Progression of varus deformity in osteoarthritic knees induces anterior paradoxical motion of the femur during early knee flexion

Kinoshita, Tomofumi; Hino, Kazunori; Kutsuna, Tatsuhiko; Watamori, Kunihiko; Tsuda, Takashi; Takao, Masaki

doi:10.1007/s00167-023-07363-6

Cited by 3 publications

(2 citation statements)

References 23 publications

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“…Data were measured every 0.5° or 1 mm. Regarding the AP position of the femur relative to the tibia, we evaluated femoral center movement relative to the tibia as previously described [ 12 , 13 ]. We calculated the AP position of the femur relative to the tibia using the status of the tibia relative to the femur obtained using a navigation system (Figs.…”

Section: Methodsmentioning

confidence: 99%

“…In addition to reporting normal knee rotational kinematics, some studies have proposed the occurrence of anterior paradoxical motion after TKA [ 9 – 11 ]. Moreover, the degree of preoperative varus deformity has been related to preoperative anterior paradoxical motion [ 12 ]. In these studies, the knees of many patients exhibited non-anatomical anteroposterior (AP) movement pre- and postoperatively that affected clinical outcomes.…”

Section: Introductionmentioning

confidence: 99%

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Changes in the anteroposterior position of the femur relative to the tibia impact patient satisfaction in total knee arthroplasty

Kinoshita,

Hino,

Kutsuna

et al. 2024

BMC Musculoskelet Disord

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Background In this study, we aimed to investigate the preoperative and postoperative anteroposterior position (AP) of the femur relative to the tibia in total knee arthroplasty (TKA) and assess the influence of change in the AP position on clinical outcomes. Methods We evaluated 49 knees that underwent bi-cruciate-substituted TKA using a navigation system. The preoperative and postoperative AP position of the femur relative to the tibia at maximum extension, 15°, 30°, 45°, 60°, 90°, 105°, and 120° and maximum flexion angles were calculated. The 2011 Knee Society Score was evaluated preoperatively and 1 year postoperatively. The Wilcoxon signed rank and Spearman’s rank correlation tests were performed, with statistical significance set at P < 0.05. Results The postoperative AP position was significantly correlated with the preoperative AP position at each measured angle. The postoperative AP positions were statistically more anterior than those preoperatively. Furthermore, the changes in the AP position after TKA negatively correlated with the symptom (P = 0.027 at 30°, P = 0.0018 at 45°, P = 0.0003 at 60°, P = 0.01 at 90°, and P = 0.028 at 105°) and patient satisfaction (P = 0.018 at 60° and P = 0.009 at 90°) scores at 1 year postoperatively. Conclusion The postoperative AP position of the femur relative to the tibia was strongly influenced by the preoperative those in TKA. Postoperative anterior deviation of the femur relative to the tibia from mid-flexion to deep flexion could worsen clinical outcomes.

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Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Changes in the anteroposterior position of the femur relative to the tibia impact patient satisfaction in total knee arthroplasty

Kinoshita,

Hino,

Kutsuna

et al. 2024

BMC Musculoskelet Disord

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Preoperative tibiofemoral contact point on standing lateral radiograph predicts anteroposterior knee kinematics in total knee arthroplasty

Tominaga,

Kinoshita,

Hino

et al. 2024

J. exp. orthop.

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PurposeThis study investigated the tibiofemoral contact point (CP) on standing lateral radiographs in knee osteoarthritis and assessed the relationship between CP and pre‐ and postoperative knee kinematics in total knee arthroplasty (TKA).MethodsThe intraoperative knee status of 46 knees with varus deformity that underwent bicruciate stabilized TKA using a navigation system was investigated. The intraoperative anteroposterior (AP) position of the femur relative to the tibia at maximum extension, 15°, 30°, 45°, 60° and 90° was evaluated by the navigation system before and after TKA. The CP, defined as the CP between the femur and tibia, was assessed on standing lateral radiographs at the maximum extension of the knee before and 1 year after TKA. CP was expressed as the ratio of tibial plateau distance on a scale of 0–1, with 0 indicating the most anterior position of the femur relative to the tibia.ResultsThe mean CP on standing lateral radiographs was 0.54 ± 0.12 and 0.46 ± 0.08 before and after TKA, respectively. The postoperative CP was significantly more anterior than the preoperative CP (p = 0.0002). The mean AP position of the femur relative to the tibia moved anteriorly during early knee flexion both before and after TKA, representing nonanatomical AP movement. The preoperative posterior CP group (CP > 0.54) showed more nonanatomical AP movement from 15° to 60° before and after TKA compared with the preoperative anterior CP group (CP < 0.54).ConclusionPreoperative posterior deviation of the femur relative to the tibia in the standing position was a predictive factor for nonanatomical AP knee kinematics. Biomechanical analysis of postoperative knees will be necessary; however, surgeons should focus on preoperative tibiofemoral CP on standing lateral radiographs to predict knee kinematics.Level of EvidenceLevel Ⅲ.

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Change in quality of life and return to work and sports after isolated closing-wedge distal femoral osteotomy

Fang,

Wang,

Liu

et al. 2023

BMC Sports Sci Med Rehabil

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Purpose To analyze return to work and sports, and health-related quality of life (HRQoL) after closing-wedge distal femoral osteotomy (CWDFO) for valgus deformity and lateral compartmental osteoarthritis. Methods Thirty-three patients underwent isolated CWDFO in our center between January 2018 and June 2020 were enrolled, of whom 32 and 23 patients were included in the return-to-work and return-to-sports analyses, respectively. Short Form-36 (SF-36), Tegner score, Knee injury and Osteoarthritis Outcome Score (KOOS) and visual analog scale (VAS) pain score were compared preoperatively and postoperatively. And postoperative complications were recorded. Results Overall, 33 patients were contacted at a mean follow-up of 37.94 ± 6.68 months, with a median age of 35 years (range: 26–63 years) at the surgery time. The physical component summary of SF-36 (p < 0.001) increased significantly at 1 year postoperatively. All patients returned to work, including 96.86% who returned to the same level of work in 1.89 ± 0.98 months, and to sports, including 78.26% who returned to the same sport level in 6.50 ± 2.05 months. Rates of returning to work (p = 0.215) and sports (p = 0.165) did not differ with work/sports intensity. Tegner scores (p = 0.025) and VAS pain scores (p < 0.001) decreased, and KOOS (p < 0.001) increased at 1 year postoperatively. Revision/conversion surgery was not required. In all, 30.43% patients reported a subjective decrease in sports ability; 82.61% patients considered their sports ability acceptable. Conclusion Patients returned to work/sports after isolated CWDFO, and had increased HRQoL. Patients playing high-impact sports had lower rates of returning to the same sport level, and may require preoperative counseling. Level of evidence IV, Case series.

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Progression of varus deformity in osteoarthritic knees induces anterior paradoxical motion of the femur during early knee flexion

Cited by 3 publications

References 23 publications

Changes in the anteroposterior position of the femur relative to the tibia impact patient satisfaction in total knee arthroplasty

Changes in the anteroposterior position of the femur relative to the tibia impact patient satisfaction in total knee arthroplasty

Preoperative tibiofemoral contact point on standing lateral radiograph predicts anteroposterior knee kinematics in total knee arthroplasty

Change in quality of life and return to work and sports after isolated closing-wedge distal femoral osteotomy

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