Skip to main content
Top
Published in: Knee Surgery, Sports Traumatology, Arthroscopy 6/2015

01-06-2015 | Knee

Different femorotibial contact on the weight-bearing: midflexion between normal and varus aligned knees after total knee arthroplasty

Authors: Eisaku Fujimoto, Yoshiaki Sasashige, Tetsuya Tomita, Kenji Kashiwagi, Amiko Inoue, Mikiya Sawa, Yuki Ota

Published in: Knee Surgery, Sports Traumatology, Arthroscopy | Issue 6/2015

Login to get access

Abstract

Purpose

The influence of residual malalignment on biomechanical analysis after total knee arthroplasty (TKA) is currently uncertain. The hypothesis is that postoperative alignment would influence the in vivo kinematics after TKA, under weight-bearing conditions but not under non-weight-bearing condition. The purpose of the present study was to compare weight-bearing and non-weight-bearing conditions and to evaluate the effect of the postoperative alignment on the in vivo kinematics after posterior cruciate ligament-retaining TKA during midflexion using 2-dimensional/3-dimensional registration.

Methods

Thirty knees of 30 patients with pre-operative varus deformity were divided into 2 groups according to their postoperative alignment: the normal alignment group (N = 21) and the varus alignment group (N = 9).

Results

Under weight-bearing conditions, the varus alignment group showed a significant posterior displacement of the medial femoral condyle (flexion: 80°, 90° P < 0.05) and a significant anterior displacement of the lateral femoral condyle (flexion: 10° P < 0.01, 20° P < 0.05, and extension: 10°, 20° P < 0.01, 30°, 40° P < 0.05) as compared with the normal alignment group. In contrast, no significant difference in the medial and lateral femoral condyle positions under non-weight-bearing conditions was observed between the normal and varus alignment groups.

Conclusion

The postoperative alignment influenced knee kinematics under weight-bearing conditions. The weight load influenced knee kinematics through posterior tibial slope and induced greater lateral femoral condyle mobility, which might explain the better clinical and functional outcome. These findings contribute to gaining a proper understanding of the in vivo kinematics of the postoperative varus alignment and might be useful for orthopaedic surgeons in the achievement of patient satisfaction.

