The influence of the tibial slope on intra-operative soft tissue balance in cruciate-retaining and posterior-stabilized total knee arthroplasty

Oka, Shiro; Matsumoto, Tomoyuki; Muratsu, Hirotsugu; Kubo, Seiji; Matsushita, Takehiko; Ishida, Kazunari; Kuroda, Ryosuke; Kurosaka, Masahiro

doi:10.1007/s00167-013-2535-7

Cited by 32 publications

(22 citation statements)

References 41 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…In addition to the positive association between lower preoperative bone quality and better postoperative outcomes on the KOOS, a larger tibial slope was associated with postoperative improvement on the “pain,” “sport and recreation function,” and “knee‐related quality of life” domains of the KOOS at 2 months postoperatively. Tibial slope is reported to be positively associated with flexion gap and maximal knee flexion following TKA . Although there was a trend that larger tibial slope was associated with larger maximal flexion of the knee postoperatively in our series (data not shown), the correlation was not statistically significant.…”

Section: Discussioncontrasting

confidence: 70%

Local bone quality affects the outcome of prosthetic total knee arthroplasty

Huang

Jiang

Hsieh

et al. 2015

Journal Orthopaedic Research

View full text Add to dashboard Cite

Osteoporosis and osteoarthritis commonly coexist in the elderly. In patients undergoing prosthetic total knee arthroplasty (TKA), the bone quality around the knee joint may affect the safety of prosthetic implantation and consequently satisfaction with the surgical outcome. We recruited 50 postmenopausal women undergoing TKA for primary osteoarthritis; 43 completed the study protocol. The bone quality parameters of the operated knee, including bone mineral density assessed using dual-energy X-ray absorptiometry and microarchitecture variables assessed using micro-computed tomography, were determined. Surgical outcomes were assessed according to immediate (<1 week) postoperative pain quantified using the visual analog scale and knee function quantified using the Knee Injury and Osteoarthritis Outcome Score (KOOS) at 2 and 6 months postoperatively. The influence of bone quality parameters on surgical outcomes was analyzed using simple and multiple regression analyses. Volumetric bone mineral density (R 2 ¼ 0.187-0.234, p < 0.01), the structural model index (R 2 ¼ 0.103-0.181, p < 0.05), and trabecular separation (R 2 ¼ 0.289-0.424, p < 0.05) were significantly associated with postoperative pain and improvement according to the KOOS. In conclusion, local bone quality, including mineral content and microarchitecture, affects the surgical outcome of TKA. ß

show abstract

Section: Discussioncontrasting

confidence: 70%

Local bone quality affects the outcome of prosthetic total knee arthroplasty

Huang

Jiang

Hsieh

et al. 2015

Journal Orthopaedic Research

View full text Add to dashboard Cite

show abstract

“…However, reducing the conformity would likely increase the anterior laxity . Hence, alterations to the posterior slope, which are associated with the A‐P neutral position, posterior cruciate ligament tension, and flexion gap size, in conjunction with changes in the conformity of the insert, may be necessary to achieve an A‐P neutral position closer to native. Similarly, it may be possible to better limit differences in the laxities and neutral positions from native in the other degrees of freedom by optimizing component alignment and component design to more effectively compensate for loss of the ACL and menisci.…”

Section: Discussionmentioning

confidence: 99%

Analysis of differences in laxities and neutral positions from native after kinematically aligned TKA using cruciate retaining implants

