Yifei Dai1, Michael B Cross2, Laurent D Angibaud1, Cyril Hamad3, Amaury Jung3, Jean-Yves Jenny4. 1. Exactech Inc, 2320 NW 66th Ct, Gainesville, FL, 32653, USA. 2. Hospital for Special Surgery, 535 E 70th St, New York, NY, 10021, USA. 3. Blue Ortho, 6 Allée de Bethléem, 38610, Gières, France. 4. Hôpitaux Universitaires de Strasbourg, 10 avenue Baumann, 67400, Illkirch, France. jean-yves.jenny@chru-strasbourg.fr.
Abstract
PURPOSE: Posterior tibial slope (PTS) for cruciate-retaining (CR) total knee arthroplasty (TKA) is usually pre-determined by the surgeon. Limited information is available comparing different choices of PTS on the kinematics of the CR TKA, independent of the balancing of the extension gap. This study hypothesized that with the same balanced extension gap, the choice of PTS significantly impacts the intraoperatively measured kinematics of CR TKA. METHODS: Navigated CR TKAs were performed on seven fresh-frozen cadavers with healthy knees and intact posterior cruciate ligament (PCL). A custom designed tibial baseplate was implanted to allow in situ modification of the PTS, which altered the flexion gap but maintained the extension gap. Knee kinematics were measured by performing passive range of motion (ROM) tests from full extension to 120° of flexion on the intact knee and CR TKAs with four different PTSs (1°, 4°, 7°, and 10°). The measured kinematics were compared across test conditions to assess the impact of PTS. RESULTS: With a consistent extension gap, the change of PTS had significant impact on the anteroposterior (AP) kinematics of the CR TKA knees in mid-flexion range (45°-90°), but not so much for the high-flexion range (90°-120°). No considerable impacts were found on internal/external (I/E) rotation and hip-knee-ankle (HKA) angle. However, the findings on the individual basis suggested the impact of PTS on I/E rotation and HKA angle may be patient-specific. CONCLUSIONS: The data suggested that the choice of PTS had the greatest impact on the mid-flexion AP translation among the intraoperatively measured kinematics. This impact may be considered while making surgical decisions in the context of AP kinematics. When using a tibial component designed with "center" pivoting PTS, a surgeon may be able to fine tune the PTS to achieve proper mid-flexion AP stability.
PURPOSE: Posterior tibial slope (PTS) for cruciate-retaining (CR) total knee arthroplasty (TKA) is usually pre-determined by the surgeon. Limited information is available comparing different choices of PTS on the kinematics of the CR TKA, independent of the balancing of the extension gap. This study hypothesized that with the same balanced extension gap, the choice of PTS significantly impacts the intraoperatively measured kinematics of CR TKA. METHODS: Navigated CR TKAs were performed on seven fresh-frozen cadavers with healthy knees and intact posterior cruciate ligament (PCL). A custom designed tibial baseplate was implanted to allow in situ modification of the PTS, which altered the flexion gap but maintained the extension gap. Knee kinematics were measured by performing passive range of motion (ROM) tests from full extension to 120° of flexion on the intact knee and CR TKAs with four different PTSs (1°, 4°, 7°, and 10°). The measured kinematics were compared across test conditions to assess the impact of PTS. RESULTS: With a consistent extension gap, the change of PTS had significant impact on the anteroposterior (AP) kinematics of the CR TKA knees in mid-flexion range (45°-90°), but not so much for the high-flexion range (90°-120°). No considerable impacts were found on internal/external (I/E) rotation and hip-knee-ankle (HKA) angle. However, the findings on the individual basis suggested the impact of PTS on I/E rotation and HKA angle may be patient-specific. CONCLUSIONS: The data suggested that the choice of PTS had the greatest impact on the mid-flexion AP translation among the intraoperatively measured kinematics. This impact may be considered while making surgical decisions in the context of AP kinematics. When using a tibial component designed with "center" pivoting PTS, a surgeon may be able to fine tune the PTS to achieve proper mid-flexion AP stability.
Entities:
Keywords:
Cruciate-retaining design; Kinematics; Posterior tibial slope; Range of motion; Total knee arthroplasty
Authors: Pramod Kumar Puthumanapully; Simon J Harris; Anthony Leong; Justin P Cobb; Andrew A Amis; Jonathan Jeffers Journal: Knee Surg Sports Traumatol Arthrosc Date: 2014-09-27 Impact factor: 4.342
Authors: Marco A Marra; Marta Strzelczak; Petra J C Heesterbeek; Sebastiaan A W van de Groes; Dennis W Janssen; Bart F J M Koopman; Ate B Wymenga; Nico J J Verdonschot Journal: Knee Surg Sports Traumatol Arthrosc Date: 2017-05-12 Impact factor: 4.342
Authors: Lucas Beckers; Jacobus H Müller; Jeremy Daxhelet; Salvatore Ratano; Mo Saffarini; Tarik Aït-Si-Selmi; Michel P Bonnin Journal: Knee Surg Sports Traumatol Arthrosc Date: 2021-06-01 Impact factor: 4.342
Authors: M Kebbach; R Grawe; A Geier; E Winter; P Bergschmidt; D Kluess; D D'Lima; C Woernle; R Bader Journal: Sci Rep Date: 2019-10-10 Impact factor: 4.379