Level of evidence

III.
Literature
1.
go back to reference Banks SA, Markovich GD, Hodge WA (1997) In vivo kinematics of cruciate-retaining and -substituting knee arthroplasties. J Arthroplast 12(3):297–304CrossRef Banks SA, Markovich GD, Hodge WA (1997) In vivo kinematics of cruciate-retaining and -substituting knee arthroplasties. J Arthroplast 12(3):297–304CrossRef
2.
go back to reference Bargren JH, Blaha JD, Freeman MA (1983) Alignment in total knee arthroplasty. Correlated biomechanical and clinical observations. Clin Orthop Relat Res 173:178–183PubMed Bargren JH, Blaha JD, Freeman MA (1983) Alignment in total knee arthroplasty. Correlated biomechanical and clinical observations. Clin Orthop Relat Res 173:178–183PubMed
3.
go back to reference Bellemans J, Banks S, Victor J, Vandenneucker H, Moemans A (2002) Fluoroscopic analysis of the kinematics of deep flexion in total knee arthroplasty. Influence of posterior condylar offset. J Bone Joint Surg Br 84(1):50–53CrossRefPubMed Bellemans J, Banks S, Victor J, Vandenneucker H, Moemans A (2002) Fluoroscopic analysis of the kinematics of deep flexion in total knee arthroplasty. Influence of posterior condylar offset. J Bone Joint Surg Br 84(1):50–53CrossRefPubMed
4.
go back to reference Bellemans J, Robijns F, Duerinckx J, Banks S, Vandenneucker H (2005) The influence of tibial slope on maximal flexion after total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 13(3):193–196CrossRefPubMed Bellemans J, Robijns F, Duerinckx J, Banks S, Vandenneucker H (2005) The influence of tibial slope on maximal flexion after total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 13(3):193–196CrossRefPubMed
5.
go back to reference Berend ME, Ritter MA, Meding JB, Faris PM, Keating EM, Redelman R, Faris GW, Davis KE (2004) Tibial component failure mechanisms in total knee arthroplasty. Clin Orthop Relat Res 428:26–34CrossRefPubMed Berend ME, Ritter MA, Meding JB, Faris PM, Keating EM, Redelman R, Faris GW, Davis KE (2004) Tibial component failure mechanisms in total knee arthroplasty. Clin Orthop Relat Res 428:26–34CrossRefPubMed
6.
go back to reference Chong DY, Hansen UN, Amis AA (2010) Analysis of bone-prosthesis interface micromotion for cementless tibial prosthesis fixation and the influence of loading conditions. J Biomech 43(6):1074–1080CrossRefPubMed Chong DY, Hansen UN, Amis AA (2010) Analysis of bone-prosthesis interface micromotion for cementless tibial prosthesis fixation and the influence of loading conditions. J Biomech 43(6):1074–1080CrossRefPubMed
7.
go back to reference Dennis DA, Komistek RD, Colwell CE Jr, Ranawat CS, Scott RD, Thornhill TS, Lapp MA (1998) In vivo anteroposterior femorotibial translation of total knee arthroplasty: a multicenter analysis. Clin Orthop Relat Res 356:47–57CrossRefPubMed Dennis DA, Komistek RD, Colwell CE Jr, Ranawat CS, Scott RD, Thornhill TS, Lapp MA (1998) In vivo anteroposterior femorotibial translation of total knee arthroplasty: a multicenter analysis. Clin Orthop Relat Res 356:47–57CrossRefPubMed
8.
go back to reference Dennis DA, Komistek RD, Mahfouz MR (2003) In vivo fluoroscopic analysis of fixed-bearing total knee replacements. Clin Orthop Relat Res 410:114–130CrossRefPubMed Dennis DA, Komistek RD, Mahfouz MR (2003) In vivo fluoroscopic analysis of fixed-bearing total knee replacements. Clin Orthop Relat Res 410:114–130CrossRefPubMed
9.
go back to reference Dennis DA, Komistek RD, Mahfouz MR, Walker SA, Tucker A (2004) A multicenter analysis of axial femorotibial rotation after total knee arthroplasty. Clin Orthop Relat Res 428:180–189CrossRefPubMed Dennis DA, Komistek RD, Mahfouz MR, Walker SA, Tucker A (2004) A multicenter analysis of axial femorotibial rotation after total knee arthroplasty. Clin Orthop Relat Res 428:180–189CrossRefPubMed
10.
go back to reference Dennis DA, Mahfouz MR, Komistek RD, Hoff W (2005) In vivo determination of normal and anterior cruciate ligament-deficient knee kinematics. J Biomech 38(2):241–253CrossRefPubMed Dennis DA, Mahfouz MR, Komistek RD, Hoff W (2005) In vivo determination of normal and anterior cruciate ligament-deficient knee kinematics. J Biomech 38(2):241–253CrossRefPubMed
11.
go back to reference Fang DM, Ritter MA, Davis KE (2009) Coronal alignment in total knee arthroplasty: just how important is it? J Arthroplast 24(6 Suppl):39–43CrossRef Fang DM, Ritter MA, Davis KE (2009) Coronal alignment in total knee arthroplasty: just how important is it? J Arthroplast 24(6 Suppl):39–43CrossRef
