title: Navigation-based tibial rotation at 90° of flexion is associated with better range of motion in navigated total knee arthroplasty.
abstract: OBJECTIVE
  In clinical practice, people with better femorotibial rotation in the flexed position often achieve a favourable postoperative maximum flexion angle (MFA). However, no objective data have been reported to support this clinical observation. In the present study, we aimed to investigate the correlation between the amount of intraoperative rotation and the pre- and postoperative flexion angles.
  
  
  METHODS
  Fifty-five patients with varus osteoarthritis undergoing computer-assisted posterior-stabilized total knee arthroplasty (TKA) were enrolled. After registration, rotational stress was applied towards the knee joint, and the rotational angles were recorded by using a navigation system at maximum extension and 90° of flexion. After implantation, rotational stress was applied for a second time, and the angles were recorded once more. The MFA was measured before surgery and 1 month after surgery, and the correlation between the amount of femorotibial rotation during surgery and the MFA was statistically evaluated.
  
  
  RESULTS
  Although the amount of tibial rotation at maximum extension was not correlated with the MFA, the amount of tibial rotation at 90° of flexion after registration was positively correlated with the pre- and postoperative MFA (both p < 0.005). However, no significant relationship was observed between the amount of tibial rotation after implantation and the postoperative MFA (n.s.).
  
  
  CONCLUSIONS
  The results showed that better femorotibial rotation at 90° of flexion is associated with a favourable postoperative MFA, suggesting that the flexibility of the surrounding soft tissues is an important factor for obtaining a better MFA, which has important clinical relevance. Hence, further evaluation of navigation-based kinematics during TKA may provide useful information on MFA.
  
  
  METHODS
  Diagnostic studies, development of diagnostic criteria in a consecutive series of patients, and a universally applied "gold" standard, Level II.
authors: Department of Orthopedic Surgery, Kobe Kaisei Hospital, 3-11-15, Shinohara-Kita, Nada, Kobe, 657-0068, Japan. wavedreamer17@yahoo.co.jp.
authors: Kazunari
authors: K
authors: Ishida
authors: Department of Orthopedic Surgery, Kobe Kaisei Hospital, 3-11-15, Shinohara-Kita, Nada, Kobe, 657-0068, Japan.
authors: Nao
authors: N
authors: Shibanuma
authors: Department of Orthopedic Surgery, Kobe University Graduate School of Medicine, 7-5-1, Kusunoki, Chuo, Kobe, 650-0017, Japan.
authors: Tomoyuki
authors: T
authors: Matsumoto
authors: Department of Orthopedic Surgery, Kobe Kaisei Hospital, 3-11-15, Shinohara-Kita, Nada, Kobe, 657-0068, Japan.
authors: Hiroshi
authors: H
authors: Sasaki
authors: Department of Orthopedic Surgery, Kobe University Graduate School of Medicine, 7-5-1, Kusunoki, Chuo, Kobe, 650-0017, Japan.
authors: Koji
authors: K
authors: Takayama
authors: Department of Orthopedic Surgery, Kobe University Graduate School of Medicine, 7-5-1, Kusunoki, Chuo, Kobe, 650-0017, Japan.
authors: Yuji
authors: Y
authors: Hiroshima
authors: Department of Orthopedic Surgery, Kobe University Graduate School of Medicine, 7-5-1, Kusunoki, Chuo, Kobe, 650-0017, Japan.
authors: Ryosuke
authors: R
authors: Kuroda
authors: Department of Orthopedic Surgery, Kobe University Graduate School of Medicine, 7-5-1, Kusunoki, Chuo, Kobe, 650-0017, Japan.
authors: Masahiro
authors: M
authors: Kurosaka
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D019645:Arthroplasty, Replacement, Knee / Q000379:methods*; D001696:Biomechanical Phenomena; D005260:Female; D006801:Humans; D007719:Knee Joint / Q000601:surgery; D008297:Male; D008875:Middle Aged; D010003:Osteoarthritis / Q000601:surgery; D011184:Postoperative Period; D016059:Range of Motion, Articular / Q000502:physiology*; D012399:Rotation; D025321:Surgery, Computer-Assisted; D013977:Tibia / Q000502:physiology* / Q000601:surgery
keywords: Kinematics; Maximum flexion angle; Medical examination; Navigation; Rotational flexibility; Total knee arthroplasty