Influence of intentional femoral component flexion in navigated TKA on gap balance and sagittal anatomy

Roßkopf, J.; Singh, Pradeep K; Wolf, Petra; Strauch, M.; Graichen, Heiko

doi:10.1007/s00167-013-2731-5

Cited by 17 publications

(14 citation statements)

References 32 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Previous cadaver and clinical studies could not separate the effect of FFC from that of other possible confounding variables (e.g. PCO), and have shown contrasting results [ 5 , 6 , 23 , 25 ].…”

Section: Introductionmentioning

confidence: 99%

Flexing and downsizing the femoral component is not detrimental to patellofemoral biomechanics in posterior-referencing cruciate-retaining total knee arthroplasty

Marra¹,

Strzelczak²,

Heesterbeek

et al. 2018

Knee Surg Sports Traumatol Arthrosc

View full text Add to dashboard Cite

PurposeWhen downsizing the femoral component to prevent mediolateral overhang, notching of the anterior femoral cortex may occur, which could be solved by flexing the femoral component. In this study, we investigated the effect of flexion of the femoral component on patellar tendon moment arm, patellofemoral forces and kinematics in posterior-referencing CR-TKA. Our hypothesis was that flexion of the femoral component increases the patellar tendon moment arm, reduces the patellofemoral forces and provides stable kinematics.MethodsA validated musculoskeletal model of CR-TKA was used. The flexion of the femoral component was increased in four steps (0°, 3°, 6°, 9°) using posterior referencing, and different alignments were analysed in combination with three implant sizes (3, 4, 5). A chair-rising trial was analysed using the model, while simultaneously estimating quadriceps muscle force, patellofemoral contact force, tibiofemoral and patellofemoral kinematics.ResultsCompared to the reference case (size 4 and 0° flexion), for every 3° of increase in flexion of the femoral component the patellar tendon moment arm increased by 1% at knee extension. The peak quadriceps muscle force and patellofemoral contact force decreased by 2%, the patella shifted 0.8 mm more anteriorly and the remaining kinematics remained stable, with knee flexion. With the smaller size, the patellar tendon moment arm decreased by 6%, the quadriceps muscle force and patellofemoral contact force increased by 8 and 12%, and the patellar shifted 5 mm more posteriorly. Opposite trends were found with the bigger size.ConclusionFlexing the femoral component with posterior referencing reduced the patellofemoral contact forces during a simulated chair-rising trial with a patient-specific musculoskeletal model of CR-TKA. There seems to be little risk when flexing and downsizing the femoral component, compared to when using a bigger size and neutral alignment. These findings provide relevant information to surgeons who wish to prevent anterior notching when downsizing the femoral component.Electronic supplementary materialThe online version of this article (10.1007/s00167-018-4900-z) contains supplementary material, which is available to authorized users.

show abstract

Section: Introductionmentioning

confidence: 99%

Flexing and downsizing the femoral component is not detrimental to patellofemoral biomechanics in posterior-referencing cruciate-retaining total knee arthroplasty

Marra¹,

Strzelczak²,

Heesterbeek

et al. 2018

Knee Surg Sports Traumatol Arthrosc

View full text Add to dashboard Cite

show abstract

“…Recent studies have shown that 1 of flexion is around 1e1.5 mm decrease of flexion gap. 18,19 This correlation is shown in Fig. 3.…”

Section: New Techniques For Ligament Balancingmentioning

confidence: 64%

Navigation in TKA surgery – Evolutionary technique or blind alley?

Graichen

2015

Journal of Orthopaedics

View full text Add to dashboard Cite

“…In the first years, navigation could show that it is able to improve coronal alignment from 61% to 75% up to 91%-96% within the 3°corridor. [1][2][3] Even in Indian population with severe deformities those results could be confirmed. 4 Over the following years alternative techniques, like patient specific instrumentation had been introduced however never reached this high accuracy.…”

Section: Navigation/robotics/aimentioning

confidence: 71%

How will digitalisation affect patient treatment in arthroplasty? Part I: Intraoperative aspects

Graichen

Lekkreusuwan

Scior

2020

Journal of Orthopaedics

View full text Add to dashboard Cite

We cannot deny that technology has become an important part of our daily life, not only in automobiles, houses or cellphones but also in hospitals. In the OR, in particular for knee arthroplasty, image free navigation has proven to reduce the number of outliers and by that the revision rate in younger patients. Over the last years robotics has again been introduced into the operation theatres. However, in their present version they add time and costs, but only minimal benefits to the procedure. Therefore, future robots should be faster and instrumentation free. Beside those more economical aspects, the goal of this digital technology must be an improvement in clinical outcome. To achieve that, additional steps for analyzing the pre-, and intra-OP quantitative data is key. With the use of artificial intelligence and/or machine learning a data based algorithm will probably be developed, which helps the surgeon to integrate all parameters into his individual cutting and releasing plan for each patient. Digital data therefore, might become the key to enable the surgeon to treat patients more individual and by that hopefully deliver better outcome.

show abstract

Influence of intentional femoral component flexion in navigated TKA on gap balance and sagittal anatomy

Abstract: II.

Cited by 17 publications

References 32 publications

Flexing and downsizing the femoral component is not detrimental to patellofemoral biomechanics in posterior-referencing cruciate-retaining total knee arthroplasty

Flexing and downsizing the femoral component is not detrimental to patellofemoral biomechanics in posterior-referencing cruciate-retaining total knee arthroplasty

Navigation in TKA surgery – Evolutionary technique or blind alley?

How will digitalisation affect patient treatment in arthroplasty? Part I: Intraoperative aspects

Contact Info

Product

Resources

About