12.
go back to reference Fujimoto E, Sasashige Y, Tomita T, Iwamoto K, Masuda Y, Hisatome T (2013) Significant effect of the posterior tibial slope on the weight-bearing, midflexion in vivo kinematics after cruciate-retaining total knee arthroplasty. J Arthroplast. doi:10.1016/j.arth.2013.10.018 Fujimoto E, Sasashige Y, Tomita T, Iwamoto K, Masuda Y, Hisatome T (2013) Significant effect of the posterior tibial slope on the weight-bearing, midflexion in vivo kinematics after cruciate-retaining total knee arthroplasty. J Arthroplast. doi:10.​1016/​j.​arth.​2013.​10.​018
13.
go back to reference Green GV, Berend KR, Berend ME, Glisson RR, Vail TP (2002) The effects of varus tibial alignment on proximal tibial surface strain in total knee arthroplasty: the posteromedial hot spot. J Arthroplast 17(8):1033–1039CrossRef Green GV, Berend KR, Berend ME, Glisson RR, Vail TP (2002) The effects of varus tibial alignment on proximal tibial surface strain in total knee arthroplasty: the posteromedial hot spot. J Arthroplast 17(8):1033–1039CrossRef
14.
go back to reference Halder A, Kutzner I, Graichen F, Heinlein B, Beier A, Bergmann G (2012) Influence of limb alignment on mediolateral loading in total knee replacement: in vivo measurements in five patients. J Bone Joint Surg Am 94(11):1023–1029CrossRefPubMed Halder A, Kutzner I, Graichen F, Heinlein B, Beier A, Bergmann G (2012) Influence of limb alignment on mediolateral loading in total knee replacement: in vivo measurements in five patients. J Bone Joint Surg Am 94(11):1023–1029CrossRefPubMed
15.
go back to reference Hallen LG, Lindahl O (1966) The “screw-home” movement in the knee-joint. Acta Orthop Scand 37(1):97–106CrossRefPubMed Hallen LG, Lindahl O (1966) The “screw-home” movement in the knee-joint. Acta Orthop Scand 37(1):97–106CrossRefPubMed
16.
go back to reference Han HS, Chang CB, Seong SC, Lee S, Lee MC (2008) Evaluation of anatomic references for tibial sagittal alignment in total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 16(4):373–377CrossRefPubMed Han HS, Chang CB, Seong SC, Lee S, Lee MC (2008) Evaluation of anatomic references for tibial sagittal alignment in total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 16(4):373–377CrossRefPubMed
17.
go back to reference Horiuchi H, Akizuki S, Tomita T, Sugamoto K, Yamazaki T, Shimizu N (2012) In vivo kinematic analysis of cruciate-retaining total knee arthroplasty during weight-bearing and non-weight-bearing deep knee bending. J Arthroplast 27(6):1196–1202CrossRef Horiuchi H, Akizuki S, Tomita T, Sugamoto K, Yamazaki T, Shimizu N (2012) In vivo kinematic analysis of cruciate-retaining total knee arthroplasty during weight-bearing and non-weight-bearing deep knee bending. J Arthroplast 27(6):1196–1202CrossRef
18.
go back to reference Howell SM, Howell SJ, Kuznik KT, Cohen J, Hull ML (2013) Does a kinematically aligned total knee arthroplasty restore function without failure regardless of alignment category? Clin Orthop Relat Res 471(3):1000–1007CrossRefPubMedCentralPubMed Howell SM, Howell SJ, Kuznik KT, Cohen J, Hull ML (2013) Does a kinematically aligned total knee arthroplasty restore function without failure regardless of alignment category? Clin Orthop Relat Res 471(3):1000–1007CrossRefPubMedCentralPubMed
19.
go back to reference Howell SM, Papadopoulos S, Kuznik KT, Hull ML (2013) Accurate alignment and high function after kinematically aligned TKA performed with generic instruments. Knee Surg Sports Traumatol Arthrosc 21(10):2271–2280CrossRefPubMed Howell SM, Papadopoulos S, Kuznik KT, Hull ML (2013) Accurate alignment and high function after kinematically aligned TKA performed with generic instruments. Knee Surg Sports Traumatol Arthrosc 21(10):2271–2280CrossRefPubMed
20.
go back to reference Jeffery RS, Morris RW, Denham RA (1991) Coronal alignment after total knee replacement. J Bone Joint Surg Br 73(5):709–714PubMed Jeffery RS, Morris RW, Denham RA (1991) Coronal alignment after total knee replacement. J Bone Joint Surg Br 73(5):709–714PubMed
21.
