Effect of sagittal femoral component alignment on biomechanics after mobile-bearing total knee arthroplasty
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(2019) 14:400
RESEARCH ARTICLE
Open Access
Effect of sagittal femoral component alignment on biomechanics after mobilebearing total knee arthroplasty Yong-Gon Koh1†, Jin-Ah Lee2†, Hwa-Yong Lee2, Dong-Suk Suh1, Hyo-Jeong Kim3 and Kyoung-Tak Kang2*
Abstract Background: Recently, there has been increasing interest in mobile-bearing total knee arthroplasty (TKA). However, changes in biomechanics with respect to femoral component alignment in mobile-bearing TKA have not been explored in depth. This study aims to evaluate the biomechanical effect of sagittal alignment of the femoral component in mobile-bearing TKA. Methods: We developed femoral sagittal alignment models with − 3°, 0°, 3°, 5°, and 7°. We also examined the kinematics of the tibiofemoral (TF) joint, contact point on the TF joint, contact stress on the patellofemoral (PF) joint, collateral ligament force, and quadriceps force using a validated computational model under a deep-knee-bend condition. Results: Posterior kinematics of the TF joint increased as the femoral component flexed. In addition, contact stress on the PF joint, collateral ligament force, and quadriceps force decreased as the femoral component flexed. The results of this study can assist surgeons in assessing risk factors associated with femoral component sagittal alignment for mobile-bearing TKA. Conclusions: Our results showed that slight flexion implantation may be an effective alternative technique because of its advantageous biomechanical effect. However, excessive flexion should be avoided because of potential loosening of the TF joint. Keywords: Total knee arthroplasty, Mobile-bearing, Malalignment, Finite element analysis
Introduction Mobile-bearing total knee arthroplasty (TKA) was developed in the 1970s as an alternative to fixed-bearing TKA to provide high conformity and low contact stress between the metallic component and the polyethylene (PE) insert [1–3]. Mobile-bearing TKA features full or partial conformity of the superior surface of the insert with femoral condylar geometry, while the inferior surface of the insert is flat to allow rotation or sliding on the tibial baseplate with minimal friction [4]. Conformity with mobility in mobile-bearing TKA allows both minimal contact stress and minimal constraint, which cannot be * Correspondence: [email protected] † Yong-Gon Koh and Jin-Ah Lee contributed equally to this work and should be considered co-first authors. 2 Department of Mechanical Engineering, Yonsei University, 50 Yonsei-ro, Seodaemun-gu, Seoul 03722, Republic of Korea Full list of author information is available at the end of the article
achieved in fixed-bearing TKA [4]. Moreover, the shear forces on the bone-implanted components are expected to be minimized with an associated smaller risk of tibial component loosening as well as with a higher resistance by the ligaments [5]. The associated potential risk of wear on superior and interior surfaces has been controversial in recent retrieval studies [6, 7]. Early positive results have been observed in the design
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