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J Knee Surg 2019; 32(10): 1008-1014
DOI: 10.1055/s-0038-1675421
Original Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

A Total Knee Arthroplasty Is Stiffer When the Intraoperative Tibial Force Is Greater than the Native Knee

Trevor J. Shelton
1   Department of Orthopaedic Surgery, University of California Davis, Sacramento, California
,
Stephen M. Howell
2   Department of Biomedical Engineering, University of California Davis, Sacramento, Sacramento
,
Maury L. Hull
1   Department of Orthopaedic Surgery, University of California Davis, Sacramento, California
2   Department of Biomedical Engineering, University of California Davis, Sacramento, Sacramento
3   Department of Mechanical Engineering, University of California Davis, Davis, California
› Author Affiliations
Further Information

Publication History

29 March 2018

16 September 2018

Publication Date:
09 November 2018 (online)

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Abstract

We hypothesized that a total knee arthroplasty (TKA) with an intraoperative tibial force greater than the tibial force of the native knee has signs of stiffness as measured by loss of extension and flexion, and anterior translation of the tibia. Intraoperative forces in the medial and lateral tibial compartments were measured during passive motion in 71 patients treated with calipered kinematically aligned TKA. Maximum extension, flexion, and the anterior–posterior position of the tibia with respect to the distal femur at 90 degrees of flexion were measured. Measurements were repeated after exchanging to a 2 mm thicker insert. The sum of the average of the medial and lateral compartment forces at 0, 45, and 90 degrees of flexion represented the tibial force through a 90-degree motion arc. For the implanted insert, the tibial force averaged 28 ± 17 lb, which is comparable to the 20 ± 7 lb reported for the native knee. At 6 months, patients reported an average 40 point Oxford Knee and 15 point Western Ontario and McMaster Universities Osteoarthritis (WOMAC) score. For the 2 mm thicker insert, the tibial force averaged 50 ± 28 lb. A 30 lb tibial force greater than native generated a 3-degree loss of extension, a 3-degree loss of flexion, and 3-mm anterior translation of the tibia. Because a TKA with a tibial force greater than native has signs of stiffness, a strategy for lowering this risk is to match the tibial force of the native knee when balancing a TKA as this restored high function.

Keywords

total knee arthroplasty - kinematic alignment - instrumented tibial insert - tibial compartment force
 

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