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



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.


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.


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.


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.

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


There is no funding source for this study.

Author information




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.

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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.

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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).

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