Impact of Axial Component Alignment in Total Knee Arthroplasty on Lower Limb Rotational Alignment: An In Vitro Study

Abstract

Correct rotational implant alignment is associated with increased postoperative function and implant survival in total knee arthroplasty (TKA). Due to conformity between tibial and femoral implants, particularly in full extension, we assumed a mutual interference of femoral and tibial component rotations. We, therefore, hypothesized that different rotational alignments of the tibial or femoral components change the rotational postures between the tibia and femur after TKA. In 10 healthy knees of whole body cadavers, TKA was performed. Both femoral and tibial components were implanted in different internal (6 degrees) and external (3 and 6 degrees) rotational alignments. Consequential osseous rotational changes between the tibia and the femur were measured in full extension using a commercial computer navigation device. External rotation of the femoral component resulted in significant external rotation of the tibia, while external rotation of the tibial component caused a significant internal rotation of the tibia. The opposite applied to femoral and tibial component internal rotations. Therefore, largest changes of the osseous tibiofemoral rotational postures were found by the combination of 6 degrees femoral component internal and 6 degrees tibial component external rotations (mean 11.2 degrees, standard deviation 5.0, p < 0.001), as both cause tibial internal rotation. In conclusion, the present results suggest that axial component alignment significantly affects lower limb rotational alignment. However, its clinical impact on forefoot progression, Q-angle, the patella, collateral, and cruciate ligaments, and surrounding soft tissues has to be clarified in further clinical and biomechanical studies.

Keywords

TKA - total knee arthroplasty - navigation - rotational alignment - lower limb rotational alignment

• References

• 1 Graves S, Davidson D, de Steiger RN. National Joint Replacement Registry Annual Report. Australian Orthopaedic Association; 2013
• 2 Kim YH, Park JW, Kim JS, Kulkarni SS, Kim YH. Long-term clinical outcomes and survivorship of press-fit condylar sigma fixed-bearing and mobile-bearing total knee prostheses in the same patients. J Bone Joint Surg Am 2014; 96 (19) e168
• 3 Bourne RB, Chesworth BM, Davis AM, Mahomed NN, Charron KDJ. Patient satisfaction after total knee arthroplasty: who is satisfied and who is not?. Clin Orthop Relat Res 2010; 468 (1) 57-63
• 4 Choong PF, Dowsey MM, Stoney JD. Does accurate anatomical alignment result in better function and quality of life? Comparing conventional and computer-assisted total knee arthroplasty. J Arthroplasty 2009; 24 (4) 560-569
• 5 Ritter MA, Faris PM, Keating EM, Meding JB. Postoperative alignment of total knee replacement. Its effect on survival. Clin Orthop Relat Res 1994; (299) 153-156
• 6 Gromov K, Korchi M, Thomsen MG, Husted H, Troelsen A. What is the optimal alignment of the tibial and femoral components in knee arthroplasty?. Acta Orthop 2014; 85 (5) 480-487
• 7 Anouchi YS, Whiteside LA, Kaiser AD, Milliano MT. The effects of axial rotational alignment of the femoral component on knee stability and patellar tracking in total knee arthroplasty demonstrated on autopsy specimens. Clin Orthop Relat Res 1993; (287) 170-177
• 8 Rhoads DD, Noble PC, Reuben JD, Mahoney OM, Tullos HS. The effect of femoral component position on patellar tracking after total knee arthroplasty. Clin Orthop Relat Res 1990; (260) 43-51
• 9 Akagi M, Matsusue Y, Mata T , et al. Effect of rotational alignment on patellar tracking in total knee arthroplasty. Clin Orthop Relat Res 1999; (366) 155-163
• 10 Berger RA, Crossett LS, Jacobs JJ, Rubash HE. Malrotation causing patellofemoral complications after total knee arthroplasty. Clin Orthop Relat Res 1998; (356) 144-153
• 11 Matsuda S, Miura H, Nagamine R, Urabe K, Hirata G, Iwamoto Y. Effect of femoral and tibial component position on patellar tracking following total knee arthroplasty: 10-year follow-up of Miller-Galante I knees. Am J Knee Surg 2001; 14 (3) 152-156
• 12 Lee DH, Seo JG, Moon YW. Synchronisation of tibial rotational alignment with femoral component in total knee arthroplasty. Int Orthop 2008; 32 (2) 223-227
• 13 Akagi M, Oh M, Nonaka T, Tsujimoto H, Asano T, Hamanishi C. An anteroposterior axis of the tibia for total knee arthroplasty. Clin Orthop Relat Res 2004; (420) 213-219
• 14 Barrack RL, Schrader T, Bertot AJ, Wolfe MW, Myers L. Component rotation and anterior knee pain after total knee arthroplasty. Clin Orthop Relat Res 2001; (392) 46-55
• 15 Bédard M, Vince KG, Redfern J, Collen SR. Internal rotation of the tibial component is frequent in stiff total knee arthroplasty. Clin Orthop Relat Res 2011; 469 (8) 2346-2355
• 16 Bell SW, Young P, Drury C , et al. Component rotational alignment in unexplained painful primary total knee arthroplasty. Knee 2014; 21 (1) 272-277
• 17 Lützner J, Krummenauer F, Günther KP, Kirschner S. Rotational alignment of the tibial component in total knee arthroplasty is better at the medial third of tibial tuberosity than at the medial border. BMC Musculoskelet Disord 2010; 11: 57
• 18 Nicoll D, Rowley DI. Internal rotational error of the tibial component is a major cause of pain after total knee replacement. J Bone Joint Surg Br 2010; 92 (9) 1238-1244
• 19 Keshmiri A, Maderbacher G, Baier C , et al. The influence of component alignment on patellar kinematics in total knee arthroplasty. Acta Orthop 2015; 86 (4) 444-450
• 20 Maderbacher G, Baier C, Springorum HR, Zeman F, Grifka J, Keshmiri A. Lower Limb anatomy and alignment affect natural tibiofemoral knee kinematics: a cadaveric investigation. J Arthroplasty 2016; (e-pub ahead of print)
• 21 Huddleston JI, Scott RD, Wimberley DW. Determination of neutral tibial rotational alignment in rotating platform TKA. Clin Orthop Relat Res 2005; 440 (440) 101-106
• 22 Yau WP, Leung A, Liu KG, Yan CH, Wong LLS, Chiu KY. Interobserver and intra-observer errors in obtaining visually selected anatomical landmarks during registration process in non-image-based navigation-assisted total knee arthroplasty. J Arthroplasty 2007; 22 (8) 1150-1161
• 23 Maderbacher G, Schaumburger J, Baier C , et al. Predicting knee rotation by the projection overlap of the proximal fibula and tibia in long-leg radiographs. Knee Surg Sports Traumatol Arthrosc 2014; 22 (12) 2982-2988