Are undesirable contact kinematics minimized after kinematically aligned total knee arthroplasty? An intersurgeon analysis of consecutive patients In vivo kneeling biomechanics after posterior stabilized total knee arthroplasty In vivo kinematic comparison of posterior cruciate-retaining and posterior stabilized total knee arthroplasties under passive and weight-bearing conditions. Do we need a gender-specific total knee replacement? A randomised controlled trial comparing a high-flex and a gender-specific posterior design. In vivo deep-flexion kinematics in patients with posterior-cruciate retaining and anterior-cruciate substituting total knee arthroplasty. Kinematics of a highly congruent mobile-bearing total knee prosthesis Prosthesis alignment affects axial rotation motion after total knee replacement: a prospective in vivo study combining computed tomography and fluoroscopic evaluations Comparison between standard and high-flexion posterior-stabilized rotating-platform mobile-bearing total knee arthroplasties: a randomized controlled study. Does ligament balancing technique affect kinematics in rotating platform, PCL retaining knee arthroplasties? After Partial Knee Replacement, Patients Can Kneel, But They Need to Be Taught to Do So: A Single-Blind Randomized Controlled Trial Does the Dual-Mobility Hip Prosthesis Produce Better Joint Kinematics During Extreme Hip Flexion Task? Contact Kinematic Differences Between Gap Balanced vs Measured Resection Techniques for Single Radius Posterior-Stabilized Total Knee Arthroplasty. Kinematics and early migration in single-radius mobile- and fixed-bearing total knee prostheses. Changed gait pattern in patients with total knee arthroplasty but minimal influence of tibial insert design Preservation of the posterior cruciate ligament is not helpful in highly conforming mobile-bearing total knee arthroplasty: a randomized controlled study Knee Arthroplasty With a Medially Conforming Ball-and-Socket Tibiofemoral Articulation Provides Better Function Patient preferences in knee prostheses.
Purpose Tibiofemoral contact kinematics or knee implant motions have a direct influence on patient function and implant longevity and should be evaluated for any new alignment technique such as kinematically aligned total knee arthroplasty ( TKA ) . Edge loading of the tibial liner and external rotation ( reverse of normal ) and adduction of the tibial component on the femoral component are undesirable contact kinematics that should be minimized . Accordingly , this study determined whether the overall prevalence of undesirable contact kinematics during st and ing , mid kneeling near 90 degrees and full kneeling with kinematically aligned TKA are minimal and not different between groups of consecutive patients treated by different surgeons . Methods Three surgeons were asked to perform cemented , kinematically aligned TKA with patient-specific guides in a consecutive series of patients with their preferred cruciate-retaining ( CR ) implant .  In vivo tibiofemoral contact positions were obtained using a 3- to 2-dimensional image registration technique in 69 subjects ( Vanguard CR – TKA N = 22 , and Triathlon CR – TKA N = 47 ) . Results Anterior or posterior edge loading of the tibial liner was not observed . The overall prevalence of external rotation of the tibial component on the femoral component of 6 % was low and not different between surgeons ( n.s . ) . The overall prevalence of adduction of the tibial component on the femoral component of 4 % was low and not different between surgeons ( n.s . ) . Conclusions Kinematically aligned TKA minimized the undesirable contact kinematics of edge loading of the tibial liner , and external rotation and adduction of the tibial component on the femoral component during st and ing and kneeling , which suggests an optimistic prognosis for durable long-term function . Level of evidence III Background Kneeling is one of the activities sought by patients after total knee arthroplasty ( TKA ) . This study investigated the six degrees of freedom ( DOF ) kinematics and three-dimensional ( 3D ) contact during weight-bearing kneeling . Methods A total of 16 South Korean female patients ( 22 knees ) after posteriorly stabilized ( PS ) TKA ( LPS-Flex ) were r and omly recruited and had the same surgeon . The patients were imaged using a dual fluoroscopic technique while they kneeled from initial to maximum flexion . The acquired images and 3D models were then used to recreate the in vivo pose of the components . Contact was determined by locating the surface intersections in the tibiofemoral and cam/post ( between the femoral cam and tibial post ) articular compartments . Results Patients flexed , on average , from 107.3 ° to 128.0 ° during the kneeling activity . Changes in kinematics included 1.0 mm of proximal , 0.9 mm of medial , and 7.6 mm of posterior translation and 1.7 ° of varus rotation ( P < 0.04 ) . A difference in internal tibial rotation was not detected . Articular contact moved posteriorly by 5.9 mm and 6.4 mm in the medial and lateral