Influence of posterior tibial slope on knee flexion in posterior stabilized fixed bearing primary total knee arthroplasty
DOI:
https://doi.org/10.18203/issn.2455-4510.IntJResOrthop20201018Keywords:
Total knee arthroplasty, Range of motion, Posterior tibial slope, PCL-substituting TKAAbstract
Background: The goal of total knee arthroplasty (TKA) is to relieve pain and maintain stable range of motion (ROM) for day to day activities. Among the various factors, posterior tibial slope slope (PTS) may play an important role in achieving good postoperative knee flexion. Our study aims to know the effectiveness of PTS on the ROM of the knee in a posterior cruciate ligament (PCL)-substituting TKA.
Methods: A total of 125 unilateral PCL-substituting TKA’s were included in the study. Based on postoperative PTA which was measured on lateral radiograph, patients were divided into 3 groups, Group A (PTS of ≤2) comprise of 24 patients. Group B consists of 91 patients (PTS of 3 to 7). Group C includes 10 patients (PTS of 8 or more). Functional outcome was measured by using knee society score (KSS) and Western Ontario and McMaster Universities osteoarthritis index (WOMAC) which were evaluated preoperatively and at 18months post operatively.
Results: Mean postop ROM was 92.91 ± 10.632; 107.24±10.905; 107.49±13.944 in group A, B, C respectively which was significantly related to mean postop PTS (0.74; 5.62; 9.87 in group A, B, C respectively) (P<0.05). Functional outcome was measured by KSS and WOMAC which showed no significant difference pre and postoperatively.
Conclusions: The results of our study validate the hypothesis that a positive correlation exists between the postoperative flexion and PTS in the PCL-substituting TKA, an increase in PTS can lead to a greater degree of the knee flexion for every extra degree of PTS.
References
Cross WW, Saleh KJ, Wilt TJ, Kane RL. Agreement about indications for total knee arthroplasty. Clin Orthop Relat Res. 2006;446:34-9.
Bellemans J, Robijns F, Duerinckx J, Banks S, Vandenneucker H. The influence of tibial slope on maximal flexion after total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc. 2005;13:193-6.
Kim JH. Effect of posterior femoral condylar offset and posterior tibial slope on maximal flexion angle of the knee in posterior cruciate ligament sacrificing total knee arthroplasty. Knee Surg Relat Res. 2013;25:54-9.
Dennis DA, Komistek RD, Scuderi GR, Zingde S. Factors affecting flexion after total knee arthroplasty. Clin Orthop Relat Res. 2007;464:53-60.
Higuchi H, Hatayama K, Shimizu M, Kobayashi A, Kobayashi T, Takagishi K. Relationship between joint gap difference and range of motion in total knee arthroplasty: a prospective randomised study between different platforms. Int Orthop. 2009;33:997-1000.
Kotani A, Yonekura A, Bourne RB. Factors influencing range of motion after contemporary total knee arthroplasty. J Arthroplasty. 2005;20:850-6.
Kurosaka M, Yoshiya S, Mizuno K, Yamamoto T. Maximizing flexion after total knee arthroplasty: the need and the pitfalls. J Arthroplasty. 2002;17(4):59-62.
Ritter MA, Berend ME, Harty LD, Davis KE, Meding JB, Keating EM. Predicting range of motion after revision total knee arthroplasty: clustering and log-linear regression analyses. J Arthroplasty. 2004;19:338-43.
Bin SI, Nam TS. Early results of high-flex total knee arthroplasty: comparison study at 1 year after surgery. Knee Surg Sports Traumatol Arthrosc. 2007;15:350-5.
Bellemans J, Banks S, Victor J, Vandenneucker H, Moemans A. Fluoroscopic analysis of the kinematics of deep flexion in total knee arthroplasty. Influence of posterior condylar offset. J Bone Joint Surg Br. 2002;84:50-3.
Goldstein WM, Raab DJ, Gleason TF, Branson JJ, Berland K. Why posterior cruciate-retaining and substituting total knee replacements have similar ranges of motion: the importance of posterior condylar offset and cleanout of posterior condylar space. J Bone Joint Surg Am. 2006;88(4):182-8.
