Skip to main content
SpringerLink
Log in

Changes in sagittal component alignment alters patellar kinematics in TKA: an in vitro study

  • Knee
  • Published:
Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Purpose

Patellar maltracking due to incorrect component alignment is considered as a main reason for anterior knee pain after total knee arthroplasty (TKA). In contrast to coronal and axial component placement, the influence of sagittal component alignment on patellar kinematics has not been investigated so far.

Methods

In ten lower cadaveric limbs, TKAs were implanted using a commercial computer navigation system. In six knees, the femoral component was aligned in 5° and in four knees in 0° of flexion, respectively. Patellar kinematics were registered by means of a computer navigation system using an additional patella tracking array and correlated with femoral and tibial sagittal component alignment.

Results

Sagittal component alignment significantly altered patellar mediolateral shift (p < 0.05). In contrast, patellar epicondylar distance, rotation and tilt were not significantly influenced.

Conclusions

Sagittal component alignment in TKA has a major impact on patellar kinematics and should therefore be considered while addressing tibiofemoral kinematics intraoperatively.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Akagi M, Oh M, Nonaka T, Tsujimoto H, Asano T, Hamanishi C (2004) An anteroposterior axis of the tibia for total knee arthroplasty. Clin Orthop Relat Res 420:213–219

    Article  PubMed  Google Scholar 

  2. Baier C, Fitz W, Craiovan B, Keshmiri A, Winkler S, Springorum R, Grifka J, Beckmann J (2014) Improved kinematics of total knee replacement following partially navigated modified gap-balancing technique. Int Orthop 38:243–249

    Article  PubMed Central  PubMed  Google Scholar 

  3. Bargren J, Blaha J, Freeman M (1983) Alignment in total knee arthroplasty. Correlated biomechanical and clinical observations. Clin Orthop Relat Res 173:178–183

    PubMed  Google Scholar 

  4. Barrack RL, Schrader T, Bertot AJ, Wolfe MW, Myers L (2001) Component rotation and anterior knee pain after total knee arthroplasty. Clin Orthop Relat Res 392:46–55

    Article  PubMed  Google Scholar 

  5. Belvedere C, Ensini A, Leardini A, Dedda V, Feliciangeli A, Cenni F, Timoncini A, Barbadoro P, Giannini S (2014) Tibio-femoral and patello-femoral joint kinematics during navigated total knee arthroplasty with patellar resurfacing. Knee Surg Sports Traumatol Arthrosc 22:1719–1727

    Article  CAS  PubMed  Google Scholar 

  6. Berger RA, Crossett LS, Jacobs JJ, Rubash HE (1998) Malrotation causing patellofemoral complications after total knee arthroplasty. Clin Orthop Relat Res 356:144–153

    Article  PubMed  Google Scholar 

  7. Colle F, Lopomo N, Bruni D, Visani A, Iacono F, Zaffagnini S, Marcacci M (2014) Analysis of knee functional flexion axis in navigated TKA: identification and repeatability before and after implant positioning. Knee Surg Sports Traumatol Arthrosc 22:694–702

    Article  PubMed  Google Scholar 

  8. Dennis DA, Komistek RD, Colwell CEJ, Ranawat CS, Scott RD, Thornhill TS, Lapp MA (1998) In vivo anteroposterior femorotibial translation of total knee arthroplasty: a multicenter analysis. Clin Orthop Relat Res 356:47–57

    Article  PubMed  Google Scholar 

  9. Dennis D, Kim R, Johnson D, Springer B, Fehring T, Sharma A (2011) The John Insall Award: control-matched evaluation of painful patellar crepitus after total knee arthroplasty. Clin Orthop Relat Res 469:10–17

    Article  PubMed Central  PubMed  Google Scholar 

  10. Eckhoff DG, Metzger RG, Vandewalle MV (1995) Malrotation associated with implant alignment technique in total knee arthroplasty. Clin Orthop Relat Res 321:28–31

    PubMed  Google Scholar 

  11. Farrokhi S, Keyak JH, Powers CM (2011) Individuals with patellofemoral pain exhibit greater patellofemoral joint stress: a finite element analysis study. Osteoarthr Cartil 19(3):287–294

    Article  CAS  PubMed  Google Scholar 

  12. Figgie H, Goldberg V, Figgie M, Inglis A, Kelly M, Sobel M (1989) The effect of alignment of the implant on fractures of the patella after condylar total knee arthroplasty. J Bone Joint Surg 71:1031–1039

    PubMed  Google Scholar 

  13. Fitz W, Sodha S, Reichmann W, Minas T (2012) Does a modified gap-balancing technique result in medial-pivot knee kinematics in cruciate-retaining total knee arthroplasty? A pilot study. Clin Orthop Relat Res 470:91–98

    Article  PubMed Central  PubMed  Google Scholar 

  14. Giffin JR, Vogrin TM, Zantop T, Woo SL-Y, Harner CD (2004) Effects of increasing tibial slope on the biomechanics of the knee. Am J Sports Med 32:376–382

    Article  PubMed  Google Scholar 

  15. Griffin FM, Insall JN, Scuderi GR (2000) Accuracy of soft tissue balancing in total knee arthroplasty. J Arthroplasty 15:970–973

    Article  CAS  PubMed  Google Scholar 

  16. Gromov K, Korchi M, Thomsen MG, Husted H, Troelsen A (2014) What is the optimal alignment of the tibial and femoral components in knee arthroplasty? Acta Orthop 85(5):480–487

    Article  PubMed Central  PubMed  Google Scholar 

  17. Howell SM, Papadopoulos S, Kuznik KT, Hull ML (2013) Accurate alignment and high function after kinematically aligned TKA performed with generic instruments. Knee Surg Sports Traumatol Arthrosc 21:2271–2280

