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Does total knee arthroplasty modify flexion axis of the knee?

Knee Surgery, Sports Traumatology, Arthroscopy volume 22, pages 1728–1735 (2014)Cite this article

Abstract

Purpose

To prospectively investigate whether preoperative functional flexion axis in patients with osteoarthritis- and varus-alignment changes after total knee arthroplasty and whether a correlation exists both between preoperative functional flexion axis and native limb deformity.

Methods

A navigated total knee arthroplasty was performed in 108 patients using a specific software to acquire passive joint kinematics before and after implant positioning. The knee was cycled through three passive range of motions, from 0° to 120°. Functional flexion axis was computed using the mean helical axis algorithm. The angle between the functional flexion axis and the surgical transepicondylar axis was determined on frontal (α F) and axial (α A) plane. The pre- and postoperative hip-knee-ankle angle, related to femur mechanical axis, was determined.

Results

Postoperative functional flexion axis was different from preoperative only on frontal plane, while no differences were found on axial plane. No correlation was found between preoperative α A and native limb deformity, while a poor correlation was found in frontal plane, between α F and preoperative hip-knee-ankle angle.

Conclusions

Total knee arthroplasty affects functional flexion axis only on frontal plane while has no effect on axial plane. Preoperative functional flexion axis is in a more varus position respect to the transepicondylar axis both in pre- and postoperative conditions. Moreover, the position of the functional axis on frontal plane in preoperative conditions is dependent on native limb alignment, while on axial plane is not dependent on the amount of preoperative varus deformity.

Level of evidence

IV.

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Author information

Affiliations

  1. 2nd Orthopaedics and Traumatologic Clinic, Rizzoli Orthopaedic Institute, Via Pupilli 1, 40136, Bologna, Italy

    F. Iacono, D. Bruni & M. Marcacci

  2. Biomechanics and Innovation Technology Laboratory, Rizzoli Orthopaedic Institute, Via di Barbiano 1/10, 40136, Bologna, Italy

    S. Bignozzi, F. Colle & M. Marcacci

  3. The BioRobotics Institute, Scuola Superiore Sant’Anna, Pisa, Italy

    F. Colle

  4. Nanobiotechnology Laboratory (Nabi), Rizzoli Orthopaedic Institute, Via di Barbiano 1/10, 40136, Bologna, Italy

    F. Colle & M. Marcacci

Authors
  1. F. Iacono
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  2. D. Bruni
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  3. S. Bignozzi
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  4. F. Colle
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  5. M. Marcacci
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Corresponding author

Correspondence to D. Bruni.

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Iacono, F., Bruni, D., Bignozzi, S. et al. Does total knee arthroplasty modify flexion axis of the knee?. Knee Surg Sports Traumatol Arthrosc 22, 1728–1735 (2014). https://doi.org/10.1007/s00167-014-3054-x

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  • DOI: https://doi.org/10.1007/s00167-014-3054-x

Keywords

  • Total knee arthroplasty
  • Functional flexion axis
  • Computer-assisted surgery
  • Varus alignment