J Knee Surg 2017; 30(04): 372-377
DOI: 10.1055/s-0036-1592148
Original Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

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

Guenther Maderbacher
1   Department of Orthopaedic Surgery, University of Regensburg, Regensburg, Germany
,
Clemens Baier
1   Department of Orthopaedic Surgery, University of Regensburg, Regensburg, Germany
,
Hans-Robert Springorum
1   Department of Orthopaedic Surgery, University of Regensburg, Regensburg, Germany
,
Hermann Maderbacher
2   Department of Mechanical Engineering, Montanuniversität Leoben, Leoben, Austria
,
Anne-Maria Birkenbach
1   Department of Orthopaedic Surgery, University of Regensburg, Regensburg, Germany
,
Achim Benditz
1   Department of Orthopaedic Surgery, University of Regensburg, Regensburg, Germany
,
Joachim Grifka
1   Department of Orthopaedic Surgery, University of Regensburg, Regensburg, Germany
,
Armin Keshmiri
1   Department of Orthopaedic Surgery, University of Regensburg, Regensburg, Germany
› Author Affiliations
Further Information

Publication History

24 April 2016

25 July 2016

Publication Date:
19 September 2016 (online)

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.

 
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