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05.04.2018 | Knee | Ausgabe 10/2018

Knee Surgery, Sports Traumatology, Arthroscopy 10/2018

The increase in posterior tibial slope provides a positive biomechanical effect in posterior-stabilized total knee arthroplasty

Zeitschrift:
Knee Surgery, Sports Traumatology, Arthroscopy > Ausgabe 10/2018
Autoren:
Kyoung-Tak Kang, Sae Kwang Kwon, Juhyun Son, Oh-Ryong Kwon, Jun-Sang Lee, Yong-Gon Koh
Wichtige Hinweise
Kyoung-Tak Kang and Sae Kwang Kwon contributed equally to this work and should be considered co-first authors.

Abstract

Purpose

This study aims to clarify the influence of the posterior tibial slope (PTS) on knee joint biomechanics after posterior-stabilized (PS) total knee arthroplasty (TKA) using a computer simulation.

Methods

A validated TKA computational model was used to evaluate and quantify the effects of an increased PTS. In order to conduct a squat simulation, models with a − 3° to 15° PTS using increments of 3° were developed. Forces on the quadriceps and collateral ligament, a tibial posterior translation, contact point on a polyethylene (PE) insert, and contact stress on the patellofemoral (PF) joint and post in a PE insert were compared.

Results

The maximum force on the quadriceps and the PF contact stress decreased with increases in the PTS. The kinematics on the tibiofemoral (TF) joint translated in an increasingly posterior manner, and the medial and lateral contact points on a PE insert were located in posterior regions with increases in the PTS. Additionally, increases in the PTS decreased the force on the collateral ligament and increased the contact stress on the post in a PE insert. A higher force on the quadriceps is required when the PTS decreases with an equivalent flexion angle.

Conclusions

A surgeon should be prudent in terms of determining the PTS because an excessive increase in the PTS may lead to the progressive loosening of the TF joint due to a reduction in collateral ligament tension and failure of the post in a PE insert. Thus, we support a more individualized approach of optimal PTS determination given the findings of the study.

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