Valgus position of the femoral component causes abnormal kinematics in the presence of medial looseness in total knee arthroplasty: a computer simulation model of TKA for valgus knee osteoarthritis

Abstract

Purpose

Total knee arthroplasty (TKA) for valgus knee osteoarthritis is challenging. Although overcorrection in TKA for valgus knee osteoarthritis is recommended, supportive data based on biomechanics have rarely been reported. The purpose of this study was to elucidate whether coronal rotation of the femoral compartment causes abnormal kinematics with or without medial looseness.

Methods

Multi- and single-radius posterior-stabilised TKA implants were utilised in a computer simulation. A total of 4 mm of slack were provided in the medial collateral ligament (MCL) with varus or valgus position of the femoral component to simulate the context of valgus knee osteoarthritis. Kinematics during gait and squatting activities were evaluated in each condition.

Results

During squatting, medial looseness and valgus replacement caused anterior translation of the medial femoral component in mid-flexion in the multi-radius implant. In the worst condition (7° valgus replacement with MCL looseness), there was rapid anterior translation in the multi-radius implant, and moderate anterior translation in the single-radius implant. Although medial looseness alone did not cause abnormal kinematics during gait, the worst condition exhibited an anterior translation to 4.9 mm in the multi-radius implant. This worst condition also exhibited a marked lift-off of 8.0 and 2.9 mm in the multi- and single-radius implants, respectively. Varus position caused little abnormal kinematics even with MCL looseness.

Conclusion

Valgus, not varus position of the femoral component caused abnormal kinematics with MCL looseness. To avoid valgus position, the safety target angle of femoral component would be slight varus rather than neutral in valgus knee OA.

This is a preview of subscription content, access via your institution.

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6

References

  1. 1.

    Anderson KC, Buehler KC, Markel DC (2005) Computer assisted navigation in total knee arthroplasty: comparison with conventional methods. J Arthroplasty 20:132–138

    Article  PubMed  Google Scholar 

  2. 2.

    Blankevoort L, Kuiper JH, Huiskes R, Grootenboer HJ (1991) Articular contact in a three-dimensional model of the knee. J Biomech 24:1019–1031

    Article  CAS  PubMed  Google Scholar 

  3. 3.

    Chua KHZ, Chen Y, Lingaraj K (2014) Navigated total knee arthroplasty: is it error-free? Knee surgery, sports traumatology. Arthroscopy 22:643–649

    Google Scholar 

  4. 4.

    Collados-Maestre I, Lizaur-Utrilla A, Gonzalez-Navarro B, Miralles-Muñoz FA, Marco-Gomez L, Lopez-Prats FA, Gil-Guillen V (2017) Better functional outcome after single-radius TKA compared with multi-radius TKA. Knee Surg Sports Traumatol Arthrosc 25:3508–3514

    Article  PubMed  Google Scholar 

  5. 5.

    Dennis D (2001) Femoral condylar lift-off in vivo in total knee arthroplasty. J Bone Jt Surg Br 83:33–39

    Article  CAS  Google Scholar 

  6. 6.

    Dennis DA, Komistek RD, Kim RH, Sharma A (2010) Gap balancing versus measured resection technique for total knee arthroplasty. Clin Orthop Relat Res 468:102–107

    Article  PubMed  Google Scholar 

  7. 7.

    Elkus M, Ranawat CS, Rasquinha VJ, Babhulkar S, Rossi R, Ranawat AS (2004) Total knee arthroplasty for severe valgus deformity. Five to fourteen-year follow-up. J Bone Jt Surg Am 86-A:2671–2676

    Article  Google Scholar 

  8. 8.

    Favorito P (2002) Total knee arthroplasty in the valgus knee. J Am Acad Orthop Surg 10:16–24

    Article  PubMed  Google Scholar 

  9. 9.

    Hino K, Ishimaru M, Iseki Y, Watanabe S, Onishi Y, Miura H (2013) Mid-flexion laxity is greater after posterior-stabilised total knee replacement than with cruciate-retaining procedures: a computer navigation study. Bone Jt J 95-B:493–497

    Article  CAS  Google Scholar 

  10. 10.

    Hino K, Kutsuna T, Oonishi Y, Watamori K, Kiyomatsu H, Iseki Y, Watanabe S, Ishimaru Y, Miura H (2017) Assessment of the midflexion rotational laxity in posterior-stabilized total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 25:3495–3500

    Article  PubMed  Google Scholar 

  11. 11.

    Kang K-T, Kwon SK, Son J, Kwon O-R, Lee J-S, Koh Y-G (2018) The increase in posterior tibial slope provides a positive biomechanical effect in posterior-stabilized total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 26:3188–3195

    Article  PubMed  Google Scholar 

  12. 12.

    Komistek R (2002) In vivo comparison of femorotibial contact positions for press-fit posterior stabilized and posterior cruciate-retaining total knee arthroplasties. J Arthroplasty 17:209–216

    Article  PubMed  Google Scholar 

  13. 13.

    Koskinen E, Remes V, Paavolainen P, Harilainen A, Sandelin J, Tallroth K, Kettunen J, Ylinen P (2011) Results of total knee replacement with a cruciate-retaining model for severe valgus deformity—a study of 48 patients followed for an average of 9 years. Knee 18:145–150

    Article  PubMed  Google Scholar 

  14. 14.

    Kuriyama S, Ishikawa M, Furu M, Ito H, Matsuda S (2014) Malrotated tibial component increases medial collateral ligament tension in total knee arthroplasty. J Orthop Res 32:1658–1666

    Article  PubMed  Google Scholar 

  15. 15.

