How does TKA kinematics vary with transverse plane alignment changes in a contemporary implant?
BACKGROUND
Assessment of patient function after TKA often focuses on implant alignment and daily activity capabilities, but the functional results and kinematics of the TKA are not easily predicted by some of these parameters during surgery.


OBJECTIVE
We asked whether differences in implant alignment in the transverse plane may affect fluorokinematics and be one of the many variables that help explain the discrepancies in fluorokinematic results.


METHODS
We utilized a computer model (LifeMOD™/KneeSIM; LifeModeler, Inc, San Clemente, CA, USA) to show variability in polyethylene contact patterns. We imported components of a cruciate-retaining TKA into the model and subjected the systems to a simulated lunge. We modeled five different combinations of implant positioning in the transverse plane of both the femoral and tibial components in internal or external rotation and compared the resulting changes in joint rotations and displacements of these five variations to those for published fluorokinematic observations using the same modeled lunge-type maneuver for five patients.


RESULTS
We observed variations in AP translation of the lateral and medial femoral condyles resembling several of those in the literature for individual patients with the same cruciate-retaining knee implant. The largest AP translational changes were seen with the tibia internally rotated 5°. Using the five different implant transverse plane alignment scenarios resulted in a coefficient of determination of 0.6 for the linear regression when compared to five subjects from a published fluorokinematic study.


CONCLUSIONS
Variations in implant positioning may be responsible for variations in fluorokinematics reported for individual subjects with the same implant design.
Campbell Clinic Orthopaedics, University of Tennessee, 1458 West Poplar Avenue, Suite 100, Memphis, TN 38017, USA. wmihalko@campbellclinic.com
William M
WM
Mihalko
Devin J
DJ
Conner
Rodney
R
Benner
John L
JL
Williams
D019645:Arthroplasty, Replacement, Knee / Q000379:methods*; D001696:Biomechanical Phenomena; D017760:Bone Malalignment / Q000517:prevention & control; D003198:Computer Simulation; D005471:Fluoroscopy / Q000379:methods; D006801:Humans; D007719:Knee Joint / Q000601:surgery*; D007720:Knee Prosthesis; D016014:Linear Models; D011474:Prosthesis Design; D016059:Range of Motion, Articular / Q000502:physiology*; D012680:Sensitivity and Specificity