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Internal Rotation of the Tibial Component is Frequent in Stiff Total Knee Arthroplasty

  • Clinical Research
  • Published:
Clinical Orthopaedics and Related Research®

Abstract

Background

Stiffness complicating TKA is a complex and multifactorial problem. We suspected internally rotated components compromised motion because of pain, patellar maltracking, a tight medial flexion gap, and limited femoral rollback on a conforming lateral tibial condyle.

Questions/purposes

We sought to determine: (1) the incidence of internal rotation of the femoral and tibial components in stiff TKAs; (2) if revision surgery that included correction of rotational positioning improved pain, ROM, and patellar tracking; and (3) if revision altered nonrotational radiographic parameters.

Methods

From a cohort of 52 patients with TKAs revised for stiffness, we performed CT scans of 34 before and 18 after revision to quantify rotational positioning of the femoral and tibial components using a previously validated scanning protocol.

Results

All 34 patients with TKAs had internal rotation of the summed values for tibial and femoral components (mean, 14.8°; range, 2.7°–33.7°) before revision for stiffness. The incidence of internal rotation was 24 of 34 femoral (mean, 3.1°; internal) and 33 of 34 tibial components (mean, 13.7° internal). Revision arthroplasty improved Knee Society function, knee, and pain scores. Mean extension improved from a contracture of 10.1° to 0.8° and flexion from 71.5° to 100°. Postrevision CT scans confirmed correction of component rotation. Nonrotational parameters were unchanged.

Conclusions

We recommend CT scanning of patients with stiff TKAs before surgical intervention to identify the presence of internally rotated components.

Level of Evidence

Level IV, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.

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Author information

Authors and Affiliations

  1. Department of Orthopaedic Surgery, CHA-Hôpital de l’Enfant-Jésus, Laval University, Quebec City, QC, Canada

    Martin Bédard MD, FRCS(C)

  2. Department of Orthopaedic Surgery, Northland District Health Board, Whangarei, 0112, New Zealand

    Kelly G. Vince MD, FRCS(C)

  3. Colorado Springs Orthopedic Group, Colorado Springs, Colorado, USA

    John Redfern MD

  4. Department of Biostatistics, University of Southern California, Los Angeles, CA, USA

    Stacy R. Collen MS

Authors
  1. Martin Bédard MD, FRCS(C)
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  2. Kelly G. Vince MD, FRCS(C)
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  3. John Redfern MD
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  4. Stacy R. Collen MS
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Corresponding author

Correspondence to Kelly G. Vince MD, FRCS(C).

Additional information

One or more of the authors (KGV) has a consultancy agreement and has received royalties from Zimmer Inc (Warsaw, IN).

Each author certifies that his or her institution approved the human protocol for this investigation, that all investigations were conducted in conformity with ethical principles of research, and that informed consent for participation in the study was obtained.

This work was performed at the Department of Orthopaedic Surgery, University of Southern California, Los Angeles, CA, USA.

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Bédard, M., Vince, K.G., Redfern, J. et al. Internal Rotation of the Tibial Component is Frequent in Stiff Total Knee Arthroplasty. Clin Orthop Relat Res 469, 2346–2355 (2011). https://doi.org/10.1007/s11999-011-1889-8

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  • DOI: https://doi.org/10.1007/s11999-011-1889-8

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