compartments , respectively . Contact also moved medially by 3.2 mm and 5.8 mm in the medial and lateral compartments . A decrease in articular contact was observed in both condyles , and lateral condylar lift-off increased with flexion ( P = 0.0001 ) . More than 80 % of the patients demonstrated cam/post engagement , which always occurred in the distal portion of the post . Conclusions In this patient cohort , the knee joint was constrained during the weight-bearing activity such that femoral subluxation and dislocation were not observed . Furthermore , posterior cam/post engagement occurred only in the distal portion of the tibial post , which may improve the longevity of the post . The tibiofemoral and cam/post articular contact data presented in this study further suggest that kneeling may be performed by patients after clinical ly successful PS TKA who feel comfortable with the activity and are free of pain An in vivo comparison of flexion kinematics for  posterior cruciate-retaining ( PCR ) and posterior stabilized ( PS ) total knee arthroplasty ( TKA ) was performed . Twenty patients who underwent bilateral paired TKAs were included in this prospect i ve study . Both PCR and PS prostheses were from the same TKA series with comparable surface geometries , and all were implanted by a single surgeon . Of these 20 patients , 3-dimensional kinematics during flexion could be analyzed using a computer model fitting technique in 18 patients . The follow-up period ranged from 18 to 53 months . In the PCR TKA , an anterior femoral translation from 30 degrees to 60 degrees of flexion was observed in the weight-bearing condition . In contrast , flexion kinematics for the PS TKA was characterized by the maintenance of a constant contact position under weight-bearing conditions and posterior femoral rollback in passive flexion The purpose of this study was to investigate whether a gender-specific high-flexion posterior-stabilised ( PS ) total knee replacement ( TKR ) would offer advantages over a high-flex PS TKR regarding range of movement ( ROM ) , ' feel ' of the knee , pain and satisfaction , as well as during activity . A total of 24 female patients with bilateral osteoarthritis entered this prospect i ve , blind r and omised trial in which they received a high-flex PS TKR in one knee and a gender-specific high-flexion PS TKR in the other knee . At follow-up , patients were assessed clinical ly measuring ROM , and question ed about pain , satisfaction and daily ' feel ' of each knee . Patients underwent gait analysis pre-operatively and at one year , which yielded kinematic , kinetic and temporospatial parameters indicative of knee function during gait . At final follow-up we found no statistically significant differences in ROM ( p = 0.82 ) . The median pain score was 0 ( 0 to 8) in both groups ( p = 0.95 ) . The median satisfaction score was 9 ( 4 to 10 ) in the high-flex group and 8 ( 0 to 10 ) in the gender-specific group ( p = 0.98 ) . The median ' feel ' score was 9 ( 3 to 10 ) in the high-flex group and 8 ( 0 to 10 ) in the gender-specific group ( p = 0.66 ) . Gait analysis showed no statistically significant differences between the two prosthetic design s in any kinematic , kinetic or temporospatial parameters . Both design s produced good clinical results with significant improvements in several gait parameters without evidence of any advantage in the gender-specific design BACKGROUND Posterior-cruciate ligament retaining total knee arthroplasty design s have long been used with excellent clinical success , but often have shown kinematics and flexion performance that are significantly different from the natural knee . The purpose of this study was to compare deep-flexion knee kinematics in patients with two types of posterior-cruciate ligament retaining total knee arthroplasty .  METHODS One group received a traditional curved symmetric articular configuration , and one group received a design incorporating a lateral compartment which constrains the lateral condyle to the antero-posterior center of the tibial plateau in extension , but allows translation in flexion -- roughly approximating the role of the anterior cruciate ligament . In vivo kinematics were analyzed using three-dimensional model registration and plain radiographs of kneeling and squatting activities in 20 knees in 18 patients . FINDINGS Knees with the anterior cruciate ligament substituting design exhibited greater flexion , femoral antero-posterior translation and tibial internal rotation . INTERPRETATION Geometric features intended to improve knee flexion , including greater antero-posterior stability , a more posterior tibial sulcus , and reshaped femoral condyles , do provide measurable and significant differences in deep-flexion knee kinematics Purpose Limited or absent axial rotation of the mobile insert of total knee prostheses could lead to high contact stresses and stresses at the bone-implant interface , which in turn might lead to implant loosening . The aim of this study was to assess knee kinematics and muscle activation and their possible change over time in patients with a highly congruent , mobile-bearing total knee prosthesis . Methods A prospect i ve series of 11 rheumatoid arthritis patients was included to participate in this fluoroscopic and EMG study ; only 7 patients completed the study .  