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Internal rotation of the tibial component in total knee arthroplasty can lead to extension deficit

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Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Purpose

Stiffness is a common problem following total knee arthroplasty (TKA). Mal-rotated components have been claimed to be the major cause of pain and limited motion after TKA. The present study investigates whether intra-operative intentional malrotation of the tibial component would change in vivo kinematics. The hypothesis is excessive internal rotation of the tibial component would result in postoperative extension deficit.

Methods

Thirty-one patients were enrolled in this study. After completing bony cuts and proper soft tissue balancing, the femoral and tibial trials were impacted and fixed using small pins. Lateral radiographs were used to measure and compare intraoperative full knee extension during normal and after intentional internal rotation of the tibial component. The extension deficit angles were also compared between the posterior stabilised (PS) and cruciate retaining (CR) implants.

Results

For normal tibial component rotation, the median (interquartile range) extension deficit was 0° (4). The mean tibial trial intentional internal rotation was 21.2° (± 4.5). The median (interquartile range) extension deficit significantly increased to 6° (4) after tibial component internal rotation (p = 0.001). The use of PS spacers resulted in a significantly greater extension deficit after intentional internal rotation 9° (5) compared to that of the CR implant 1° (4) (p = 0.001).

Conclusion

Internal rotation of the tibial component in total knee arthroplasty can lead to postoperative extension deficit. This could be attributed to interference with “screw home” mechanism that requires full external rotation of the tibia on the femur. Consequently, this deficit may cause pain and knee stiffness following TKA.

Level of evidence

III.

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Funding

No funding has been received for this study.

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Authors and Affiliations

  1. Orthopedic Department, Assiut University Hospital, Assiut, Egypt

    Mohammad Kamal Abdelnasser

  2. Burjeel Hospital for Advanced Surgery, Dubai, UAE

    Mohammad Kamal Abdelnasser & Ahmed Aly Elnaggar

  3. Sheikh Khalifa Medical City, Abu Dhabi, UAE

    Mohammad Muath Adi

  4. Alzahra Hospital, Dubai, UAE

    Samih Tarabichi

Authors
  1. Mohammad Kamal Abdelnasser
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  2. Mohammad Muath Adi
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  3. Ahmed Aly Elnaggar
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  4. Samih Tarabichi
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Corresponding author

Correspondence to Mohammad Kamal Abdelnasser.

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Conflict of interest

The authors declare that they have no conflicts of interest.

Ethical approval

This present study obtained approval from the Local Institutional Ethical Committee of Burjeel Hospital for Advanced Surgery (IRB no. E10022).

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Informed consent was obtained from patients.

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Abdelnasser, M.K., Adi, M.M., Elnaggar, A.A. et al. Internal rotation of the tibial component in total knee arthroplasty can lead to extension deficit. Knee Surg Sports Traumatol Arthrosc 28, 2948–2952 (2020). https://doi.org/10.1007/s00167-019-05695-w

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  • DOI: https://doi.org/10.1007/s00167-019-05695-w

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