    Article  PubMed  Google Scholar 

  18. Kansara D, Markel DC (2006) The effect of posterior tibial slope on range of motion after total knee arthroplasty. J Arthroplasty 21:809–813

    Article  PubMed  Google Scholar 

  19. Keshmiri A, Maderbacher G, Baier C, Sendtner E, Schaumburger J, Zeman F, Grifka J, Springorum HR (2015) The influence of component alignment on patellar kinematics in total knee arthroplasty: an in vivo study using a navigation system. Acta Orthop 86:1–7

    Article  Google Scholar 

  20. Keshmiri A, Springorum H, Baier C, Zeman F, Grifka J, Maderbacher G (2014) Is it possible to re-establish pre-operative patellar kinematics using a ligament-balanced technique in total knee arthroplasty? A cadaveric investigation. Int Orthop 39(3):441–448

    Article  PubMed  Google Scholar 

  21. Kienapfel H, Springorum H-P, Ziegler A, Klose K-J, Georg C, Griss P (2003) Der Einfluss der Femur- und Tibiakomponentenrotation auf das patellofemorale Versagen beim künstlichen Kniegelenkersatz. Orthop 32:312–318

    Article  CAS  Google Scholar 

  22. Kim Y-H, Park J-W, Kim J-S, Park S-D (2014) The relationship between the survival of total knee arthroplasty and postoperative coronal, sagittal and rotational alignment of knee prosthesis. Int Orthop 38:379–385

    Article  PubMed Central  PubMed  Google Scholar 

  23. Lee D-H, Park J-H, Song D-I, Padhy D, Jeong W-K, Han S-B (2010) Accuracy of soft tissue balancing in TKA: comparison between navigation-assisted gap balancing and conventional measured resection. Knee Surg Sports Traumatol Arthrosc 18:381–387

    Article  CAS  PubMed  Google Scholar 

  24. Luring C, Perlick L, Bathis H, Tingart M, Grifka J (2007) The effect of femoral component rotation on patellar tracking in total knee arthroplasty. Orthopedics 30(11):965–967

    PubMed  Google Scholar 

  25. Masri BA, McCormack RG (1995) The effect of knee flexion and quadriceps contraction on the axial view of the patella. Clin J Sport Med 5(1):9–17

    Article  CAS  PubMed  Google Scholar 

  26. Miller MC, Berger RA, Petrella AJ, Karmas A, Rubash HE (2001) Optimizing femoral component rotation in total knee arthroplasty. Clin Orthop Relat Res 392:38–45

    Article  PubMed  Google Scholar 

  27. Moreland JR (1988) Mechanisms of failure in total knee arthroplasty. Clin Orthop Relat Res 226:49–64

    PubMed  Google Scholar 

  28. Ranawat CS (1986) The patellofemoral joint in total condylar knee arthroplasty: pros and cons based on five-to ten-year follow-up observations. Clin Orthop Relat Res 205:93–99

    PubMed  Google Scholar 

  29. Shelburne KB, Kim H-J, Sterett WI, Pandy MG (2011) Effect of posterior tibial slope on knee biomechanics during functional activity. J Orthop Res 29:223–231

    Article  PubMed  Google Scholar 

  30. Stiehl J, Komistek R, Dennis D, Paxson R, Hoff W (1995) Fluoroscopic analysis of kinematics after posterior-cruciate-retaining knee arthroplasty. J Bone Joint Surg 77(6):884–889

    CAS  Google Scholar 

  31. Stoddard J, Deehan D, Bull A, McCaskie A, Amis A (2014) No difference in patellar tracking between symmetrical and asymmetrical femoral component designs in TKA. Knee Surg Sports Traumatol Arthrosc 22:534–542

    Article  CAS  PubMed  Google Scholar 

  32. Vandenneucker H, Labey L, Victor J, Vander Sloten J, Desloovere K, Bellemans J (2014) Patellofemoral arthroplasty influences tibiofemoral kinematics: the effect of patellar thickness. Knee Surg Sports Traumatol Arthrosc 22:2560–2568

    Article  PubMed  Google Scholar 

  33. Wasielewski RC, Galante JO, Leighty RM, Natarajan RN, Rosenberg AG (1994) Wear patterns on retrieved polyethylene tibial inserts and their relationship to technical considerations during total knee arthroplasty. Clin Orthop Relat Res 299:31–43

    PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Orthopaedic Surgery, University of Regensburg, Kaiser-Karl-V Allee 3, 93077, Bad Abbach, Germany

    Armin Keshmiri, Hans Robert Springorum, Clemens Baier, Joachim Grifka & Günther Maderbacher

  2. Centre for Clinical Studies, Franz-Josef-Strauß-Allee 11, 93053, Regensburg, Germany

    Florian Zeman

Authors
  1. Armin Keshmiri
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Hans Robert Springorum
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Clemens Baier
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Florian Zeman
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Joachim Grifka
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Günther Maderbacher
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Armin Keshmiri.

Ethics declarations

Conflict of interest

No benefits in any form have been received or will be received from a commercial party related directly or indirectly to the subject of this article.

Additional information

The work was performed at the Department of Orthopedic Surgery at the Medical University of Regensburg/Germany.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Keshmiri, A., Springorum, H.R., Baier, C. et al. Changes in sagittal component alignment alters patellar kinematics in TKA: an in vitro study. Knee Surg Sports Traumatol Arthrosc 24, 823–829 (2016). https://doi.org/10.1007/s00167-016-4004-6

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00167-016-4004-6

Keywords

Search

Navigation