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- Title
Internal-external malalignment of the femoral component in kinematically aligned total knee arthroplasty increases tibial force imbalance but does not change laxities of the tibiofemoral joint.
- Authors
Riley, Jeremy; Roth, Joshua D.; Howell, Stephen M.; Hull, Maury L.
- Abstract
<bold>Purpose: </bold>The purposes of this study were to quantify the increase in tibial force imbalance (i.e. magnitude of difference between medial and lateral tibial forces) and changes in laxities caused by 2° and 4° of internal-external (I-E) malalignment of the femoral component in kinematically aligned total knee arthroplasty. Because I-E malalignment would introduce the greatest changes to the articular surfaces near 90° of flexion, the hypotheses were that the tibial force imbalance would be significantly increased near 90° flexion and that primarily varus-valgus laxity would be affected near 90° flexion.<bold>Methods: </bold>Kinematically aligned TKA was performed on ten human cadaveric knee specimens using disposable manual instruments without soft tissue release. One 3D-printed reference femoral component, with unmodified geometry, was aligned to restore the native distal and posterior femoral joint lines. Four 3D-printed femoral components, with modified geometry, introduced I-E malalignments of 2° and 4° from the reference component. Medial and lateral tibial forces were measured from 0° to 120° flexion using a custom tibial force sensor. Bidirectional laxities in four degrees of freedom were measured from 0° to 120° flexion using a custom load application system.<bold>Results: </bold>Tibial force imbalance increased the greatest at 60° flexion where a regression analysis against the degree of I-E malalignment yielded sensitivities (i.e. slopes) of 30 N/° (medial tibial force > lateral tibial force) and 10 N/° (lateral tibial force > medial tibial force) for internal and external malalignments, respectively. Valgus laxity increased significantly with the 4° external component with the greatest increase of 1.5° occurring at 90° flexion (p < 0.0001).<bold>Conclusion: </bold>With the tibial component correctly aligned, I-E malalignment of the femoral component caused significant increases in tibial force imbalance. Minimizing I-E malalignment lowers the increase in the tibial force imbalance. By keeping the resection thickness of each posterior femoral condyle to within ± 0.5 mm of the thickness of the respective posterior region of the femoral component, the increase in imbalance can be effectively limited to 38 N. Generally laxities were unaffected within the ± 4º range tested indicating that instability is not a clinical concern and that manual testing of laxities is not useful to detect I-E malalignment.
- Subjects
TOTAL knee replacement; PATELLOFEMORAL joint; KNEE surgery; KNEE pain; SURGICAL complications; TIBIOFEMORAL joint; FEMUR surgery; TIBIA surgery; BONE diseases; KNEE joint; MEDICAL cadavers; RANGE of motion of joints; JOINT instability; ARTIFICIAL joints; RESEARCH funding; TIBIA; THREE-dimensional printing; FEMUR; KINEMATICS
- Publication
Knee Surgery, Sports Traumatology, Arthroscopy, 2018, Vol 26, Issue 6, p1618
- ISSN
0942-2056
- Publication type
journal article
- DOI
10.1007/s00167-017-4776-3