The increase in posterior tibial slope provides a positive biomechanical effect in posterior-stabilized total knee arthroplasty
- 38 Downloads
This study aims to clarify the influence of the posterior tibial slope (PTS) on knee joint biomechanics after posterior-stabilized (PS) total knee arthroplasty (TKA) using a computer simulation.
A validated TKA computational model was used to evaluate and quantify the effects of an increased PTS. In order to conduct a squat simulation, models with a − 3° to 15° PTS using increments of 3° were developed. Forces on the quadriceps and collateral ligament, a tibial posterior translation, contact point on a polyethylene (PE) insert, and contact stress on the patellofemoral (PF) joint and post in a PE insert were compared.
The maximum force on the quadriceps and the PF contact stress decreased with increases in the PTS. The kinematics on the tibiofemoral (TF) joint translated in an increasingly posterior manner, and the medial and lateral contact points on a PE insert were located in posterior regions with increases in the PTS. Additionally, increases in the PTS decreased the force on the collateral ligament and increased the contact stress on the post in a PE insert. A higher force on the quadriceps is required when the PTS decreases with an equivalent flexion angle.
A surgeon should be prudent in terms of determining the PTS because an excessive increase in the PTS may lead to the progressive loosening of the TF joint due to a reduction in collateral ligament tension and failure of the post in a PE insert. Thus, we support a more individualized approach of optimal PTS determination given the findings of the study.
KeywordsPosterior tibial slope Total knee arthroplasty Kinematics
Compliance with ethical standards
Conflict of interest
The authors declare no conflict of interest.
Approval was not required, as neither human participants nor animals were involved in this study.
- 11.Dorr LD, Boiardo RA (1986) Technical considerations in total knee arthroplasty. Clin Orthop Relat Res 205:5–11Google Scholar
- 20.Insall JN, Binazzi R, Soudry M, Mestriner LA (1985) Total knee arthroplasty. Clin Orthop Relat Res 192:13–22Google Scholar
- 25.Kim YS, Kang KT, Son J, Kwon OR, Choi YJ, Jo SB, Choi YW, Koh YG (2015) Graft extrusion related to the position of allograft in lateral meniscal allograft transplantation: biomechanical comparison between parapatellar and transpatellar approaches using finite element analysis. Arthroscopy 31:2380–2391CrossRefPubMedGoogle Scholar
- 28.Marra MA, Strzelczak M, Heesterbeek PJC, van de Groes SAW, Janssen DW, Koopman B, Wymenga AB, Verdonschot NJJ (2017) Anterior referencing of tibial slope in total knee arthroplasty considerably influences knee kinematics: a musculoskeletal simulation study. Knee Surg Sports Traumatol Arthrosc. https://doi.org/10.1007/s00167-017-4561-3 PubMedGoogle Scholar
- 35.Oka S, Matsumoto T, Muratsu H, Kubo S, Matsushita T, Ishida K, Kuroda R, Kurosaka M (2014) The influence of the tibial slope on intra-operative soft tissue balance in cruciate-retaining and posterior-stabilized total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 22:1812–1818CrossRefPubMedGoogle Scholar