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The effect of femoral component rotation on the kinematics of the tibiofemoral and patellofemoral joints after total knee arthroplasty

  • Knee
  • Published:
Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Purpose

Complications after total knee arthroplasty (TKA) often involve the patellofemoral joint, and problems with patellar maltracking or lateral instability have sometimes been addressed by external rotation of the femoral component. This work sought to measure the changes of knee kinematics caused by TKA and then to optimise the restoration of both the patellofemoral and tibiofemoral joint kinematics, by variation of femoral component internal–external rotation.

Methods

The kinematics of the patella and tibia were measured in eight cadaveric knees during active extension motion. This was repeated with the knee intact, with a Genesis II TKA in the standard position (3° of external rotation) and with the femoral component at ±5° rotation from there.

Results

Both patellar and tibial motions were significantly different from normal with the standard TKA rotation, with 3° tibial abduction at 90° flexion and reversal of the screw-home from 5° external rotation to 6° internal rotation. The patella was shifted medially 6 mm in flexion and tilted 7° more laterally near extension. Femoral rotation to address one abnormality caused increased abnormality in other degrees of freedom. Internal and then external rotation of 5° caused tibial abduction and then adduction of 5° at 90° flexion. These femoral rotations also caused increased patellar lateral tilt of 4° with femoral external rotation and decreased tilt by 4° with internal rotation. Thus, correction of tibial abduction in flexion, by external rotation of the femoral component, worsened the patellar lateral tilt near extension.

Conclusions

It was concluded that femoral rotation alone could not restore all aspects of both patellar and tibial kinematics to normal with this specific implant. The clinical relevance of this is that it appears to be inadvisable to reposition the femoral component, in an attempt to improve patellar tracking, if that repositioning may then cause abnormal tibiofemoral kinematics. Further, the pattern of patellar tracking, with the type of TKA used in this study, could not be adjusted to normal by femoral component rotation.

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Acknowledgments

K. Milton Ghosh and the running costs of this work were supported by Smith and Nephew (Reconstructive) Ltd., UK. Azhar M Merican was supported by the University of Malaya Medical Centre, Kuala Lumpur and the Arthritis Research (UK) charity. Farhad Iranpour was supported by the Furlong Charitable Research Foundation. We thank W. Scott Selbie PhD, C-Motion Inc., for his software support. None of the authors have any financial or commercial links that may be perceived to have biased this article.

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Authors and Affiliations

  1. Department of Orthopaedic Surgery, Imperial College London, South Kensington Campus, London, SW7 2AZ, UK

    A. M. Merican & F. Iranpour

  2. Department of Mechanical Engineering, Imperial College London, South Kensington Campus, London, SW7 2AZ, UK

    K. M. Ghosh & Andrew A. Amis

  3. Department of Orthopaedic Surgery, University of Malaya Medical Centre, Kuala Lumpur, Malaysia

    A. M. Merican

  4. Department of Orthopaedic Surgery, Newcastle University Hospital, Newcastle-Upon-Tyne, UK

    K. M. Ghosh & D. J. Deehan

Authors
  1. A. M. Merican
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  2. K. M. Ghosh
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  3. F. Iranpour
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  4. D. J. Deehan
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  5. Andrew A. Amis
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Correspondence to Andrew A. Amis.

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Merican, A.M., Ghosh, K.M., Iranpour, F. et al. The effect of femoral component rotation on the kinematics of the tibiofemoral and patellofemoral joints after total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 19, 1479–1487 (2011). https://doi.org/10.1007/s00167-011-1499-8

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  • DOI: https://doi.org/10.1007/s00167-011-1499-8

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