The tibial cut in total knee arthroplasty influences the varus alignment, the femoral roll-back and the tibiofemoral rotation in patients with constitutional varus

Abstract

Purpose

Different alignment types for a better outcome after TKA were described. However, it is not clear how kinematic alignment influences knee joint kinematic. The purpose of this study was to analyze whether adapted tibial cuts in constitutional varus knees affect knee joint kinematics regarding femoral roll-back, varus/valgus angle, and femorotibial rotation.

Methods

Seven cadaveric knees with constitutional varus alignment were examined in the native state and after implantation of a cruciate retaining (CR)-TKA with 0°, 3° and 6° tibia cuts using an established knee joint simulator. The effects of varus alignment on femorotibial rollback and rotation was determined. In addition, the native knee joint and different tibial cuts in CR-TKA were compared with Student’s t test.

Results

Total knee replacement with a 3° and 6° varus tibia cut had the greatest varus deviation to the native knee (mean 1.6° ± 0.09°, respectively); while, knees with a 0° (mean 0.2° ± 0.01°) tibia cut were most similar to the constitutional varus knee joint. The femoral roll-back in the medial compartment was increased in the native knee (5.7–12.5 mm). A 6° varus cut had a restricted translation in the medial compartment (2–3.2 mm). In the lateral compartment, the extensive translation was observed with a 0° varus cut, followed by 3° and 6° and the native knee. All cuts showed significantly different mean values. Only the cuts at 3° and at 6° in the medial compartment and the cuts at 0° and at 3° in the lateral compartment did not differ significantly. In respect to tibiofemoral rotation, 0° and 3° varus cuts across all loads had the least difference to the native knee (3.4°), with a 0° varus cut showing a higher absolute internal rotation of the tibia than the native knee. Changes in knee kinematics of the tibiofemoral rotation showed significantly different mean values.

Conclusion

The potentially improved outcome parameters in TKA with adapted tibia cuts in constitutional varus knees cannot be completely explained by the changes to knee kinematics. Mechanical alignment seems to result in more balanced load distribution and kinematics more closely resembling the native knee. From a kinematic point of view, it is not recommended to place the tibia in more than 3° of varus.

Level of evidence

Biomechanical study.

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Funding

Funding was provided by Deutsche Arthrosehilfe e.V.

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Correspondence to Martin Faschingbauer.

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Conflict of interest

We certify that we have not signed any agreement with commercial interest related to this study, which would in any way limit publication of any and all data generated for the study or to delay publication for any reason. Dr. Faschingbauer reports personal fees from Deutsche Arthrosehilfe e.V. during the conduct of the study.

Ethical approval

The authors’ institutional review board approved this study.

Study conduct and appointment

FM: planning/conception of the study, collection of data, analysis and interpretation, statistical analysis, writing and revising article; (orthopedic surgeon). HS: collection of data, analysis and interpretation, statistical analysis; (Dr. bio. hum.). SA, DL: interpretation of data, critical revision of the article; (Dr. bio. hum.). BF: critical revision of the article, final approval of the article, overall responsibility; (senior surgeon Hospital for Special Surgery). RH: critical revision of the article, final approval of the article, overall responsibility; (surgeon in chief University of Ulm).

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Faschingbauer, M., Hacker, S., Seitz, A. et al. The tibial cut in total knee arthroplasty influences the varus alignment, the femoral roll-back and the tibiofemoral rotation in patients with constitutional varus. Knee Surg Sports Traumatol Arthrosc 29, 641–651 (2021). https://doi.org/10.1007/s00167-020-05996-5

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Keywords

  • Knee
  • Total knee replacement
  • Mechanics