Moderate External Rotation of Tibial Component Generates More Natural Kinematics Than Internal Rotation After Total Knee Arthroplasty

Abstract

This study aimed to investigate the influence of tibial malrotation on knee kinematics after total knee arthroplasty (TKA). A symmetric fixed-bearing posterior-stabilized prosthesis was implanted in the validated knee model with different rotational alignments of the tibial component (neutral, 3° external rotation, 5° external rotation, 3° internal rotation, and 5° internal rotation). Computational kinematic simulations were used to evaluate the postoperative kinematics of the knee joint including anteroposterior translation femoral condyles and axial rotation of tibial component during 0°–135° knee flexion. The results revealed that the neutral position of the tibial component was not the closest kinematics to the intact knee, the model with 5° external rotation of the tibial component showed the closest lateral condyle translation and tibial axial rotation, and moderate external rotation could improve the kinematics after TKA.

Comparison of navigation systems for total knee arthroplasty: A systematic review and meta-analysis

“…There is no evidence to indicate that the ABN and CN systems improve long-term clinical outcomes, although they have been shown to improve the accuracy of the alignments. Studies have demonstrated that component rotational alignment plays a key role in knee mechanics and kinematics and can have a demonstratable effect on postoperative clinical outcome ( 6 , 8 , 9 ). Complications like anterior knee pain, patellar subluxation, excessive polyethylene wear, and early failure have been associated with component malrotation.…”

“…Previous studies demonstrated that the alignment of the knee prosthesis was a key factor influencing postoperative clinical outcomes (4,5). Malalignment of the prosthesis can affect the mechanics and kinematics of the joint, such as femoral roll-back, tibial rotation, and stress on the ligaments and insert, as well as increasing the wear rate of polyethylene components (6)(7)(8)(9)(10). Some prosthetic designs can also take longer to insert, with longer surgical durations being linked to an increased risk of clinical complications and revision (11,12).…”

Mechanical alignment tolerance of a cruciate-retaining knee prosthesis under gait loading—A finite element analysis

“…The liner was bonded to the tibial component, and the femoral component was set to contact the tibial liner with a friction coefficient of 0.04 ( Fitzpatrick et al, 2016 ). The femoral component was only permitted to flex around the flexion-extension axis, while the tibial component was restricted in the flexion-extension but permitted to move in all other degrees of freedom ( Wang et al, 2019 ; Wang et al, 2021 ; Fang et al, 2022 ).…”

“…F3141-17a, 2017 ) are the most wildly used standards for the pre-clinical wear testing of knee prostheses; In contrast, both standards require the prosthesis to be installed in the standard alignment position, the normal alignment position is rarely replaced in TKA procedures. Previous studies have shown that component alignment affects the kinematics of the knee joint, including the femoral anteroposterior translation and tibial rotation ( Shih et al, 2020 ; Wang et al, 2021 ; Fang et al, 2022 ). Malignment can also produce higher stress and contact pressure on the tibial insert, which may increase wear and lead to premature failure ( Rostoker and Galante, 1979 ; Liau et al, 1999 ; Liau et al, 2002 ; Cheng et al, 2003 ; Koh et al, 2020 ).…”

Individualizing a Total Knee Arthroplasty with Three-Dimensional Planning

“…In addition, self-seating of the tibial implant in these cases can move the tibial tubercle medially attempting to improve the Q-angle and allow for correction of preexisting patellofemoral subluxation without releases. [32][33][34][35] An algorithm for helping align the patella is presented in Table 1.…”