Roth

Howell

Hull

2019

Journal Orthopaedic Research

View full text Add to dashboard Cite

One biomechanical goal of kinematically aligned total knee arthroplasty (KA TKA) is to achieve knee laxities and neutral positions that are not different from those of the native knee without soft tissue release. However, replacing the articular surfaces and menisci with implants of discrete sizes and average shapes and resecting the anterior cruciate ligament (ACL) might prevent KA TKA from achieving this goal in the tibiofemoral joint. Accordingly, the objective was to determine whether either or both surgically induced changes cause differences in laxities and/or neutral positions from native using a cruciate retaining implant. Eight laxities and four neutral positions were measured from 0˚to 120˚flexion in 30˚increments in 13 human cadaveric knees in three knee conditions: native, ACL-deficient, and KA TKA. After KA TKA, 5 of the 40 laxity measures (8 laxities Â 5 flexion angles) and 6 of the 20 neutral position measures (4 neutral positions Â 5 flexion angles) were statistically different from those of the native knee. The greatest differences in laxities from native after KA TKA occurred at 30˚flexion in anterior translation (1.6 AE 2.1 mm increase, p < 0.0001); this difference was 1.7 AE 2.1 mm less than that in the ACL-d knee (p < 0.0001). The greatest difference in neutral positions from native after KA TKA occurred in anterior-posterior translation at 0˚flexion (3.8 AE 1.9 mm anterior, p < 0.0001); this difference was 2.6 AE 1.9 mm greater than that in the ACL-d knee (p ¼ 0.0002). Clinical Significance: These results indicate that the biomechanical goal of KA TKA is largely realized despite the two surgically induced changes. ß

show abstract

“…The finite element models have been developed to estimate the knee contact pressures with different PTS, but there is a paucity of in vitro studies evaluating the effect of PTS on the tibiofemoral joint contact pressures after posterior-stabilized (PS) TKA [ 10 ]. There are few cadaveric studies concerning the PTS in PS-TKA, and it still remains controversial whether or not increasing PTS in PS-TKA is beneficial [ 2 , 26 , 27 ].…”

Section: Introductionmentioning

confidence: 99%

The biomechanical effect of different posterior tibial slopes on the tibiofemoral joint after posterior-stabilized total knee arthroplasty

2020

View full text Add to dashboard Cite

Background Different posterior tibial slopes (PTS) after posterior-stabilized total knee arthroplasty (PS-TKA) may lead to different biomechanical characteristics of knee joint. This cadaveric study was designed to investigate the tibiofemoral kinematics and contact pressures after PS-TKA with different PTS. Methods Nine human cadaveric knee specimens were used for PS-TKA with the PTS of 3°, 6°, and 9°. The tibiofemoral kinematics and contact pressures were measured during knee flexion angle changing from 0 to 120° (with an increment of 10°) with an axial load of 1000 N at each angle. Results The root mean square (RMS) of the tibiofemoral contact area and the mean and peak contact pressures during knee flexion were 586.2 mm 2 , 1.85 MPa, and 5.39 MPa before TKA and changed to 130.2 mm 2 , 7.56 MPa, and 17.98 MPa after TKA, respectively. Larger contact area and smaller mean and peak contact pressures were found in the joints with the larger PTS after TKA. The RMS differences of femoral rotation before and after TKA were more than 9.9°. The posterior translation of the lateral condyle with larger PTS was more than that with smaller PTS, while overall, the RMS differences before and after TKA were more than 11.4 mm. Conclusion After TKA, the tibiofemoral contact area is reduced, and the contact pressure is increased greatly. Approximately 80% of the femoral rotation is lost, and only about 60% of the femoral translation of lateral condyle is recovered. TKA with larger PTS results in more posterior femoral translation, larger contact area, and smaller contact pressure, indicating that with caution, it may be beneficial to properly increase PTS for PS-TKA.

show abstract

The influence of the tibial slope on intra-operative soft tissue balance in cruciate-retaining and posterior-stabilized total knee arthroplasty

Cited by 32 publications

References 41 publications

Local bone quality affects the outcome of prosthetic total knee arthroplasty

Local bone quality affects the outcome of prosthetic total knee arthroplasty

Analysis of differences in laxities and neutral positions from native after kinematically aligned TKA using cruciate retaining implants

The biomechanical effect of different posterior tibial slopes on the tibiofemoral joint after posterior-stabilized total knee arthroplasty

Contact Info

Product

Resources

About