Posterior Condyle Offset and Maximum Knee Flexion Following a Cruciate Retaining Total Knee Arthroplasty

Wei Wang; Bin Yue; JianHua Wang; Hany Bedair; Harry Rubash; Guoan Li

doi:10.1055/s-0038-1636912

The Journal of Knee Surgery, Table of Contents

J Knee Surg 2019; 32(02): 146-152
DOI: 10.1055/s-0038-1636912

Original Article

Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Posterior Condyle Offset and Maximum Knee Flexion Following a Cruciate Retaining Total Knee Arthroplasty

Wei Wang

¹Orthopaedic Biomechanics Laboratory, Department of Orthopaedic Surgery, Newton-Wellesley Hospital, Harvard Medical School, Newton, Massachusetts

²Department of Orthopaedic Surgery, Second Hospital of Xi'an Jiao Tong University, Xi'an, China

,

Bin Yue

¹Orthopaedic Biomechanics Laboratory, Department of Orthopaedic Surgery, Newton-Wellesley Hospital, Harvard Medical School, Newton, Massachusetts

³Department of Orthopaedic Surgery, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China

,

JianHua Wang

¹Orthopaedic Biomechanics Laboratory, Department of Orthopaedic Surgery, Newton-Wellesley Hospital, Harvard Medical School, Newton, Massachusetts

⁴Department of Orthopaedic Surgery, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China

,

Hany Bedair

¹Orthopaedic Biomechanics Laboratory, Department of Orthopaedic Surgery, Newton-Wellesley Hospital, Harvard Medical School, Newton, Massachusetts

⁵Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts

,

Harry Rubash

¹Orthopaedic Biomechanics Laboratory, Department of Orthopaedic Surgery, Newton-Wellesley Hospital, Harvard Medical School, Newton, Massachusetts

⁵Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts

,

Guoan Li

¹Orthopaedic Biomechanics Laboratory, Department of Orthopaedic Surgery, Newton-Wellesley Hospital, Harvard Medical School, Newton, Massachusetts

› Author Affiliations

Abstract

Inconsistent data has been reported on the effect of the femoral posterior condyle offset (PCO) on the maximal knee flexion after total knee arthroplasty (TKA). This study investigated the relationship between the postoperative changes of the PCO and the changes of maximal knee flexion after a cruciate retaining (CR) TKA. Nine patients with medial osteoarthritis (OA) in one knee were investigated. Before operation, each index knee was magnetic resonance imaging (MRI) scanned for construction of a three-dimensional (3D) knee model. The patient then performed a maximal weight-bearing (WB) flexion and the index knee flexion was measured using a dual fluoroscopy technique. At an average of 8 months after a CR TKA, all patients performed the same WB knee flexion. The postoperative changes of the PCO, the posterior cruciate ligament (PCL) elongation, and the posterior tibial slope (PTS) were determined. The postoperative changes of maximal knee flexion were determined by comparing with the preoperative maximal flexion angles of the knee. The correlations of the postoperative changes of PCO and PTS with the postoperative changes of the maximal flexion angle and PCL elongation of the knee were analyzed. The preoperative PCO (28.5 ± 4.5 mm) was significantly smaller than the postoperative PCO (31.1 ± 5.1 mm) (p < 0.05). The increasing of PCO after surgery is correlated with the decreasing of maximal knee flexion angle (r = 0.74) and the increasing of PCL elongation (r = 0.64) after the TKA. The PTS was not found to change significantly after the TKA and was not significantly correlated to the maximal knee flexion angle and PCL elongation. The postoperative increases of the PCO were shown to cause overstretching of the PCL and poor flexion angle of the knee after the CR TKA. Restoration of PCO could help optimize the maximal flexion of the knee after the TKA with consideration about PCL tension.

Keywords

total knee arthroplasty - total knee replacement - femoral condyle - femoral condyle height - posterior condyle offset - high flexion - posterior tibial slope

Full Text

References

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