Tibiofemoral contact stress after total knee arthroplasty: comparison of fixed and mobile-bearing inlay designs

We measured tibiofemoral contact stresses and the load-bearing contact area of fixed and mobile-bearing inlay knee prostheses under dynamic loading conditions. An electronic resistive pressure-measuring sensor was used to detect contact stresses and contact area in five cadaver knees. Stresses were measured with the tibial component aligned normally, as well as in internally- and externally-rotated positions. The average peak contact stresses measured on the fixed inlay were greater (medial 21 MPa and lateral 21 MPa) than those on the mobile inlay (medial/lateral 7.7/5.3 MPa, p = 0.04). Although the average peak contact stresses of the fixed standard inlay greatly exceeded the contact stresses of the other two inlay designs in each malrotated position tested, no statistically significant differences were seen. The data suggest that the ability of the inlay to translate on the tibial baseplate permits the inlay to align itself on the femoral component so that the contact surface area is maximized and contact stresses are reduced.