Influence of Variation in Sagittal Placement of the Femoral Component after Cruciate-Retaining Total Knee Arthroplasty

Koh, Yong‐Gon; Hong, Hyoung-Taek; Lee, Hwa-Yong; Kim, Hyo-Jeong; Kang, Kyoung‐Tak

doi:10.1055/s-0039-1696958

Cited by 6 publications

(10 citation statements)

References 55 publications

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“…Previous studies have investigated the kinematic and biomechanical effects of flexion of the femoral component in TKA. A previous computer simulation study described that anteroposterior translation of the femoral component and quadriceps force decreased in both PS and cruciate-retaining TKA implants 8 , 15 These studies evaluated a 10° range from − 3° of extension to 7° of flexion of the femoral component against the mechanical axis of the femur. In our study, the femoral component angle was defined against the distal femoral anatomical axis, which was 1.0° flexed to the mechanical axis of the femur in this case; the evaluation range was from 0° to 10° of flexion.…”

Section: Discussionmentioning

confidence: 99%

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Excessive flexed position of the femoral component causes abnormal kinematics and joint contact/ ligament forces in total knee arthroplasty

Nishitani

Kuriyama

Nakamura

et al. 2023

Sci Rep

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Poor clinical outcomes are reported in excessive flexion of the femoral component in total knee arthroplasty (TKA), but their mechanisms have not yet been elucidated. This study aimed to investigate the biomechanical effect of flexion of the femoral component. Cruciate-substituting (CS) and posterior-stabilised (PS) TKA were reproduced in a computer simulation. The femoral component was then flexed from 0° to 10° with anterior reference, keeping the implant size and the extension gap. Knee kinematics, joint contact, and ligament forces were evaluated in deep-knee-bend activity. When the femoral component was flexed 10° in CS TKA, paradoxical anterior translation of the medial compartment was observed at mid-flexion. The PS implant was best stabilised with a 4° flexion model in mid-flexion range. The medial compartment contact force and the medial collateral ligament (MCL) force increased with the flexion of the implant. There were no remarkable changes in the patellofemoral contact force or quadriceps in either implant. In conclusions, excessive flexion of the femoral component yielded abnormal kinematics and contact/ligament forces. Avoiding excessive flexion and maintaining mild flexion of the femoral component would provide better kinematics and biomechanical effects in CS and PS TKA.

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Section: Discussionmentioning

confidence: 99%

“…In a computer simulation study, flexion of the femoral component with a posterior reference has been reported to improve kinematics and biomechanical effects in TKA 8 , 15 . However, in a previous study, excessive flexion was reported to yield inferior satisfaction and function 16 .…”

Section: Introductionmentioning

confidence: 99%

Excessive flexed position of the femoral component causes abnormal kinematics and joint contact/ ligament forces in total knee arthroplasty

Nishitani

Kuriyama

Nakamura

et al. 2023

Sci Rep

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“…In this study, the FEA was also correlated with muscle strength and stability. Koh et al reported that the quadriceps force, collateral ligament force and patella-femoral contact stress decreased as the angle between the axis of the femoral component and anterior cortex became smaller ( 39 ). This indicates that changes in the biomechanical environment around the knee may affect muscle strength and joint stability.…”

Section: Discussionmentioning

confidence: 99%

“…Using finite element models, Koh et al investigated how variations in the FEA impacted knee mechanics and kinematics, and found the femorotibial contact points were positioned more posteriorly with larger FEA angles, and the quadriceps force, as well as the PF contact force, was reduced because of the decreased lever arm. It was suggested that placing the prosthesis in slight flexion could be an effective alternative technique to enable positive biomechanical effects with TKA ( 39 , 50 ). Besides, the discrepancy of medial and lateral collateral ligaments between different femoral flexion-extension angles, the collateral ligament force decreased as the femoral component flexed during the knee bending.…”

Section: Discussionmentioning

confidence: 99%

Correlation between component alignment and short-term clinical outcomes after total knee arthroplasty

Luan

Zhang²,

Ran³

et al. 2022

Front. Surg.