Kinematic evaluations took place 7 months , 1 and 2 years post-operatively . Repeated measurements ANOVA and linear mixed-effects model for longitudinal data were used to compare the differences between the follow-ups . Results There are no significant changes in axial rotations between follow-up moments for the femoral component as well as the mobile insert . The insert remained mobile and followed the femoral component from 0 ° until approximately 60 ° of knee flexion . Diverging and reversed axial rotations and translations were seen during the dynamic motions . Conclusions Knee kinematics and muscle activation do not appear to change in the first 2 post-operative years . Reversed and divergent axial rotations with increasing knee flexion indicate that as soon as the congruency decreases , the femoral component is no longer forced in a certain position by the insert and moves to a self-imposed position . At lower knee flexion angles , the femoral component might be obstructed by the highly congruent insert and therefore might not be able to move freely . Level of evidence Therapeutic study , Level IV Background Clinical consequences of alignment errors in  total knee replacement ( TKR ) have led to the rigorous evaluation of surgical alignment techniques . Rotational alignment in the transverse plane has proven particularly problematic , with errors due to component malalignment relative to bone anatomic l and marks and an overall mismatch between the femoral and tibial components ’ relative positions . Ranges of nominal rotational alignment are not well defined , especially for the tibial component and for relative rotational mismatch , and some studies advocate the use of mobile-bearing TKR to accommo date the result ing small rotation errors . However , the relationships between prosthesis rotational alignment and mobile-bearing polyethylene insert motion are poorly understood . This prospect i ve , in vivo study evaluates whether component malalignment and mismatch affect axial rotation motions during passive knee flexion after TKR . Methods Eighty patients were implanted with mobile-bearing TKR .  Rotational alignment of the femoral and tibial components was measured from postoperative CT scans . All TKR were categorized into nominal or outlier groups based on defined norms for surgical rotational alignment relative to bone anatomic l and marks and relative rotational mismatch between the femoral and tibial components . Axial rotation motion of the femoral , tibial and polyethylene bearing components was measured from fluoroscopic images acquired during passive knee flexion . Results Axial rotation motion was generally accomplished in two phases , dominated by polyethylene bearing rotation on the tibial component in early to mid-flexion and then femoral component rotation on the polyethylene articular surface in later flexion . Opposite rotations of the femur-bearing and bearing-baseplate articulations were evident at flexion greater than 80 ° . Knees with outlier alignment had lower magnitudes of axial rotation and distinct transitions from external to internal rotation during mid-flexion . Knees with femoral-tibial rotational mismatch had significantly lower total axial rotation compared to knees with nominal alignment . Conclusions Maintaining relative rotational mismatch within ±5 ° during TKR provided for controlled knee axial rotation during flexion . TKR with rotational alignment outside of defined surgical norms , with either positive or negative mismatch , experienced measurable kinematic differences and presented different patterns of axial rotation motions during passive knee flexion compared to TKR with nominal mismatch . These findings support previous studies linking prosthesis rotational alignment with inferior clinical and functional outcomes .Trial Registration Clinical Trials BACKGROUND A high-flexion posterior-stabilized rotating-platform mobile-bearing prosthesis was design ed in an attempt to improve the range of motion after total knee arthroplasty without compromising the theoretical advantages of the posterior-stabilized rotating-platform mobile-bearing system . The aim of this study was to compare the outcomes of st and ard and high-flexion posterior-stabilized rotating-platform mobile-bearing total knee arthroplasties . METHODS One hundred and seventy knees were r and omly allocated to receive either a st and ard ( n = 85 ) or a high-flexion ( n = 85 ) posterior-stabilized rotating-platform mobile-bearing prosthesis and were followed prospect ively for a minimum of two years . Ranges of motion , functional outcomes determined with use of st and ard scoring systems , and radiographic measurements were assessed . In addition , patients ' abilities to perform activities requiring deep knee flexion and patient satisfaction