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 .
Are undesirable contact kinematics minimized after kinematically aligned total knee arthroplasty? An intersurgeon analysis of consecutive patients
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
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 .