation":[{"name":"Biomechanics Group, Mechanical Engineering Department Imperial College London London UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mick","family":"Rock","sequence":"additional","affiliation":[{"name":"De Puy Synthes Ltd Beeston Leeds UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Richard","family":"van Arkel","sequence":"additional","affiliation":[{"name":"Biomechanics Group, Mechanical Engineering Department Imperial College London London UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Angela","family":"Brivio","sequence":"additional","affiliation":[{"name":"King Edward VII Hospital London UK"},{"name":"Department of Trauma and Orthopaedic Surgery Istituto Clinico Citt\u00e0 Studi Milano Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"David","family":"Barrett","sequence":"additional","affiliation":[{"name":"King Edward VII Hospital London UK"},{"name":"School of Engineering Sciences University of Southampton Southampton UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4489-1381","authenticated-orcid":false,"given":"Andrew A.","family":"Amis","sequence":"additional","affiliation":[{"name":"Biomechanics Group, Mechanical Engineering Department Imperial College London London UK"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2024,10,24]]},"reference":[{"key":"e_1_2_11_2_1","unstructured":"American Society for Testing Materials. (2020) F1223\u201020: standard test method for determination of total knee replacement constraint. West Conshoshocken PA: American Society for Testing Materials."},{"key":"e_1_2_11_3_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00167-015-3796-0"},{"key":"e_1_2_11_4_1","doi-asserted-by":"publisher","DOI":"10.1002\/jor.23477"},{"key":"e_1_2_11_5_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jbiomech.2013.01.025"},{"key":"e_1_2_11_6_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.arth.2013.04.051"},{"key":"e_1_2_11_7_1","volume-title":"Attune knee system, in attune GRADIUS curve","author":"Dalury D.F.","year":"2022"},{"key":"e_1_2_11_8_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.clinbiomech.2015.12.006"},{"key":"e_1_2_11_9_1","doi-asserted-by":"publisher","DOI":"10.1115\/1.3138397"},{"key":"e_1_2_11_10_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.arth.2017.07.021"},{"key":"e_1_2_11_11_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jbiomech.2018.03.042"},{"key":"e_1_2_11_12_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00423-003-0406-2"},{"key":"e_1_2_11_13_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.arth.2019.10.053"},{"key":"e_1_2_11_14_1","doi-asserted-by":"publisher","DOI":"10.1302\/0301-620X.105B1.BJJ-2022-0465.R2"},{"key":"e_1_2_11_15_1","doi-asserted-by":"publisher","DOI":"10.1097\/01.blo.0000214421.21712.62"},{"key":"e_1_2_11_16_1","doi-asserted-by":"publisher","DOI":"10.1002\/jor.20655"},{"key":"e_1_2_11_17_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00167-017-4622-7"},{"key":"e_1_2_11_18_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.otsr.2017.07.010"},{"key":"e_1_2_11_19_1","doi-asserted-by":"publisher","DOI":"10.1007\/s11420-011-9217-0"},{"key":"e_1_2_11_20_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00402-023-05033-3"},{"key":"e_1_2_11_21_1","doi-asserted-by":"publisher","DOI":"10.1097\/00003086-200211000-00003"},{"key":"e_1_2_11_22_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.arth.2013.07.024"},{"key":"e_1_2_11_23_1","volume-title":"Triathlon design rationale","author":"Stryker","year":"2013"},{"key":"e_1_2_11_24_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00167-020-06050-0"},{"key":"e_1_2_11_25_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0021-9290(96)00112-1"},{"key":"e_1_2_11_26_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.knee.2005.01.004"},{"key":"e_1_2_11_27_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0128877"}],"container-title":["Knee Surgery, Sports Traumatology, Arthroscopy"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/esskajournals.onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/ksa.12516","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,19]],"date-time":"2025-10-19T13:57:07Z","timestamp":1760882227000},"score":1,"resource":{"primary":{"URL":"https:\/\/esskajournals.onlinelibrary.wiley.com\/doi\/10.1002\/ksa.12516"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,10,24]]},"references-count":26,"journal-issue":{"issue":"4","published-print":{"date-parts":[[2025,4]]}},"alternative-id":["10.1002\/ksa.12516"],"URL":"https:\/\/doi.org\/10.1002\/ksa.12516","archive":["Portico"],"relation":{},"ISSN":["0942-2056","1433-7347"],"issn-type":[{"value":"0942-2056","type":"print"},{"value":"1433-7347","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,10,24]]},"assertion":[{"value":"2024-07-29","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2024-10-10","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2024-10-24","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}