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Knee Surgery, Sports Traumatology, Arthroscopy

Published in:

01-07-2019 | KNEE

Valgus position of the femoral component causes abnormal kinematics in the presence of medial looseness in total knee arthroplasty: a computer simulation model of TKA for valgus knee osteoarthritis

Authors: Kohei Nishitani, Shinichi Kuriyama, Shinichiro Nakamura, Yugo Morita, Hiromu Ito, Shuichi Matsuda

Published in: Knee Surgery, Sports Traumatology, Arthroscopy | Issue 7/2019

Abstract

Purpose

Total knee arthroplasty (TKA) for valgus knee osteoarthritis is challenging. Although overcorrection in TKA for valgus knee osteoarthritis is recommended, supportive data based on biomechanics have rarely been reported. The purpose of this study was to elucidate whether coronal rotation of the femoral compartment causes abnormal kinematics with or without medial looseness.

Methods

Multi- and single-radius posterior-stabilised TKA implants were utilised in a computer simulation. A total of 4 mm of slack were provided in the medial collateral ligament (MCL) with varus or valgus position of the femoral component to simulate the context of valgus knee osteoarthritis. Kinematics during gait and squatting activities were evaluated in each condition.

Results

During squatting, medial looseness and valgus replacement caused anterior translation of the medial femoral component in mid-flexion in the multi-radius implant. In the worst condition (7° valgus replacement with MCL looseness), there was rapid anterior translation in the multi-radius implant, and moderate anterior translation in the single-radius implant. Although medial looseness alone did not cause abnormal kinematics during gait, the worst condition exhibited an anterior translation to 4.9 mm in the multi-radius implant. This worst condition also exhibited a marked lift-off of 8.0 and 2.9 mm in the multi- and single-radius implants, respectively. Varus position caused little abnormal kinematics even with MCL looseness.

Conclusion

Valgus, not varus position of the femoral component caused abnormal kinematics with MCL looseness. To avoid valgus position, the safety target angle of femoral component would be slight varus rather than neutral in valgus knee OA.

Anderson KC, Buehler KC, Markel DC (2005) Computer assisted navigation in total knee arthroplasty: comparison with conventional methods. J Arthroplasty 20:132–138CrossRefPubMed

Blankevoort L, Kuiper JH, Huiskes R, Grootenboer HJ (1991) Articular contact in a three-dimensional model of the knee. J Biomech 24:1019–1031CrossRefPubMed

Chua KHZ, Chen Y, Lingaraj K (2014) Navigated total knee arthroplasty: is it error-free? Knee surgery, sports traumatology. Arthroscopy 22:643–649

Collados-Maestre I, Lizaur-Utrilla A, Gonzalez-Navarro B, Miralles-Muñoz FA, Marco-Gomez L, Lopez-Prats FA, Gil-Guillen V (2017) Better functional outcome after single-radius TKA compared with multi-radius TKA. Knee Surg Sports Traumatol Arthrosc 25:3508–3514CrossRefPubMed

Dennis D (2001) Femoral condylar lift-off in vivo in total knee arthroplasty. J Bone Jt Surg Br 83:33–39CrossRef

Dennis DA, Komistek RD, Kim RH, Sharma A (2010) Gap balancing versus measured resection technique for total knee arthroplasty. Clin Orthop Relat Res 468:102–107CrossRefPubMed

Elkus M, Ranawat CS, Rasquinha VJ, Babhulkar S, Rossi R, Ranawat AS (2004) Total knee arthroplasty for severe valgus deformity. Five to fourteen-year follow-up. J Bone Jt Surg Am 86-A:2671–2676CrossRef

Favorito P (2002) Total knee arthroplasty in the valgus knee. J Am Acad Orthop Surg 10:16–24CrossRefPubMed

Hino K, Ishimaru M, Iseki Y, Watanabe S, Onishi Y, Miura H (2013) Mid-flexion laxity is greater after posterior-stabilised total knee replacement than with cruciate-retaining procedures: a computer navigation study. Bone Jt J 95-B:493–497CrossRef

10.

Hino K, Kutsuna T, Oonishi Y, Watamori K, Kiyomatsu H, Iseki Y, Watanabe S, Ishimaru Y, Miura H (2017) Assessment of the midflexion rotational laxity in posterior-stabilized total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 25:3495–3500CrossRefPubMed

11.

Kang K-T, Kwon SK, Son J, Kwon O-R, Lee J-S, Koh Y-G (2018) The increase in posterior tibial slope provides a positive biomechanical effect in posterior-stabilized total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 26:3188–3195CrossRefPubMed

12.

Komistek R (2002) In vivo comparison of femorotibial contact positions for press-fit posterior stabilized and posterior cruciate-retaining total knee arthroplasties. J Arthroplasty 17:209–216CrossRefPubMed

13.

