title: Effect of component mal-rotation on knee loading in total knee arthroplasty using multi-body dynamics modeling under a simulated walking gait.
abstract: Mal-rotation of the components in total knee arthorplasty (TKA) is a major cause of postoperative complications, with an increased propensity for implant loosening or wear leading to revision. A musculoskeletal multi-body dynamics model was used to perform a parametric study of the effects of the rotational mal-alignments in TKA on the knee loading under a simulated walking gait. The knee contact forces were found to be more sensitive to variations in the varus-valgus rotation of both the tibial and the femoral components and the internal-external rotation of the femoral component in TKA. The varus-valgus mal-rotation of the tibial or femoral component and the internal-external mal-rotation of the femoral component with a 5° variation were found to affect the peak medial contact force by 17.8-53.1%, the peak lateral contact force by 35.0-88.4% and the peak total contact force by 5.2-18.7%. Our findings support the clinical observations that a greater than 3° internal mal-rotation of the femoral component may lead to unsatisfactory pain levels and a greater than 3° varus mal-rotation of the tibial component may lead to medial bone collapse. These findings determined the quantitative effects of the mal-rotation of the components in TKA on the contact load. The effect of such mal-rotation of the components of TKA on the kinematics would be further addressed in future studies.
authors.affiliation: State Key Laboratory for Manufacturing System Engineering, School of Mechanical Engineering, Xi'an Jiaotong University, Xi'an, 710054, Shaanxi, China.
authors.forename: Zhenxian
authors.initials: Z
authors.lastname: Chen
authors.affiliation: State Key Laboratory for Manufacturing System Engineering, School of Mechanical Engineering, Xi'an Jiaotong University, Xi'an, 710054, Shaanxi, China.
authors.forename: Ling
authors.initials: L
authors.lastname: Wang
authors.affiliation: State Key Laboratory for Manufacturing System Engineering, School of Mechanical Engineering, Xi'an Jiaotong University, Xi'an, 710054, Shaanxi, China.
authors.forename: Yaxiong
authors.initials: Y
authors.lastname: Liu
authors.affiliation: State Key Laboratory for Manufacturing System Engineering, School of Mechanical Engineering, Xi'an Jiaotong University, Xi'an, 710054, Shaanxi, China.
authors.forename: Jiankang
authors.initials: J
authors.lastname: He
authors.affiliation: State Key Laboratory for Manufacturing System Engineering, School of Mechanical Engineering, Xi'an Jiaotong University, Xi'an, 710054, Shaanxi, China.
authors.forename: Qin
authors.initials: Q
authors.lastname: Lian
authors.affiliation: State Key Laboratory for Manufacturing System Engineering, School of Mechanical Engineering, Xi'an Jiaotong University, Xi'an, 710054, Shaanxi, China.
authors.forename: Dichen
authors.initials: D
authors.lastname: Li
authors.affiliation: State Key Laboratory for Manufacturing System Engineering, School of Mechanical Engineering, Xi'an Jiaotong University, Xi'an, 710054, Shaanxi, China.|Institute of Medical and Biological Engineering, School of Mechanical Engineering, University of Leeds, Leeds, LS2 9JT, United Kingdom.
authors.forename: Zhongmin
authors.initials: Z
authors.lastname: Jin
mesh_terms: D000328:Adult; D019645:Arthroplasty, Replacement, Knee / Q000379:methods*; D001696:Biomechanical Phenomena; D003198:Computer Simulation; D005260:Female; D005269:Femur / Q000473:pathology; D005684:Gait; D006801:Humans; D007717:Knee / Q000502:physiology*; D007719:Knee Joint / Q000601:surgery; D008953:Models, Anatomic; D010146:Pain; D011183:Postoperative Complications; D012399:Rotation; D013314:Stress, Mechanical; D013977:Tibia / Q000473:pathology / Q000502:physiology; D016138:Walking
keywords: contact force; mal-rotation; multi-body dynamics; musculoskeletal model; total knee arthroplasty