Failure modes in malrotated total knee replacement

Rajgopal, Ashok; Sudarshan, Paneendra; Kumar, Sumit; Aggarwal, Kalpana

doi:10.1007/s00402-022-04569-0

Cited by 4 publications

(4 citation statements)

References 40 publications

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“…Previously described US population [32] Corrected more pronounced obliquity on the tibial side, as is especially the case in varus knees, to the femoral side in both the coronal and axial plane. The risks of causing excessive internal rotation of the femoral component have thoroughly been documented in the literature [1,4,24]. Possible disadvantages that have been described include the induction of higher quadriceps requirements as well as more pronounced alterations in native tibiofemoral kinematics and load transfer [9,15,20,33].…”

Section: Discussionmentioning

confidence: 99%

“…The risks of causing excessive internal rotation of the femoral component have thoroughly been documented in the literature [1, 4, 24]. Possible disadvantages that have been described include the induction of higher quadriceps requirements as well as more pronounced alterations in native tibiofemoral kinematics and load transfer [9, 15, 20, 33].…”

Section: Discussionmentioning

confidence: 99%

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Widening of tibial resection boundaries increases the rate of femoral component valgus and internal rotation in functionally aligned TKA

Ollivier,

Wakelin,

Plaskos

et al. 2024

Knee surg. sports traumatol. arthrosc.

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PurposeThe purpose of this study was to investigate the influence of increasing the tibial boundaries in functional alignment on femoral component orientation in total knee arthroplasty (TKA).MethodsA retrospective review of a database of robotic‐assisted TKAs using a digital joint tensioning device was performed (BalanceBot®; Corin). A total of 692 TKAs with correctable deformity were included. Functional alignment with a tibia‐first balancing technique was simulated by performing an anatomic tibial resection to recreate the native medial proximal tibial angle within certain boundaries (A, 87–90°; B, 86–90°; C, 84–92°), while accounting for wear. After balancing the knee, the resulting amount of femoral component outliers in the coronal and axial plane was calculated for each group and correlated to the coronal plane alignment of the knee (CPAK) classification.ResultsThe proportion of knees with high femoral component varus (>96°) or valgus (<87°) alignment increased from 24.5% (n = 170) in group A to 26.5% (n = 183) in group B and 34.2% (n = 237) in group C (p < 0.05). Similarly, more knees with high femoral component external rotation (>6°) or internal rotation (>3°) were identified in group C (33.4%, n = 231) than in group B (23.7%, n = 164) and A (18.4%, n = 127) (p < 0.05). There was a statistically significant (p < 0.01) overall increase in knees with both femoral component valgus <87° and internal rotation >3° from group A (4.0%, n = 28) to B (7.7%, n = 53) and C (15.8%, n = 109), with CPAK type I and II showing a 12.9‐ and 2.9‐fold increase, respectively.ConclusionExtending the tibial boundaries when using functional alignment with a tibia‐first balancing technique in TKA leads to a statistically significant higher percentage of knees with a valgus lateral distal femoral angle < 87° and >3° internal rotation of the femoral component, especially in CPAK type I and II.Level of EvidenceLevel IV.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Widening of tibial resection boundaries increases the rate of femoral component valgus and internal rotation in functionally aligned TKA

Ollivier,

Wakelin,

Plaskos

et al. 2024

Knee surg. sports traumatol. arthrosc.

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“…Accurate alignment of tibiofemoral components is a critical element in obtaining favorable clinical outcomes for patients after total knee arthroplasty (TKA). Poor rotational alignment of tibiofemoral components can result in knee stiffness ( Bedard et al, 2011 ; Kim et al, 2014 ), evaluated joint contact stress ( Chen et al, 2015 ; Ueyama et al, 2020 ; Tang et al, 2022 ), and a high prevalence of TKA revisions ( Dalury et al, 2013 ; Panni et al, 2018 ; Rajgopal et al, 2022 ). Moreover, over 50% of patients who experienced joint pain after TKA had mal-rotational alignment of the knee components, which is a substantial contributor to joint pain and functional deficit ( Hofmann et al, 2003 ; Bell et al, 2014 ; Abdelnasser et al, 2019b ; Rajgopal et al, 2022 ).…”