Koskinen E, Remes V, Paavolainen P, Harilainen A, Sandelin J, Tallroth K, Kettunen J, Ylinen P (2011) Results of total knee replacement with a cruciate-retaining model for severe valgus deformity—a study of 48 patients followed for an average of 9 years. Knee 18:145–150CrossRefPubMed

14.

Kuriyama S, Ishikawa M, Furu M, Ito H, Matsuda S (2014) Malrotated tibial component increases medial collateral ligament tension in total knee arthroplasty. J Orthop Res 32:1658–1666CrossRefPubMed

15.

Lee D-H, Padhy D, Park J-H, Jeong W-K, Park J-H, Han S-B (2011) The impact of a rectangular or trapezoidal flexion gap on the femoral component rotation in TKA. Knee Surg Sports Traumatol Arthrosc 19:1141–1147CrossRefPubMed

16.

Lee SY, Matsui N, Kurosaka M, Komistek RD, Mahfouz M, Dennis DA, Yoshiya S (2005) A posterior-stabilized total knee arthroplasty shows condylar lift-off during deep knee bends. Clin Orthop Relat Res 435:181–184CrossRef

17.

Matsuda S, Ito H (2015) Ligament balancing in total knee arthroplasty-medial stabilizing technique. Asia Pac J Sports Med Arthrosc Rehabil Technol 2:108–113PubMedPubMedCentral

18.

Nakamura S, Ito H, Yoshitomi H, Kuriyama S, Komistek RD, Matsuda S (2015) Analysis of the flexion gap on in vivo knee kinematics using fluoroscopy. J Arthroplasty 30:1237–1242CrossRefPubMed

19.

Okazaki K, Miura H, Matsuda S, Takeuchi N, Mawatari T, Hashizume M, Iwamoto Y (2006) Asymmetry of mediolateral laxity of the normal knee. J Orthop Sci 11:264–266CrossRefPubMed

20.

Ramappa M (2015) Midflexion instability in primary total knee replacement: a review. SICOT J 1:24CrossRefPubMedPubMedCentral

21.

Ritter MA, Davis KE, Davis P, Farris A, Malinzak RA, Berend ME, Meding JB (2013) Preoperative malalignment increases risk of failure after total knee arthroplasty. J Bone Jt Surg Am 95:126–131CrossRef

22.

Rossi R, Rosso F, Cottino U, Dettoni F, Bonasia DE, Bruzzone M (2014) Total knee arthroplasty in the valgus knee. Int Orthop 38:273–283CrossRefPubMed

23.

Shalhoub S, Moschetti WE, Dabuzhsky L, Jevsevar DS, Keggi JM, Plaskos C (2018) Laxity profiles in the native and replaced knee—application to robotic-assisted gap-balancing total knee arthroplasty. J Arthroplasty 33:3043–3048CrossRefPubMed

24.

Stoddard JE, Deehan DJ, Bull AMJ, McCaskie AW, Amis AA (2013) The kinematics and stability of single-radius versus multi-radius femoral components related to mid-range instability after TKA. J Orthop Res 31:53–58CrossRefPubMed

25.

Tanaka Y, Nakamura S, Kuriyama S, Ito H, Furu M, Komistek RD, Matsuda S (2016) How exactly can computer simulation predict the kinematics and contact status after TKA? Examination in individualized models. Clin Biomech (Bristol Avon) 39:65–70CrossRef

26.

Tokuhara Y, Kadoya Y, Nakagawa S, Kobayashi A, Takaoka K (2004) The flexion gap in normal knees. An MRI study. J Bone Jt Surg Br 86:1133–1136CrossRef

27.

Wellman SS, Klement MR, Queen RM (2017) Performance comparison of single-radius versus multiple-curve femoral component in total knee arthroplasty: a prospective, randomized study using the lower quarter Y-balance test. Orthopedics 40:e1074–e1080CrossRefPubMed

28.

Yang NH, Nayeb-Hashemi H, Canavan PK, Vaziri A (2010) Effect of frontal plane tibiofemoral angle on the stress and strain at the knee cartilage during the stance phase of gait. J Orthop Res 28:1539–1547CrossRefPubMed

Title: Valgus position of the femoral component causes abnormal kinematics in the presence of medial looseness in total knee arthroplasty: a computer simulation model of TKA for valgus knee osteoarthritis
Authors: Kohei Nishitani
Shinichi Kuriyama
Shinichiro Nakamura
Yugo Morita
Hiromu Ito
Shuichi Matsuda
Publication date: 01-07-2019
Publisher: Springer Berlin Heidelberg
Published in: Knee Surgery, Sports Traumatology, Arthroscopy / Issue 7/2019
Print ISSN: 0942-2056
Electronic ISSN: 1433-7347
DOI: https://doi.org/10.1007/s00167-018-5264-0

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Valgus position of the femoral component causes abnormal kinematics in the presence of medial looseness in total knee arthroplasty: a computer simulation model of TKA for valgus knee osteoarthritis

Abstract

Purpose

Methods

Results

Conclusion

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Springer Medicine

Abstract

Purpose

Methods

Results

Conclusion

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