go back to reference Kitagawa A, Tsumura N, Chin T, Gamada K, Banks SA, Kurosaka M (2010) In vivo comparison of knee kinematics before and after high-flexion posterior cruciate-retaining total knee arthroplasty. J Arthroplast 25(6):964–969CrossRef Kitagawa A, Tsumura N, Chin T, Gamada K, Banks SA, Kurosaka M (2010) In vivo comparison of knee kinematics before and after high-flexion posterior cruciate-retaining total knee arthroplasty. J Arthroplast 25(6):964–969CrossRef
22.
go back to reference Komistek RD, Dennis DA, Mahfouz M (2003) In vivo fluoroscopic analysis of the normal human knee. Clin Orthop Relat Res 410:69–81CrossRefPubMed Komistek RD, Dennis DA, Mahfouz M (2003) In vivo fluoroscopic analysis of the normal human knee. Clin Orthop Relat Res 410:69–81CrossRefPubMed
23.
go back to reference Komistek RD, Mahfouz MR, Bertin KC, Rosenberg A, Kennedy W (2008) In vivo determination of total knee arthroplasty kinematics: a multicenter analysis of an asymmetrical posterior cruciate retaining total knee arthroplasty. J Arthroplast 23(1):41–50CrossRef Komistek RD, Mahfouz MR, Bertin KC, Rosenberg A, Kennedy W (2008) In vivo determination of total knee arthroplasty kinematics: a multicenter analysis of an asymmetrical posterior cruciate retaining total knee arthroplasty. J Arthroplast 23(1):41–50CrossRef
24.
go back to reference Liau JJ, Cheng CK, Huang CH, Lo WH (2002) The effect of malalignment on stresses in polyethylene component of total knee prostheses–a finite element analysis. Clin Biomech 17(2):140–146CrossRef Liau JJ, Cheng CK, Huang CH, Lo WH (2002) The effect of malalignment on stresses in polyethylene component of total knee prostheses–a finite element analysis. Clin Biomech 17(2):140–146CrossRef
25.
go back to reference Lotke PA, Ecker ML (1977) Influence of positioning of prosthesis in total knee replacement. J Bone Joint Surg Am 59(1):77–79PubMed Lotke PA, Ecker ML (1977) Influence of positioning of prosthesis in total knee replacement. J Bone Joint Surg Am 59(1):77–79PubMed
26.
go back to reference Mahfouz MR, Komistek RD, Dennis DA, Hoff WA (2004) In vivo assessment of the kinematics in normal and anterior cruciate ligament-deficient knees. J Bone Joint Surg Am 86-A(Suppl 2):56–61PubMed Mahfouz MR, Komistek RD, Dennis DA, Hoff WA (2004) In vivo assessment of the kinematics in normal and anterior cruciate ligament-deficient knees. J Bone Joint Surg Am 86-A(Suppl 2):56–61PubMed
27.
go back to reference Massin P, Gournay A (2006) Optimization of the posterior condylar offset, tibial slope, and condylar roll-back in total knee arthroplasty. J Arthroplast 21(6):889–896CrossRef Massin P, Gournay A (2006) Optimization of the posterior condylar offset, tibial slope, and condylar roll-back in total knee arthroplasty. J Arthroplast 21(6):889–896CrossRef
28.
go back to reference Moreland JR (1988) Mechanisms of failure in total knee arthroplasty. Clin Orthop Relat Res 226:49–64PubMed Moreland JR (1988) Mechanisms of failure in total knee arthroplasty. Clin Orthop Relat Res 226:49–64PubMed
29.
go back to reference Panel NIHC (2004) NIH Consensus Statement on total knee replacement December 8-10, 2003. J Bone Joint Surg Am 86(6):1328–1335 Panel NIHC (2004) NIH Consensus Statement on total knee replacement December 8-10, 2003. J Bone Joint Surg Am 86(6):1328–1335
30.
go back to reference Ritter MA (2009) The Anatomical Graduated Component total knee replacement: a long-term evaluation with 20-year survival analysis. J Bone Joint Surg Br 91(6):745–749CrossRefPubMed Ritter MA (2009) The Anatomical Graduated Component total knee replacement: a long-term evaluation with 20-year survival analysis. J Bone Joint Surg Br 91(6):745–749CrossRefPubMed
31.
go back to reference Ritter MA, Davis KE, Meding JB, Pierson JL, Berend ME, Malinzak RA (2011) The effect of alignment and BMI on failure of total knee replacement. J Bone Joint Surg Am 93(17):1588–1596CrossRefPubMed Ritter MA, Davis KE, Meding JB, Pierson JL, Berend ME, Malinzak RA (2011) The effect of alignment and BMI on failure of total knee replacement. J Bone Joint Surg Am 93(17):1588–1596CrossRefPubMed
32.
go back to reference Ritter MA, Faris PM, Keating EM, Meding JB (1994) Postoperative alignment of total knee replacement. Its effect on survival. Clin Orthop Relat Res 299:153–156PubMed Ritter MA, Faris PM, Keating EM, Meding JB (1994) Postoperative alignment of total knee replacement. Its effect on survival. Clin Orthop Relat Res 299:153–156PubMed
33.
34.
