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Varus femoral and tibial coronal alignments result in different kinematics and kinetics after total knee arthroplasty

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

Abstract

Purpose

Abnormal knee motion under various conditions has been described after total knee arthroplasty (TKA). However, differences in kinematics and kinetics of knees with varus femoral versus varus tibial alignment have not been evaluated. It was hypothesized that varus femoral and tibial alignments have the same impact on knee motion.

Methods

A musculoskeletal computer simulation was used. Femoral and tibial alignment in the coronal plane was each varied from neutral to 5° of varus in 1° increments. Lift-off, defined as an intercomponent distance of >2 mm, and tibiofemoral contact forces were evaluated during gait up to 60° of knee flexion. Knee kinematics and contact stresses were also examined during squat, with up to 130° of knee flexion.

Results

During gait, lift-off occurred readily with more than 3° of varus tibial alignment and slight lateral joint laxity. In contrast, lift-off did not occur with varus femoral or tibial alignment of up to 5° during squat. Peak medial contact forces with varus femoral alignment were approximately twice those observed with varus tibial alignment. The lowest points of the femoral condyles moved internally with varus femoral alignment, contrary to the kinematics with neutral or varus tibial alignment. On the other hand, there was femoral medial sliding and edge loading against the tibia in mid-flexion with varus tibial alignment.

Conclusion

Varus femoral alignment affects the non-physiological rotational movement of the tibiofemoral joint, whereas varus tibial alignment causes medial–lateral instability during mid-flexion. Varus femoral and tibial alignments might lead to post-TKA discomfort and unreliability.

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Authors and Affiliations

  1. Department of Orthopaedic Surgery, Graduate School of Medicine, Kyoto University, 54 Kawahara-cho, Shogoin, Sakyo-ku, Kyoto, 606-8507, Japan

    Mutsumi Watanabe, Shinichi Kuriyama, Shinichiro Nakamura, Yoshihisa Tanaka, Kohei Nishitani, Moritoshi Furu, Hiromu Ito & Shuichi Matsuda

Authors
  1. Mutsumi Watanabe
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  2. Shinichi Kuriyama
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  3. Shinichiro Nakamura
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  4. Yoshihisa Tanaka
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  5. Kohei Nishitani
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  6. Moritoshi Furu
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  8. Shuichi Matsuda
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Correspondence to Shinichi Kuriyama.

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The authors declare that they have no conflicts of interest.

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There was no funding for this study.

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This article does not contain any studies with human participants or animals performed by any of the authors.

Informed consent

Informed consent was not applicable, because a virtual and variable model with a generic knee joint was used in this study.

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Watanabe, M., Kuriyama, S., Nakamura, S. et al. Varus femoral and tibial coronal alignments result in different kinematics and kinetics after total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 25, 3459–3466 (2017). https://doi.org/10.1007/s00167-017-4570-2

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  • DOI: https://doi.org/10.1007/s00167-017-4570-2

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