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Patients who received total knee arthroplasty frequently show problems during knee extension exercises due to biomechanical alterations. Hinged knee prostheses, which provide higher stability than non-hinged designs, were supposed to minimize them. Therefore we investigated the quadriceps force required to extend the knee after non-hinged and hinged total knee arthroplasty. Human knee specimens were tested in a kinematic knee simulator in physiologic conditions, after implantation of two types of non-hinged cruciate retaining prosthesis and a hinged prosthesis. During simulation of an extension cycle, the change of quadriceps force to produce the constant extension moment of 31 Nm was measured using a load cell attached to the quadriceps tendon. After implantation of the non-hinged prostheses maximum quadriceps force increased up to 1257 N in knee extension. Following the implantation of the hinged prosthesis quadriceps extension force decreased to 690 N in extension. Hinged knee prostheses improve the lever arm in knee extension due to higher knee joint stability. This would offer a potential advantage for patients.
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