The Biomechanical Effect of Increased Valgus on Total Knee Arthroplasty: A Cadaveric Study

Bryant, Brandon; Tilan, Justin; McGarry, Michelle H.; Takenaka, Nobuyuki; Kim, William C.; Lee, Thay Q.

doi:10.1016/j.arth.2013.09.003

Cited by 14 publications

(18 citation statements)

References 19 publications

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“… 28 29 30 In previous studies, the increased MCL tension was one of the principle causes of the pain or stiff knee in internal malrotation. 28 29 30 Internal femoral component rotation and valgus tibial component malalignment may be detrimental to the MCL. For the LCL, PFL, and ALS, the ligament forces increased with external malrotation and varus malalignment.…”

Section: Discussionmentioning

confidence: 95%

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Malpositioning of Prosthesis: Patient-specific Total Knee Arthroplasty Versus Standard Off-the-Shelf Total Knee Arthroplasty

et al. 2017

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Introduction:A recent study has challenged the premise that a patient-specific (PS)–designed total knee arthroplasty (TKA) component has better clinical survival than an off-the-shelf (OTS) prosthesis.Methods:We developed the finite element models for PS TKA and OTS TKA with 5° varus and valgus malalignment and 5° internal and external malrotations.Results:Contact stress on the medial side of the insert increased with internal femoral malrotation and varus tibial malalignment, but it decreased with external femoral malrotation and varus tibial malalignment in both PS TKA and OTS TKA. An increase in ligament force occurred in valgus malalignment and external malrotation, and in particular, the force exerted on the medial collateral ligament increased. However, PS TKA provided better biomechanical effects than did the standard OTS TKA with malpositioning in TKA.Discussion:These results emphasize the importance of precise surgical preservation in regard to the TKA position.

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Section: Discussionmentioning

confidence: 95%

“… 27 In malpositioning with valgus malalignment, previous studies reported that strain values from the valgus testing increased in both the anterior and posterior bands of the MCL, with the greatest average values found in the posterior band at 60° knee flexion. 28 …”

Section: Discussionmentioning

confidence: 99%

Malpositioning of Prosthesis: Patient-specific Total Knee Arthroplasty Versus Standard Off-the-Shelf Total Knee Arthroplasty

et al. 2017

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“…30 Relatively small surgical errors, which lead to slight implant malalignment, may not be detectable using standard follow-up tools and can still lead to considerable differences in foot loading parameters and pressure distribution. 31 Accuracy of prosthetic alignment is an important factor in achieving successful TKA, and it is essential to provide longterm implant survival. 13,21,32 It was reported that knees with varus malalignment had an increased rate of long-term failure with an increased wear of polyethylene inserts, especially for knees aligned in 5 degrees or more varus.…”

Section: Discussionmentioning

confidence: 99%

“…Normal values of component alignment angles15,27,31 and comparison of these angles among the groups created according to tibial component position in frontal plane…”

mentioning

confidence: 99%

Pedobarographic Analysis in Total Knee Arthroplasty

et al. 2017

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Pedobarographic gait analysis is a useful tool for the determination of loading distributions and alterations on the lower extremity and their reflection on the foot sole after many orthopaedic surgical applications. To date, there have been no studies evaluating the relationship between component alignment and changes of pedobarographic gait analysis in total knee arthroplasty (TKA). We aimed to investigate the effects of TKA and prosthetic alignment on the distribution of pedobarographic parameters. Quantitative gait patterns of 47 patients were prospectively evaluated by using pedobarography 1 week before surgery and at the seventh month, on average, postoperatively. Component positions were assessed, and all applications were divided into three groups according to tibial component position as varus, neutral, and valgus. Pedobarographic results were compared between pre- and postoperative values for all applications and compared among the groups. Mean postoperative tibiofemoral angle was 5.4 degrees in valgus, and preoperative knee scores were markedly improved postoperatively. The range of tibial component alignment changed between 1 and 4 degrees in the varus and valgus groups. Plantar loading parameters (force and pressure) were significantly decreased in all operated knees, especially in forefoot and midfoot. In varus tibial components, plantar loading values decreased in midfoot and hindfoot. However, in the neutral and valgus groups, similar alterations of plantar loadings were obtained, which included decreasing in forefoot and midfoot with significant increase in hindfoot. Plantar loading distribution changed statistically significantly after TKA despite good clinical and radiographic results. Tibial component alignment was also responsible for plantar loading distribution. Tibial components in varus position create different foot loading characteristics compared with neutral and valgus aligned components. Pedobarographic evaluation in TKA allows clinicians to obtain a proper understanding of abnormal gait caused by component malposition.

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“…Consistent with these clinical reports, Bryant and coworkers, in a recent cadaveric study, found valgus loading of a TKA to significantly increase lateral tibio-femoral contact pressures and MCL strain. 50 …”

Section: Tibial Component Varusmentioning

confidence: 99%

Coronal alignment after total knee arthroplasty

2016

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Recent studies have challenged the long-held notion that neutral mechanical alignment after total knee arthroplasty leads to optimal function and survivorship. The ideal alignment for function and survivorship may actually be different. Kinematic alignment, where components are implanted to re-create the natural flexion/extension axis of the knee, may lead to improved functional results. Residual varus alignment may not adversely impact survivorship provided the tibial component is implanted in neutral alignment. Cite this article: Lording T, Lustig S, Neyret P. Coronal alignment after total knee arthroplasty. EFORT Open Rev 2016;1:12-17. doi: 10.1302/2058-5241.1.000002.

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The Biomechanical Effect of Increased Valgus on Total Knee Arthroplasty: A Cadaveric Study

Cited by 14 publications

References 19 publications

Malpositioning of Prosthesis: Patient-specific Total Knee Arthroplasty Versus Standard Off-the-Shelf Total Knee Arthroplasty

Malpositioning of Prosthesis: Patient-specific Total Knee Arthroplasty Versus Standard Off-the-Shelf Total Knee Arthroplasty

Pedobarographic Analysis in Total Knee Arthroplasty

Coronal alignment after total knee arthroplasty

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