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Influence of tibial rotation in total knee arthroplasty on knee kinematics and retropatellar pressure: an in vitro study

  • Knee
  • Published:
Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Purpose

Although continuous improvements have been made, there is still a considerable amount of unsatisfied patients after total knee arthroplasty (TKA). A main reason for this high percentage is anterior knee pain, which is supposed to be provoked by post-operative increased retropatellar peak pressure. Since rotational malalignment of the implant is believed to contribute to post-operative pain, the aim of this study was to examine the influence of tibial component rotation on knee kinematics and retropatellar pressure.

Methods

Eight fresh-frozen knee specimens were tested in a weight-bearing knee rig after fixed-bearing TKA under a loaded squat from 20° to 120° of flexion. To examine tibial components with different rotations, special inlays with 3° internal rotation and 3° external rotation were produced and retropatellar pressure distribution was measured with a pressure-sensitive film. The kinematics of the patella and the femorotibial joint were recorded with an ultrasonic-based motion analysis system.

Results

Retropatellar peak pressure decreased significantly from 3° internal rotation to neutral position and 3° external rotation of the tibial component (8.5 ± 2.3 vs. 8.2 ± 2.4 vs. 7.8 ± 2.5 MPa). Regarding knee kinematics femorotibial rotation and anterior–posterior translation, patella rotation and tilt were altered significantly, but relative changes remained minimal.

Conclusion

Changing tibial rotation revealed a high in vitro influence on retropatellar peak pressure. We recommend the rotational alignment of the tibial component to the medial third of the tibial tuberosity or even more externally beyond that point to avoid anterior knee pain after TKA.

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Acknowledgements

The authors thank the Dr. Auguste Schaedel-Dantscher Foundation for their financial support of this study. We thank Aesculap AG especially PD Dr. Dr. Thomas Grupp for providing CAD-Files of the TKA. Sincere thanks are given to Moritz von Holst for his help in translating our text into English and to Dr. Alexander Crispin (Institute of Biometry and Epidemiology, LMU Munich) for his statistical council.

Conflict of interest

The authors declare that they have no conflict of interest.

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Authors and Affiliations

  1. Department of Orthopedic Surgery, Physical Medicine and Rehabilitation, University Hospital of Munich (LMU), Campus Grosshadern, Marchioninistr. 15, 81377, Munich, Germany

    Arnd Steinbrück, Christian Schröder, Matthias Woiczinski, Tatjana Müller, Peter E. Müller, Volkmar Jansson & Andreas Fottner

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  1. Arnd Steinbrück
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  2. Christian Schröder
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Correspondence to Arnd Steinbrück.

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Steinbrück, A., Schröder, C., Woiczinski, M. et al. Influence of tibial rotation in total knee arthroplasty on knee kinematics and retropatellar pressure: an in vitro study. Knee Surg Sports Traumatol Arthrosc 24, 2395–2401 (2016). https://doi.org/10.1007/s00167-015-3503-1

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