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Patients with no functional improvement after total knee arthroplasty show different kinematics

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Abstract

Purpose

As many as 20 % of all patients following total knee arthroplasty are not satisfied with the result. Rotational alignment is one factor thought to affect clinical outcome. The purpose of this study was to assess relationships between prosthesis rotational alignment, function score and knee kinematics after TKA.

Methods

In 80 patients a cemented, unconstrained, cruciate-retaining TKA with a rotating platform was implanted. Rotational alignment was measured using CT-scans. Kinematics was assessed using fluoroscopy images.

Results

Seventy-three patients were available for follow-up after two years. Nine patients had more than 10° rotational mismatch between the femoral and tibial component in the postoperative CT scans. These patients showed significantly worse results in the function score. While the normal patients with less than 10° rotational mismatch improved from a mean pre-operative 55 points to a mean 71 points at follow-up, the group with more than 10° mismatch deteriorated from a mean 60 points pre-operatively to a mean 57 points at follow-up. The pattern of motion during passive flexion from approximately 0° to 120° was quite different. While external rotation steadily increased with knee flexion in the normal group, there was internal rotation between 30° and 80° of flexion in the group with more than 10° rotational mismatch.

Conclusion

Rotational mismatch between femoral and tibial components exceeding 10° resulted in different kinematics after TKA. It might contribute to worse clinical results observed in those patients and should therefore be avoided.

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Conflict of interest

The institution of one or more of the authors (JL, SK, MKH) has received funding from Stryker Orthopaedics.

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Authors and Affiliations

  1. Department of Orthopaedic Surgery, University Hospital Carl Gustav Carus, Medical Faculty of the Technical University of Dresden, Fetscherstr. 74, 01307, Dresden, Germany

    Jörg Lützner, Stephan Kirschner & Klaus-Peter Günther

  2. Department of Bioengineering, Rhodes Engineering Research Center, Clemson University, Clemson, SC, USA

    Melinda K. Harman

Authors
  1. Jörg Lützner
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  2. Stephan Kirschner
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  3. Klaus-Peter Günther
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  4. Melinda K. Harman
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Correspondence to Jörg Lützner.

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Lützner, J., Kirschner, S., Günther, KP. et al. Patients with no functional improvement after total knee arthroplasty show different kinematics. International Orthopaedics (SICOT) 36, 1841–1847 (2012). https://doi.org/10.1007/s00264-012-1584-8

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  • DOI: https://doi.org/10.1007/s00264-012-1584-8

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