Internal rotation of the tibial component in total knee arthroplasty can lead to extension deficit
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Internal rotation of the tibial component in total knee arthroplasty can lead to extension deficit Mohammad Kamal Abdelnasser1,2 · Mohammad Muath Adi3 · Ahmed Aly Elnaggar2 · Samih Tarabichi4 Received: 28 December 2018 / Accepted: 26 August 2019 © European Society of Sports Traumatology, Knee Surgery, Arthroscopy (ESSKA) 2019
Abstract Purpose Stiffness is a common problem following total knee arthroplasty (TKA). Mal-rotated components have been claimed to be the major cause of pain and limited motion after TKA. The present study investigates whether intra-operative intentional malrotation of the tibial component would change in vivo kinematics. The hypothesis is excessive internal rotation of the tibial component would result in postoperative extension deficit. Methods Thirty-one patients were enrolled in this study. After completing bony cuts and proper soft tissue balancing, the femoral and tibial trials were impacted and fixed using small pins. Lateral radiographs were used to measure and compare intraoperative full knee extension during normal and after intentional internal rotation of the tibial component. The extension deficit angles were also compared between the posterior stabilised (PS) and cruciate retaining (CR) implants. Results For normal tibial component rotation, the median (interquartile range) extension deficit was 0° (4). The mean tibial trial intentional internal rotation was 21.2° (± 4.5). The median (interquartile range) extension deficit significantly increased to 6° (4) after tibial component internal rotation (p = 0.001). The use of PS spacers resulted in a significantly greater extension deficit after intentional internal rotation 9° (5) compared to that of the CR implant 1° (4) (p = 0.001). Conclusion Internal rotation of the tibial component in total knee arthroplasty can lead to postoperative extension deficit. This could be attributed to interference with “screw home” mechanism that requires full external rotation of the tibia on the femur. Consequently, this deficit may cause pain and knee stiffness following TKA. Level of evidence III. Keywords Total knee arthroplasty · Tibial component · Internal rotation · Extension deficit
Introduction Stiffness is a common problem with a prevalence of 1.3–13.2% in patients after total knee arthroplasty (TKA) [10, 28]. Many preoperative, intraoperative, and postoperative factors contribute to the development of stiffness after TKA [25, 26]. Mal-rotated components are reportedly the major cause of pain and limited motion after TKA because
* Mohammad Kamal Abdelnasser [email protected]; [email protected] 1
Orthopedic Department, Assiut University Hospital, Assiut, Egypt
2
Burjeel Hospital for Advanced Surgery, Dubai, UAE
3
Sheikh Khalifa Medical City, Abu Dhabi, UAE
4
Alzahra Hospital, Dubai, UAE
of patellar maltracking, extension flexion gap mismatch, and altered tibiofemoral kinematics [1, 8, 15]. Previous reports showed that internal malrotation of the tibial component was observed in more than 20% of con
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