were evaluated with use of question naires . RESULTS The average postoperative maximal flexion was 130 ° for the knees with the st and ard design and 128 ° for those with the high-flexion design , and the difference was not significant . The two prosthetic design s also did not differ significantly with regard to the Knee Society scores ; Hospital for Special Surgery ( HSS ) scores ; or the scores on the pain , stiffness , and function subscales of the Western Ontario and McMaster Universities Osteoarthritis Index ( WOMAC ) . In addition , the numbers of knees able to perform deep-flexion-related activities and the rates of patient satisfaction were similar in the two study groups . CONCLUSIONS This prospect i ve r and omized study revealed no significant differences between st and ard and high-flexion posterior-stabilized rotating-platform mobile-bearing total knee prostheses in terms of clinical or radiographic outcomes or range of motion at a minimum of two years postoperatively The goal of this prospect i ve , r and omized , blinded trial was to determine if ligament balancing techniques for rotating platform TKA affect postoperative knee kinematics .  Sixteen patients with unilateral rotating platform TKA consented to participate in this institutional review board approved study . Eight patients were r and omly selected to receive ligament balancing with an instrumented joint spreader device and eight patients received ligament balancing using fixed thickness spacer blocks .  A single plane shape matching technique was used for kinematic analysis of static deep knee flexion and dynamic stair activities . There were no differences in knee kinematics between groups during static deep flexion activities . The spreader group demonstrated kinematics more similar to the normal knee during the ascending phase of the dynamic stair activity . Knee kinematics in static knee flexion were unaffected by ligament balancing technique , while knees balanced with the spreader demonstrated a medial pivot motion pattern during stair ascent . This medial pivot motion pattern may improve long-term results by more closely replicating normal knee kinematics Background and Purpose : Kneeling is an important functional activity frequently not performed after knee replacement , thus affecting a patient 's ability to carry out basic daily tasks . Despite no clinical reason preventing kneeling , many patients fail to resume this activity . The purpose of this study was to determine whether a single physical therapy intervention would improve patient-reported kneeling ability  following partial knee replacement ( PKR ) . Subjects : Sixty adults with medial compartment osteoarthritis , suitable for a PKR , participated . Methods : This was a single-blind , prospect i ve r and omized controlled trial . Six weeks after PKR , participants r and omly received either kneeling advice and education or routine care where no specific kneeling advice was given . Re assessment was at 1 year postoperatively . The primary outcome measure was patient-reported kneeling ability , as assessed by question 7 of the Oxford Knee Score . Other factors associated with kneeling ability were recorded . These factors were scar position , numbness , range of flexion , involvement of other joints , and pain . Statistical analysis included nonparametric tests and binary logistic regression . Results : A significant improvement in patient-reported kneeling ability was found at 1 year postoperatively in those participants who received the kneeling intervention . Group allocation was the only factor determining an improvement in patient-reported kneeling ability at 1 year postoperatively . Discussion and Conclusion : The single factor that predicted patient-reported kneeling ability at 1 year postoperatively was the physical therapy kneeling intervention given at 6 weeks after PKR . The results of this study suggest that advice and instruction in kneeling should form part of a postoperative rehabilitation program after PKR . The results can be applied only to patients following PKR BACKGROUND  Total hip arthroplasty ( THA )  using dual-mobility ( DM ) design permits larger hip range of motion . However , it is unclear how it benefits the patients during activities of daily living . The purpose was to compare kinematic variables of the operated limb between  THA patients using either DM or single-bearing ( SB ) implants during a squat task . METHODS Twenty-four THA patients were r and omly assigned to either a DM or SB implant and matched to 12 healthy controls ( CTRLs ) . They underwent 3-dimensional squat motion analysis  before and 9 months after surgery . Sagittal and frontal plane angles of the pelvis and the hip were analyzed using statistical parametric mapping . Paired analyses compared presurgery and postsurgery squat depth . RESULTS Peak sagittal pelvis angle of DM was closer to normal compared with that of SB . Both implant groups had similar hip angle patterns and magnitude but significantly lower than the CTRLs . SB reached a much large hip abduction