go back to reference Stiehl JB, Komistek RD, Dennis DA (1999) Detrimental kinematics of a flat on flat total condylar knee arthroplasty. Clin Orthop Relat Res 365:139–148CrossRefPubMed Stiehl JB, Komistek RD, Dennis DA (1999) Detrimental kinematics of a flat on flat total condylar knee arthroplasty. Clin Orthop Relat Res 365:139–148CrossRefPubMed
35.
go back to reference Stiehl JB, Komistek RD, Dennis DA, Paxson RD, Hoff WA (1995) Fluoroscopic analysis of kinematics after posterior-cruciate-retaining knee arthroplasty. J Bone Joint Surg Br 77(6):884–889PubMed Stiehl JB, Komistek RD, Dennis DA, Paxson RD, Hoff WA (1995) Fluoroscopic analysis of kinematics after posterior-cruciate-retaining knee arthroplasty. J Bone Joint Surg Br 77(6):884–889PubMed
36.
go back to reference Vanlommel L, Vanlommel J, Claes S, Bellemans J (2013) Slight undercorrection following total knee arthroplasty results in superior clinical outcomes in varus knees. Knee Surg Sports Traumatol Arthrosc 21(10):2325–2330CrossRefPubMed Vanlommel L, Vanlommel J, Claes S, Bellemans J (2013) Slight undercorrection following total knee arthroplasty results in superior clinical outcomes in varus knees. Knee Surg Sports Traumatol Arthrosc 21(10):2325–2330CrossRefPubMed
37.
go back to reference Victor J, Banks S, Bellemans J (2005) Kinematics of posterior cruciate ligament-retaining and -substituting total knee arthroplasty: a prospective randomised outcome study. J Bone Joint Surg Br 87(5):646–655CrossRefPubMed Victor J, Banks S, Bellemans J (2005) Kinematics of posterior cruciate ligament-retaining and -substituting total knee arthroplasty: a prospective randomised outcome study. J Bone Joint Surg Br 87(5):646–655CrossRefPubMed
38.
go back to reference Wong J, Steklov N, Patil S, Flores-Hernandez C, Kester M, Colwell CW Jr, D’Lima DD (2011) Predicting the effect of tray malalignment on risk for bone damage and implant subsidence after total knee arthroplasty. J Orthop Res 29(3):347–353CrossRefPubMed Wong J, Steklov N, Patil S, Flores-Hernandez C, Kester M, Colwell CW Jr, D’Lima DD (2011) Predicting the effect of tray malalignment on risk for bone damage and implant subsidence after total knee arthroplasty. J Orthop Res 29(3):347–353CrossRefPubMed
39.
go back to reference Yamazaki T, Watanabe T, Nakajima Y, Sugamoto K, Tomita T, Maeda D, Sato Y, Yoshikawa H, Tamura S (2005) Development of three-dimensional kinematic analysis system for artificial knee implants using X-ray fluoroscopic imaging. Nihon Hoshasen Gijutsu Gakkai Zasshi 61(1):79–87PubMed Yamazaki T, Watanabe T, Nakajima Y, Sugamoto K, Tomita T, Maeda D, Sato Y, Yoshikawa H, Tamura S (2005) Development of three-dimensional kinematic analysis system for artificial knee implants using X-ray fluoroscopic imaging. Nihon Hoshasen Gijutsu Gakkai Zasshi 61(1):79–87PubMed
40.
go back to reference Yoshiya S, Matsui N, Komistek RD, Dennis DA, Mahfouz M, Kurosaka M (2005) In vivo kinematic comparison of posterior cruciate-retaining and posterior stabilized total knee arthroplasties under passive and weight-bearing conditions. J Arthroplast 20(6):777–783CrossRef Yoshiya S, Matsui N, Komistek RD, Dennis DA, Mahfouz M, Kurosaka M (2005) In vivo kinematic comparison of posterior cruciate-retaining and posterior stabilized total knee arthroplasties under passive and weight-bearing conditions. J Arthroplast 20(6):777–783CrossRef
41.
go back to reference Zuffi S, Leardini A, Catani F, Fantozzi S, Cappello A (1999) A model-based method for the reconstruction of total knee replacement kinematics. IEEE Trans Med Imaging 18(10):981–991CrossRefPubMed Zuffi S, Leardini A, Catani F, Fantozzi S, Cappello A (1999) A model-based method for the reconstruction of total knee replacement kinematics. IEEE Trans Med Imaging 18(10):981–991CrossRefPubMed
Metadata
Title
Different femorotibial contact on the weight-bearing: midflexion between normal and varus aligned knees after total knee arthroplasty
Authors
Eisaku Fujimoto
Yoshiaki Sasashige
Tetsuya Tomita
Kenji Kashiwagi
Amiko Inoue
Mikiya Sawa
Yuki Ota
Publication date
01-06-2015
Publisher
Springer Berlin Heidelberg
Published in
Knee Surgery, Sports Traumatology, Arthroscopy / Issue 6/2015
Print ISSN: 0942-2056
Electronic ISSN: 1433-7347
DOI
https://doi.org/10.1007/s00167-014-3194-z

Other articles of this Issue 6/2015

Knee Surgery, Sports Traumatology, Arthroscopy 6/2015 Go to the issue