Basic ScienceAre We Subluxating Knees in Total Knee Arthroplasty? A Cadaveric Investigation
Section snippets
Surgical Procedure
Ten knees of Thiel-embalmed whole cadavers without any history of operations on the lower extremities, degenerative osteoarthritis of the hips or knees, or fractures were investigated for the present study. For both TKA implantation (all cuts) and assessing knee kinematics, a commercial computed tomography-free navigation device was used (Brainlab Knee 2.6, Brainlab, Feldkirchen, Germany). A median skin incision was performed, and the capsule was marked by a waterproof pen. By means of a
Relative Shift Natural Knees vs Knees After TKA
In comparison to the natural knees, in knees after TKA, the femoral bones in average shifted 5.3 mm (standard deviation [SD] = 4.0, P = .002) laterally, 2.6 mm (SD = 4.5, P = .099) dorsally, and 2.4 mm proximally (SD = 3.1, P = .038) in full extension. Throughout flexion, the lateral shift was reduced, the relative dorsal shift changed to ventral shift, and the proximalization was reduced as well. However, not all parameters showed significant differences (Table 1, Fig. 4).
Absolute Shift Natural Knees vs Knees After TKA
In absolute values,
Discussion
The main finding of the present study is that the relative position between the femoral and tibial bone is significantly changed before and after TKA, which confirms our hypothesis: Implantation of a standard TKA results in a translation of the knee joint. In extension, the femoral bone shifts laterally, dorsally, and proximally. Within flexion, the mediolateral and proximodistal shift reduces, the dorsal shift reverses to slight ventral shift. This is the first study not only to investigate
Conclusion
This the first study to reveal a subluxation of the femur in relation to the tibia after TKA. The femur significantly shifts 5.3 mm laterally in full extension, which reduces throughout flexion to 3.0 mm. Furthermore, the femur is located more dorsal in extension and more ventral in flexion after TKA. In the proximodistal manner, the femur is shifted proximally in extension which is not found in 90° of flexion. Major reasons for this effect might be incongruences between the proximal tibial
References (28)
- et al.
Total knee arthroplasty in younger patients evaluated by alternative outcome measures
J Arthroplasty
(2014) - et al.
Looks good but feels bad: factors that contribute to poor results after total knee arthroplasty
J Arthroplasty
(2007) - et al.
Does accurate anatomical alignment result in better function and quality of life? Comparing conventional and computer-assisted total knee arthroplasty
J Arthroplasty
(2009) - et al.
Changes in the functional flexion axis of the knee before and after total knee arthroplasty using a navigation system
J Arthroplasty
(2014) - et al.
Lower limb anatomy and alignment affect natural tibiofemoral knee kinematics: a cadaveric investigation
J Arthroplasty
(2016) - Graves S, Davidson D, de Steiger RN. Australian Orthopaedic Association National Joint Replacement Registry annual...
- et al.
Patient satisfaction after total knee arthroplasty: who is satisfied and who is not?
Clin Orthop Relat Res
(2010) - et al.
What proportion of patients report long-term pain after total hip or knee replacement for osteoarthritis? A systematic review of prospective studies in unselected patients
BMJ Open
(2012) - et al.
Postoperative alignment of total knee replacement. Its effect on survival
Clin Orthop Relat Res
(1994) - et al.
The relationship between the survival of total knee arthroplasty and postoperative coronal, sagittal and rotational alignment of knee prosthesis
Int Orthop
(2014)
What is the optimal alignment of the tibial and femoral components in knee arthroplasty?
Acta Orthop
Appropriate sagittal femoral component alignment cannot be ensured by intramedullary alignment rods
Knee Surg Sports Traumatol Arthrosc
Effect of rotational alignment on patellar tracking in total knee arthroplasty
Clin Orthop Relat Res
Variability of extraarticular tibial rotation references for total knee arthroplasty
Clin Orthop Relat Res
Cited by (10)
Not Another Twisted Knee
2019, Journal of Emergency MedicineCitation Excerpt :Subluxation of TKA is rare and may occur anteriorly or posteriorly, depending upon which ligament is injured. Factors contributing to subluxation include trauma, ligamentous decline, component malalignment, polyethylene wear, and translational parameters between the tibia and the femur (1–3). Instability after total knee arthroplasty is a cause of failure in 10–22% of revisions (4).
Reproducibility of navigation based kinematic analysis of the knee – A cadaveric investigation
2019, Journal of Orthopaedic ScienceCitation Excerpt :Fluoroscopic 3D-matching technique exposes patients to radiation [7] and does not really allow any real-time kinematic examinations. Recently, an increasing number of knee kinematic studies have been published using commercially and widely available navigational devices [8–14]. The validity of these investigations are questioned as they are often made in the operation room under not fully biomechanically controlled conditions.
Influence of Component Rotation in Total Knee Arthroplasty on Tibiofemoral Kinematics—A Cadaveric Investigation
2017, Journal of ArthroplastyCitation Excerpt :Kinematic analysis is very important to understand normal and pathologic joint function. For a complete description of knee/joint kinematics, 6 degrees of freedom which consist of 3 translational and 3 rotational parameters can be distinguished [30–32]. Motion is guided by the collateral and cruciate ligaments and the surface geometry of the concave medial and convex lateral tibial plateau, as well as the asymmetric femoral condyles.
Navigation and robotics—current status and future implications
2024, OrthopadieIs Mediolateral Translation of Femur Caused by Total Knee Arthroplasty Being Ignored?
2024, Indian Journal of OrthopaedicsPatellar tracking in knee arthroplasty
2024, Orthopadie
No author associated with this paper has disclosed any potential or pertinent conflicts which may be perceived to have impending conflict with this work. For full disclosure statements refer to http://dx.doi.org/10.1016/j.arth.2016.06.001.
All authors confirm that they were fully involved in the study and preparation of the article and that the material within has not been and will not be submitted for publication elsewhere.