compared with the other groups . Both surgical groups had significantly worst squat depth than the CTRLs . CONCLUSION Neither THA implant groups were able to return pelvis and hip kinematics to the level of CTRLs . The deficit of DM implants at the pelvis combined with the poorer functional scores should caution clinicians to use this implant design in active patients . SB design causes a larger hip abduction to reach their maximum squat depth . Post-THA rehabilitation should focus on improving joint range of motion and strength BACKGROUND Measured resection ( MR ) and gap balancing ( GB ) are common surgical techniques for total knee arthroplasty ( TKA ) . Controversy has arisen as each conceptually differs in how the knee is balanced through bone and soft tissue management . The objective of the present study was to compare both the frequency of condylar liftoff and the location of femorotibial contact from extension through midflexion between patients undergoing GB or MR TKA . METHODS A total of 24 knees ( 23 patients ) were r and omly assigned at referral to either a surgeon performing MR or GB TKA  with the same single radius , posterior-stabilized implant ( 12 per cohort ) . At 1-year postoperation , patients underwent biplanar radiographic imaging at 0 ° , 20 ° , 40 ° , and 60 ° of flexion  . Condylar liftoff , contact location , and magnitude of excursion on each condyle were measured . Preoperative and postoperative clinical outcome scores were also collected . RESULTS There was no difference ( P = .41 ) in the frequency of liftoff between cohorts . The MR cohort had more posterior contact on the medial condyle ( P < .01 ) and more anterior contact on the lateral condyle ( P < .01 ) throughout flexion . Motion patterns were similar between cohorts , with similar medial ( P = .48 ) and lateral ( P = .44 ) excursion , which was equal in magnitude between condyles for both MR ( P = .48 ) and GB ( P = .73 ) . There was no difference in clinical outcome scores between groups . CONCLUSION For this particular implant system , GB and MR appear to produce similar kinematic and patient-reported outcome results BACKGROUND The mobile-bearing variant of a single-radius design is assumed to provide more freedom of motion compared to the fixed-bearing variant because the insert does not restrict the natural movements of the femoral component . This would reduce the contact stresses and wear which in turn may have a positive effect on the fixation of the prosthesis to the bone and thereby decreases the risk for loosening . The aim of this study was to evaluate early migration of the tibial component and kinematics of a mobile-bearing and fixed-bearing total knee prosthesis of the same single-radius design . METHODS Twenty Triathlon single-radius posterior-stabilized knee prostheses were implanted ( 9 mobile-bearing and 11 fixed-bearing ) .  Fluoroscopy and roentgen stereophotogrammetric analysis ( RSA ) were performed 6 and 12 months post-operatively . FINDINGS The 1 year post-operative RSA results showed considerable early migrations in 3 out of 9 mobile-bearing patients and 1 out of 11 fixed-bearing patients . The range of knee flexion was the same for the mobile-bearing and fixed-bearing group . The mobile insert was following the femoral component during motion . INTERPRETATION Despite the mobile insert following the femoral component during motion , and therefore performing as intended , no kinematic advantages of the mobile-bearing total knee prosthesis were seen . The fixed-bearing knee performed as good as the mobile-bearing knee and maybe even slightly better based on less irregular kinematics and less early migrations Introduction Previous radiostereometric studies have revealed abnormal anterior-posterior translation of the femur in patients operated with AMK ( DePuy , Johnson and Johnson , Leeds , UK ) total knee arthroplasty ( TKA ) . Based on these observations , we hypothesized that patients with TKA have an abnormal gait pattern , and that there are differences in kinematics depending on the design of the tibial joint area . Method We used a gait analysis system to evaluate the influence of joint area design on the kinematics of the hip and knee during level walking .  39 TKA patients ( 42 knees ) and 18 healthy age-matched controls were studied . Patients with 5 ° varus/valgus alignment or less were r and omized to receive either a relatively flat or a concave tibial insert with retention of the posterior cruciate ligament .  Patients who had more than 5 ° varus-valgus alignment and /or extension defect of 10 ° or more were r and omized to receive the concave or a posterior-stabilized tibial component with resection of the posterior cruciate ligament . Results Patients with TKA tended to have less hip and knee extension and decreased knee and hip extension moment than controls . They also tended to walk more slowly . TKA altered the gait pattern , but choice of implant design had little influence . Interpretation In patients with a similar degree of degenerative joint disease and within the limits of the constraints offered by the prostheses under study , the choice of joint area constraint has little influence on the gait pattern Purpose The purpose of this study is to investigate whether the preservation of the posterior cruciate ligament ( PCL ) can be helpful for improving kinematics and clinical outcome in highly conforming mobile-bearing total knee arthroplasty ( TKA ) . Methods Ninety osteoarthritic knees were r and omly allocated to either the PCL-preserving group or the PCL-sacrificing group .  