Hanratty BM, Thompson NW, Wilson RK, Beverland DE. The influence of posterior condylar offset on knee flexion after total knee replacement using a cruciate-sacrificing mobile-bearing implant. J Bone Joint Surg Br. 2007;89:915-8.
Massin P, Gournay A. Optimization of the posterior condylar offset, tibial slope, and condylar roll-back in total knee arthroplasty. J Arthroplasty. 2006;21:889-96.
Wyss T, Schuster AJ, Christen B, Wehrli U. Tension controlled ligament balanced total knee arthroplasty: 5-year results of a soft tissue orientated surgical technique. Arch Orthop Trauma Surg. 2008;128:129-35.
Bauer T, Biau D, Colmar M, Poux X, Hardy P, Jacob LA. Influence of posterior condylar offset on knee flexion after cruciate-sacrificing mobile-bearing total knee replacement: a prospective analysis of 410 consecutive cases. Knee. 2010;17:375-80.
Kansara D, Markel DC. The effect of posterior tibial slope on range of motion after total knee arthroplasty. J Arthroplasty. 2006;21:809-13.
Piazza SJ, Delp SL, Stulberg SD, Stern SH. Posterior tilting of the tibial component decreases femoral rollback in posterior-substituting knee replacement: a computer simulation study. J Orthop Res. 1998;16:264-70.
Ranawat CS. Design may be counterproductive for optimizing flexion after TKR. Clin Orthop Relat Res. 2003;(416):174-6.
Walker P. Requirements for successful total knee replacements. Design considerations. Orthop Clin North Am. 1989;20:15-29.
Walker PS, Garg A. Range of motion in total knee arthroplasty. A computer analysis. Clin Orthop. 1991;262:227.
Insall JN, Dorr LD, Scott RD, Scott WN. Rationale of the Knee Society clinical rating system. Clin Orthop. 1989;248:13-14.
Roorda LD, Jones CA, Waltz M. Satisfactory cross-cultural equivalence of the Dutch WOMAC in patients with hip osteoarthritis waiting for arthroplasty. Ann Rheum Dis. 2004;63:36-42.
Ranawat CS, Padgett DE, Ohashi Y. Total knee arthroplasty for patients younger than55 years. Clin Orthop Relat Res. 1989;248:27-33.
Rand JA, Trounsdale RT, Ilstrup DM. Factors affecting the durability of primary total knee prostheses. J Bone Joint Surg Am. 2003;85(2):259-65.
Scuderi GR, Insall JN, Windsor RE. Survivorship of cemented knee replacements. J Bone Joint Surg Br. 1989;71(5):798-803.
Gioe TJ, Killeen KK, Grimm K. Why are total knee replacements revised. Analysis of early revision in a community knee implant registry. Clin Orthop Relat Res. 2004;428:100-06.
Akagi M, Ueo T, Matsusue Y, Akiyama H, Nakamura T. Improved range of flexion after total knee arthroplasty. Bull Hosp Jt Dis. 1997;56:225-32.
Kim J, Sang MM. Squatting following total knee arthroplasty. Clin Orthop. 1994;313:177-86.
Migaud H, Ladoucette DA, Dohin B, Cloutier J, Gougeon F, Duquennoy A. Influence of the tibial slope on tibial translation and mobility of nonconstrained total knee prosthesis. Rev Chir Orthop Reparatrice Appar Mot. 1996;82:7-13.
Schurman D, Parker J, Ornstein D. Total condylar knee replacement. A study of factors influencing range of motion as late as two years after arthroplasty. J Bone Joint Surg Am. 1985;67:1006-14.
Malviya A, Lingard EA, Weir DJ, Deehan DJ. Predicting range of movement after knee replacement: the importance of posterior condylar offset and tibial slope. Knee Surg Sports Traumatol Arthrosc. 2009;17:491-8.
Catani F, Fantozzi S, Ensini A, Leardini A, Moschella D, Giannini S. Influence of tibial component posterior slope on in vivo knee kinematics in fixed-bearing total knee arthroplasty. J Orthop Res. 2006;24:581-7.
Shi X, Shen B, Kang P, Yang J, Zhou Z, Pei F. The effect of posterior tibial slope on knee flexion in posterior-stabilized total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc. 2013;21(12):2696-703.