Patients with no functional improvement after total knee arthroplasty show different kinematics
Open Access
- 29 May 2012
- journal article
- research article
- Published by Springer Science and Business Media LLC in International Orthopaedics
- Vol. 36 (9), 1841-1847
- https://doi.org/10.1007/s00264-012-1584-8
Abstract
As many as 20 % of all patients following total knee arthroplasty are not satisfied with the result. Rotational alignment is one factor thought to affect clinical outcome. The purpose of this study was to assess relationships between prosthesis rotational alignment, function score and knee kinematics after TKA. In 80 patients a cemented, unconstrained, cruciate-retaining TKA with a rotating platform was implanted. Rotational alignment was measured using CT-scans. Kinematics was assessed using fluoroscopy images. Seventy-three patients were available for follow-up after two years. Nine patients had more than 10° rotational mismatch between the femoral and tibial component in the postoperative CT scans. These patients showed significantly worse results in the function score. While the normal patients with less than 10° rotational mismatch improved from a mean pre-operative 55 points to a mean 71 points at follow-up, the group with more than 10° mismatch deteriorated from a mean 60 points pre-operatively to a mean 57 points at follow-up. The pattern of motion during passive flexion from approximately 0° to 120° was quite different. While external rotation steadily increased with knee flexion in the normal group, there was internal rotation between 30° and 80° of flexion in the group with more than 10° rotational mismatch. Rotational mismatch between femoral and tibial components exceeding 10° resulted in different kinematics after TKA. It might contribute to worse clinical results observed in those patients and should therefore be avoided.Keywords
This publication has 40 references indexed in Scilit:
- Internal Rotation of the Tibial Component is Frequent in Stiff Total Knee ArthroplastyClinical Orthopaedics & Related Research, 2011
- Influence of total knee arthroplasty on patellar kinematics and contact characteristicsInternational Orthopaedics, 2011
- Correlation between preoperative and postoperative knee kinematics in total knee arthroplasty using cruciate retaining designsInternational Orthopaedics, 2010
- Rotational alignment of the tibial component in total knee arthroplasty is better at the medial third of tibial tuberosity than at the medial borderBMC Musculoskeletal Disorders, 2010
- Early Outcome of TKA with a Medial Pivot Fixed-bearing Prosthesis is Worse than with a PFC Mobile-bearing ProsthesisClinical Orthopaedics & Related Research, 2009
- Knee arthroplasty: are patients' expectations fulfilled?Acta Orthopaedica, 2009
- Lack of Axial Rotation in Mobile-bearing Knee DesignsClinical Orthopaedics & Related Research, 2008
- Computer-assisted and conventional total knee replacementThe Journal of Bone and Joint Surgery. British volume, 2008
- Accurate measurement of three-dimensional knee replacement kinematics using single-plane fluoroscopyIEEE Transactions on Biomedical Engineering, 1996
- Rationale, of The Knee Society Clinical Rating SystemClinical Orthopaedics and Related Research, 1989