Section: Introductionmentioning

confidence: 99%

“…Poor rotational alignment of tibiofemoral components can result in knee stiffness ( Bedard et al, 2011 ; Kim et al, 2014 ), evaluated joint contact stress ( Chen et al, 2015 ; Ueyama et al, 2020 ; Tang et al, 2022 ), and a high prevalence of TKA revisions ( Dalury et al, 2013 ; Panni et al, 2018 ; Rajgopal et al, 2022 ). Moreover, over 50% of patients who experienced joint pain after TKA had mal-rotational alignment of the knee components, which is a substantial contributor to joint pain and functional deficit ( Hofmann et al, 2003 ; Bell et al, 2014 ; Abdelnasser et al, 2019b ; Rajgopal et al, 2022 ). The focus of most clinical studies has been on assessing the impact of component malrotation on knee function through postoperative evaluations.…”

Section: Introductionmentioning

confidence: 99%

Prediction of knee biomechanics with different tibial component malrotations after total knee arthroplasty: conventional machine learning vs. deep learning

Zhang,

Li,

Chen

et al. 2024

Front. Bioeng. Biotechnol.

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The precise alignment of tibiofemoral components in total knee arthroplasty is a crucial factor in enhancing the longevity and functionality of the knee. However, it is a substantial challenge to quickly predict the biomechanical response to malrotation of tibiofemoral components after total knee arthroplasty using musculoskeletal multibody dynamics models. The objective of the present study was to conduct a comparative analysis between a deep learning method and four conventional machine learning methods for predicting knee biomechanics with different tibial component malrotation during a walking gait after total knee arthroplasty. First, the knee contact forces and kinematics with different tibial component malrotation in the range of ±5° in the three directions of anterior/posterior slope, internal/external rotation, and varus/valgus rotation during a walking gait after total knee arthroplasty were calculated based on the developed musculoskeletal multibody dynamics model. Subsequently, deep learning and four conventional machine learning methods were developed using the above 343 sets of biomechanical data as the dataset. Finally, the results predicted by the deep learning method were compared to the results predicted by four conventional machine learning methods. The findings indicated that the deep learning method was more accurate than four conventional machine learning methods in predicting knee contact forces and kinematics with different tibial component malrotation during a walking gait after total knee arthroplasty. The deep learning method developed in this study enabled quickly determine the biomechanical response with different tibial component malrotation during a walking gait after total knee arthroplasty. The proposed method offered surgeons and surgical robots the ability to establish a calibration safety zone, which was essential for achieving precise alignment in both preoperative surgical planning and intraoperative robotic-assisted surgical navigation.

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Kinematic alignment adequately restores trochlear anatomy, patellar kinematics and kinetics in total knee arthroplasty: A systematic review

Ollivier,

Luyckx,

Stragier

et al. 2024

Knee surg. sports traumatol. arthrosc.

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PurposePatellofemoral pain, maltracking and instability remain common and challenging complications after total knee arthroplasty. Controversy exists regarding the effect of kinematic alignment on the patellofemoral joint, as it generally leads to more femoral component valgus and internal rotation compared to mechanical alignment. The aim of this systematic review is to thoroughly examine the influence of kinematic alignment on the third space.MethodsA systematic search of the Pubmed, Cochrane and Web of Science databases was performed to screen for relevant articles published before 7 April 2024. This led to the final inclusion of 42 articles: 2 cadaveric, 9 radiographic, 12 computer simulation and 19 clinical studies. The risk of bias was evaluated with the risk of bias in non‐randomised studies ‐ of interventions tool as the lowest level of evidence of the included clinical studies was IV. The effects of kinematic alignment on patellar kinematics and kinetics, trochlear anatomy reconstruction and patellofemoral complication rate were investigated.ResultsKinematic alignment closely restores native patellar kinematics and kinetics, better reproduces native trochlear anatomy than mechanical alignment and leads to a 0%–11.4% incidence of patellofemoral complications. A more valgus joint line of the distal femur can cause lateral trochlear undercoverage and a trochlear angle orientation medial to the quadriceps vector when applying kinematic alignment, both of which can be solved by using an adjusted design with a 20.5° valgus trochlea.ConclusionKinematic alignment appears to be a safe strategy for the patellofemoral joint in most knees, provided that certain precautions are taken to minimize the risk of complications.Level of EvidenceLevel IV clinical studies, in vitro research.

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Failure modes in malrotated total knee replacement

Cited by 4 publications

References 40 publications

Widening of tibial resection boundaries increases the rate of femoral component valgus and internal rotation in functionally aligned TKA

Widening of tibial resection boundaries increases the rate of femoral component valgus and internal rotation in functionally aligned TKA

Prediction of knee biomechanics with different tibial component malrotations after total knee arthroplasty: conventional machine learning vs. deep learning

Kinematic alignment adequately restores trochlear anatomy, patellar kinematics and kinetics in total knee arthroplasty: A systematic review

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