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ObjectiveThis study aimed to investigate the correlation between component alignment and short-term clinical outcomes after total knee arthroplasty (TKA).Methods50 TKA patients from a regional hospital were enrolled in the study. The following component alignments were measured from radiological data acquired within 1 week after surgery: hip-knee-ankle angle (HKA), medial distal femoral angle (MDFA), medial proximal tibial angle (MPTA), femoral flexion-extension angle (FEA), tibial slope angle (TSA), femoral rotational angle (FRA) and tibial rotational angle (TRA). The Hospital for Special Surgery (HSS) knee scoring system was used to assess clinical outcomes after 1 year, with patients being divided into three groups (excellent, good and not good) according to the HSS scores. Difference analysis and linear correlation analysis were used for the statistical analysis.ResultsThe results showed significant differences in MDFA (p = 0.050) and FEA (p = 0.001) among the three patient groups. It was also found that the total HSS had only a moderate correlation with FEA (r = 0.572, p < 0.001), but FEA had a positive linear correlation with pain scores (r = 0.347, p = 0.013), function scores (r = 0.535, p = 0.000), ROM scores (r = 0.368, p = 0.009), muscle scores (r = 0.354, p = 0.012) and stability scores (r = 0.312, p = 0.028). A larger MDFA was associated with lower FE deformity scores (r = −0.289, p = 0.042) and the TSA had a positive influence on the ROM (r = 0.436, p = 0.002). Also, changes in FRA produced a consequent change in the FE deformity score (r = 0.312, p = 0.027), and the muscle strength scores increased as TRA increased (r = 0.402, p = 0.004).ConclusionThe results show that the FEA plays a significant role in clinical outcomes after TKA. Surgical techniques and tools may need to be improved to accurately adjust the FEA to improve joint functionality and patient satisfaction.

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“…Immediate postoperative component malposition influences overall limb alignment, the lifespan of the components, and overall function. Despite improved alignment guides, malalignment is still very much prevalent [3][4][5][6]. There have been significant degrees of errors in mechanical axis alignment (>3°) ranging from 22% to 35% for routine TKAs using conventional instrumentation [2].…”

Section: Introductionmentioning

confidence: 99%

Comparative Analysis of Radiological Evaluation and Early Functional Outcomes of Total Knee Arthroplasty Using an Accelerometer-Based Handheld Navigation System and Conventional Instrumentation: A Prospective Study

Jagadeesh¹,

Kumar²,

sarparaju³

et al. 2022

Cureus

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BackgroundAn accelerometer-based handheld navigation system (HHNS) for total knee arthroplasty (TKA) does not require a large console needed for computer-assisted navigation systems and has been shown to decrease component malalignment in TKA. The study aimed to use HHNS with conventional instrumentation to compare the radiological evaluation and functional outcomes of TKA. Materials and methodsThis was a multi-surgeon, prospective, assessor-blinded comparative study of 122 patients undergoing unilateral TKA. We used a stratified randomized sampling method to select 35/48 patients undergoing TKA using a handheld navigation system and 35/74 patients undergoing TKA using conventional instrumentation and divided them into two groups: the HHNS group and (conventional) CONV group. Postoperative radiographic evaluation was based on the tibial and femoral alignment angle, posterior tibial slope, and tibiofemoral angle measured from full-length lower-limb anteroposterior and lateral views of the knee. The Oxford Knee Score (OKS) and Knee Society Score (KSS) with a two-year serial follow-up were used to evaluate functional outcomes. ResultsThe mean tibial alignment angle and posterior tibial slope were 0.78° ± 1.27° and 4.38° ± 0.86°, respectively, in the HHNS cohort and 2.63° ± 1.54° and 2.12° ± 1.82°, respectively, in the CONV group (p < 0.001). There was no significant difference in the femoral alignment angles. The overall alignment using the mean tibiofemoral angle was 179.21° ± 1.82° in the HHNS group and 177.31° ± 2.18° in the CONV group (p = 0.002). There were no significant differences in the KSS and OKS at the two-year follow-up between the groups. ConclusionsThe use of HHNS in TKA significantly increased accuracy in limb and implant alignment, but there was no significant difference in the two-years functional outcomes.

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Influence of Variation in Sagittal Placement of the Femoral Component after Cruciate-Retaining Total Knee Arthroplasty

Cited by 6 publications

References 55 publications

Excessive flexed position of the femoral component causes abnormal kinematics and joint contact/ ligament forces in total knee arthroplasty

Excessive flexed position of the femoral component causes abnormal kinematics and joint contact/ ligament forces in total knee arthroplasty

Correlation between component alignment and short-term clinical outcomes after total knee arthroplasty

Comparative Analysis of Radiological Evaluation and Early Functional Outcomes of Total Knee Arthroplasty Using an Accelerometer-Based Handheld Navigation System and Conventional Instrumentation: A Prospective Study

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