The biomechanical effect of increased valgus on total knee arthroplasty: a cadaveric study.

The effects of valgus load on cadaveric knees following total knee arthroplasty (TKA) were investigated using a custom testing system. TKAs were performed on 8 cadaveric knees and tested at 0°, 30°, and 60° knee flexion in both neutral and 5° valgus. Fuji pressure sensitive film was used to quantify contact areas and pressures and MCL strain was determined using a Microscribe digitizing system. Lateral tibiofemoral pressures increased (P < 0.05) at all knee flexion angles with valgus loading. Patellofemoral contact characteristics did not change significantly (P > 0.05). Significant increases in strain were observed along the anterior and posterior border of the MCL at all knee flexion angles. These findings suggest that valgus loading increases TKA joint contact pressures and MCL strain with increasing knee flexion which may increase implant instability.

Biomechanical effects of joint line elevation in total knee arthroplasty.

BACKGROUND: Inadequate restoration of the knee joint line after total knee arthroplasty may lead to a poor clinical outcome. The purpose of this study was to quantitatively assess the effects of joint line elevation following total knee arthroplasty with increased joint volume on patellofemoral contact kinematics. METHODS: Six cadaveric specimens were tested. Patellofemoral contact area, contact pressure, and kinematics were measured following total knee arthroplasty with an anatomic joint line and after 4 and 8mm of joint line elevation, at knee flexion angles of 0°, 30°, 60°, 90° and 120°. Repeated measures analysis of variance with a Tukey post hoc test with a significance level of 0.05 was used for statistical analyses. FINDINGS: There was a decrease in contact area with joint line elevation at flexion angles of 60°, 90° and 120° (P=0.009-0.04). There was a significant increase in contact pressure only at 30° of knee flexion with 8mm of joint line elevation (P=0.004). Three of the six specimens showed inferior edge loading of the patella component following 8mm of joint line elevation at 120° of knee flexion. The sagittal plane patellofemoral angle increased significantly with joint line elevation except for 0° knee flexion (P=0.0002-0.02). INTERPRETATION: Knee joint line elevation with increased knee volume significantly affects patellofemoral contact area and kinematics and produced inferior edge loading/impingement between the patella and tibial components, this may result in loss of knee range of motion, postoperative pain, and premature component wear.

Biomechanical effects of kneeling after total knee arthroplasty.

BACKGROUND: Kneeling following total knee arthroplasty can be a difficult task, impairing the activities of patients to varying degrees. Little is known about the biomechanical effects of kneeling following total knee replacement. The objective of this study was to quantify the effects of kneeling on patellofemoral joint contact areas and pressures, knee joint reaction force, and patellar kinematics. METHODS: Total knee arthroplasties were performed on eight fresh-frozen cadaveric knees, and they were tested with use of a custom knee jig, which permits the simulation of physiologic quadriceps loading as well as the application of an anterior force to simulate kneeling. The knees were tested at flexion angles of 90 degrees , 105 degrees , 120 degrees , and 135 degrees with no anterior force (mimicking a squatting position) and with an anterior force application simulating double-stance kneeling and single-stance kneeling. Patellofemoral joint contact areas and pressures were measured with pressure-sensitive film, and the knee joint reaction force was measured with use of a six-degree-of-freedom load cell. Patellar kinematics were assessed with use of digital photographs tracking fixed markers on the patella. RESULTS: Compared with the condition without kneeling, both single-stance and double-stance kneeling demonstrated significant increases in patellofemoral contact area (p < 0.05) and pressure at all flexion angles (p < 0.05), with the exception of double-stance kneeling at 135 degrees of flexion. The resultant knee joint -reaction force increased with kneeling at all flexion angles. The compressive component of this force increased with kneeling for most conditions, while the lateral component of this force decreased significantly (p < 0.05) with kneeling only at 90 degrees , and the anterior component of this force increased significantly at all knee flexion angles (p < 0.05). Overall, kneeling had minimal changes on patellar tilt, with significant changes in patellar tilt seen only with kneeling at 120 degrees (p = 0.02 for double stance, and p = 0.03 for single stance). CONCLUSIONS: The findings of this study suggest that kneeling at a higher flexion angle (135 degrees ) after total knee arthroplasty has a smaller effect on patellofemoral joint contact area and pressure than kneeling at lower flexion angles (