title: Dynamic knee behaviour: does the knee deformity change as it is flexed-an assessment and classification with computer navigation.
abstract: OBJECTIVE
  The aim of this study was to assess the kinematics of arthritic knees prior to TKA. The hypothesis was that the arthritic knee follows distinct patterns with regard to deformity in coronal plane as it flexes from extended position.
  
  
  METHODS
  Data from 585 consecutive arthritic knees that had undergone TKA using two non-image-based navigation systems were included in the study. Coronal plane alignment given by the femoro-tibial mechanical angle (FTMA) was recorded in extension, 30°, 60°, 90° and maximum flexion prior to making any bony cuts or ligamentous releases.
  
  
  RESULTS
  Complete data were available for 512 (87.5 %) of arthritic knees. It was found that pre-implant arthritic knees behaved in different distinct patterns from full extension to 90° flexion. These patterns in FTMA from extension through to 90° of flexion were classified into 4 major types (1, 2, 3, and 4) and 8 subgroups (1A, 1B, 2A, 2B, 3, 4A, 4B, 4C) for varus and valgus knees. Beyond 90° of flexion, there were no distinct or consistent patterns. There were differences between varus and valgus knee deformities not only in overall numbers (73.8 % varus vs. 21.1 % valgus) but also in kinematic behaviour. Only 14.1 % of total knees had a consistent deformity (Type 1A) which remained the same throughout the range of flexion. 14.1 % knees actually become opposite deformity as the knee flexes; thus, varus becomes valgus and valgus becomes varus as the knee flexes (Type 3 and 4C).
  
  
  CONCLUSIONS
  This study has observed and categorised distinct patterns which arthritic knees follow in the coronal plane as it flexes. This dynamic change during flexion will have bearing on collateral releases that are traditionally done based on deformity in extension or 90° flexion mainly. This may be the underlying cause of flexion instability especially for Types 3 and 4C knees if collateral soft tissue release is done based on deformity in extension. Full significance of this remains unknown and will need further investigation.
  
  
  METHODS
  III.
authors.affiliation: Department of Orthopaedics, Golden Jubilee National Hospital, Agamemnon Street, Clydebank, Glasgow, G81 4DY, UK. mrkdeep@gmail.com.
authors.forename: Kamal
authors.identifier: http://orcid.org/0000-0002-2268-9940
authors.initials: K
authors.lastname: Deep
authors.affiliation: Department of Orthopaedics, Golden Jubilee National Hospital, Agamemnon Street, Clydebank, Glasgow, G81 4DY, UK.
authors.forename: Frederic
authors.initials: F
authors.lastname: Picard
authors.affiliation: Department of Orthopaedics, Golden Jubilee National Hospital, Agamemnon Street, Clydebank, Glasgow, G81 4DY, UK.
authors.forename: Joseph
authors.initials: J
authors.lastname: Baines
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D019645:Arthroplasty, Replacement, Knee / Q000379:methods; D001696:Biomechanical Phenomena; D005260:Female; D056304:Genu Valgum / Q000209:etiology / Q000503:physiopathology*; D056305:Genu Varum / Q000209:etiology / Q000503:physiopathology*; D006801:Humans; D007717:Knee; D007719:Knee Joint / Q000503:physiopathology* / Q000601:surgery; D007720:Knee Prosthesis; D008297:Male; D008875:Middle Aged; D020370:Osteoarthritis, Knee / Q000150:complications / Q000503:physiopathology* / Q000601:surgery; D016059:Range of Motion, Articular; D025321:Surgery, Computer-Assisted / Q000379:methods; D013977:Tibia / Q000601:surgery
keywords: Alignment; Behaviour; Classification; Deformity; Dynamic; Kinematics; Knee; Mechanical axis; Pattern; Total knee arthroplasty; Total knee replacement