Passive kinematics was recorded with a navigation system immediately after implantation . Three parameters ( anterior/posterior translation , varus/valgus rotation , and internal/external rotation ) were analysed from 0 ° to 120 ° flexion . Results The PCL-preserving group ( 42 knees ) had more varus rotation over 90 ° flexion ( p < 0.05 ) and more anterior translation of the femur in all ranges of flexion ( p < 0.05 ) than those in the PCL-sacrificing group ( 44 knees ) . There was no difference in the internal/external rotation ( p > 0.05 ) . The range of motion , functional scores , and radiographic results did not significantly differ between the two groups at the final follow-up . Three knees in the PCL-preserving group were revised : two presented with instability caused by traumatic attenuation of the PCL and one with subluxation of the insert due to a tight PCL . Conclusion The preservation of the PCL was not helpful for improving kinematics and clinical outcome in highly conforming mobile-bearing TKA.Level of evidence II Background A knee design with a ball- and -socket articulation of the medial compartment has a femoral rollback profile similar to the native knee . Compared to a conventional , posterior-stabilized knee design , it provides AP stability throughout the entire ROM . However , it is unclear whether this design difference translates to clinical and functional improvement . Questions / purpose sWe asked whether the medially conforming ball- and -socket design differences would be associated with ( 1 ) improved ROM ; and ( 2 ) improved American Knee Society , WOMAC , Oxford Knee , SF-36 , and Total Knee Function Question naire scores compared to a conventional , fixed-bearing posterior-stabilized TKA . Patients and Methods We enrolled 82 patients in a single-center , single-blinded , r and omized , controlled trial comparing the medially conforming ball- and -socket design knee prosthesis to a posterior-stabilized total knee prosthesis .  Our primary end point was ROM . Our secondary end points were American Knee Society , WOMAC , Oxford Knee , SF-36 , and Total Knee Function Question naire scores . All patients were followed at 1 and 2 years . Results The mean ROM was 100.1 ° and 114.9 ° in the posterior-stabilized and medially conforming ball- and -socket groups , respectively . The physical component scores of SF-36 and Total Knee Function Question naire were better in the medially conforming ball- and -socket group . We found no difference in American Knee Society , WOMAC , and Oxford Knee scores . Conclusions Both implant design s similarly relieved pain and improved function . The medially conforming ball- and -socket articulation provided better high-end function as reflected by the Total Knee Function Question naire . Level of Evidence Level I , therapeutic study . See Guidelines for Authors for a complete description of levels of evidence A total of 344 patients underwent bilateral total knee replacement ( TKR ) using a different prosthesis on each side . Four knee prostheses were used : anterior and posterior cruciate-retaining ( ACL-PCL ) , posterior cruciate-retaining ( PCL ) , medial or lateral pivot ( MLP ) , and posterior cruciate-substituting ( PS ) . All patients had good or excellent results . The range of movement , relief from pain , alignment , and stability did not vary among any of the prostheses . Forty-one of 46 patients ( 89 % ) preferred the ACL-PCL to the PS knee and 27 of 35 patients ( 77 % ) the MLP knee to the PS knee . Of the patients with an ACL-PCL knee on one side and a MLP on the other , an equal number preferred each type . The MLP knee was preferred to the PCL by 34 ( 79 % ) patients . PS and PCL knees were preferred equally . Patients with bilateral TKRs preferred retention of both their cruciate ligaments or substitution with a medial or lateral pivot prosthesis
All design s demonstrated posterior – femoral translation and external rotation in kneeling , but posterior-stabilised design s were more posterior at maximal flexion when compared to cruciate retaining .
Modern  TKR prostheses are design ed to restore healthy kinematics including high flexion .
Kneeling is a dem and ing high-flexion activity .
There have been many studies of kneeling kinematics using a plethora of implant design s but no comprehensive comparisons .
Visualisation of contact patterns allows for quantification and comparison of knee kinematics .
The aim of this systematic review was to determine whether there are any differences in the kinematics of kneeling as a function of TKR design .