    Lee D-H, Padhy D, Park J-H, Jeong W-K, Park J-H, Han S-B (2011) The impact of a rectangular or trapezoidal flexion gap on the femoral component rotation in TKA. Knee Surg Sports Traumatol Arthrosc 19:1141–1147

    Article  PubMed  Google Scholar 

  16. 16.

    Lee SY, Matsui N, Kurosaka M, Komistek RD, Mahfouz M, Dennis DA, Yoshiya S (2005) A posterior-stabilized total knee arthroplasty shows condylar lift-off during deep knee bends. Clin Orthop Relat Res 435:181–184

    Article  Google Scholar 

  17. 17.

    Matsuda S, Ito H (2015) Ligament balancing in total knee arthroplasty-medial stabilizing technique. Asia Pac J Sports Med Arthrosc Rehabil Technol 2:108–113

    PubMed  PubMed Central  Google Scholar 

  18. 18.

    Nakamura S, Ito H, Yoshitomi H, Kuriyama S, Komistek RD, Matsuda S (2015) Analysis of the flexion gap on in vivo knee kinematics using fluoroscopy. J Arthroplasty 30:1237–1242

    Article  PubMed  Google Scholar 

  19. 19.

    Okazaki K, Miura H, Matsuda S, Takeuchi N, Mawatari T, Hashizume M, Iwamoto Y (2006) Asymmetry of mediolateral laxity of the normal knee. J Orthop Sci 11:264–266

    Article  PubMed  Google Scholar 

  20. 20.

    Ramappa M (2015) Midflexion instability in primary total knee replacement: a review. SICOT J 1:24

    Article  PubMed  PubMed Central  Google Scholar 

  21. 21.

    Ritter MA, Davis KE, Davis P, Farris A, Malinzak RA, Berend ME, Meding JB (2013) Preoperative malalignment increases risk of failure after total knee arthroplasty. J Bone Jt Surg Am 95:126–131

    Article  Google Scholar 

  22. 22.

    Rossi R, Rosso F, Cottino U, Dettoni F, Bonasia DE, Bruzzone M (2014) Total knee arthroplasty in the valgus knee. Int Orthop 38:273–283

    Article  PubMed  Google Scholar 

  23. 23.

    Shalhoub S, Moschetti WE, Dabuzhsky L, Jevsevar DS, Keggi JM, Plaskos C (2018) Laxity profiles in the native and replaced knee—application to robotic-assisted gap-balancing total knee arthroplasty. J Arthroplasty 33:3043–3048

    Article  PubMed  Google Scholar 

  24. 24.

    Stoddard JE, Deehan DJ, Bull AMJ, McCaskie AW, Amis AA (2013) The kinematics and stability of single-radius versus multi-radius femoral components related to mid-range instability after TKA. J Orthop Res 31:53–58

    Article  PubMed  Google Scholar 

  25. 25.

    Tanaka Y, Nakamura S, Kuriyama S, Ito H, Furu M, Komistek RD, Matsuda S (2016) How exactly can computer simulation predict the kinematics and contact status after TKA? Examination in individualized models. Clin Biomech (Bristol Avon) 39:65–70

    Article  Google Scholar 

  26. 26.

    Tokuhara Y, Kadoya Y, Nakagawa S, Kobayashi A, Takaoka K (2004) The flexion gap in normal knees. An MRI study. J Bone Jt Surg Br 86:1133–1136

    Article  CAS  Google Scholar 

  27. 27.

    Wellman SS, Klement MR, Queen RM (2017) Performance comparison of single-radius versus multiple-curve femoral component in total knee arthroplasty: a prospective, randomized study using the lower quarter Y-balance test. Orthopedics 40:e1074–e1080

    Article  PubMed  Google Scholar 

  28. 28.

    Yang NH, Nayeb-Hashemi H, Canavan PK, Vaziri A (2010) Effect of frontal plane tibiofemoral angle on the stress and strain at the knee cartilage during the stance phase of gait. J Orthop Res 28:1539–1547

    Article  PubMed  Google Scholar 

Download references

Acknowledgements

The authors thanked Drs. Yoshihisa Tanaka and Mutsumi Watanabe for their technical support in a computer simulation.

Funding

There is no funding source for this study.

Author information

Affiliations

Authors

Contributions

KN carried out designing the study, data acquisition with computer simulation, drafted the manuscript, SK, SN and YM carried out data acquisition with computer simulation, HI participated in analysis and interpretation, SM conceived the study and helped to draft the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Kohei Nishitani.

Ethics declarations

Conflict of interest

SN and SM received a research grant from Kyocera and SM received research grants from Zimmer-Biomet. Neither of the companies had any influence on this study.

Ethical approval

This study was approved by the ethics committee of Kyoto University Hospital (R0980).

Informed consent

Written informed consent was obtained to create validated bone model.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Nishitani, K., Kuriyama, S., Nakamura, S. et al. Valgus position of the femoral component causes abnormal kinematics in the presence of medial looseness in total knee arthroplasty: a computer simulation model of TKA for valgus knee osteoarthritis. Knee Surg Sports Traumatol Arthrosc 27, 2051–2060 (2019). https://doi.org/10.1007/s00167-018-5264-0

Download citation

Keywords

  • Total knee arthroplasty
  • Total knee replacement
  • TKA
  • TKR
  • Valgus knee
  • Osteoarthritis
  • Computer simulation
  • Medial collateral ligament
  • Implant malposition