Factors affecting intraoperative kinematic patterns and flexion angles in navigated total knee arthroplasty

Purpose

To investigate the factors affecting intraoperative kinematics, as measured with a navigation system, and their effect on maximum flexion angles during total knee arthroplasty (TKA).

Method

One hundred posterior stabilised (PS) TKAs performed using an image-free navigation system were evaluated. Tibial internal rotation angles at maximum extension, 30°, 45°, 60°, 90°, and maximum flexion were collected at registration and after implantation. The varus angles from the coronal mechanical axis were also collected. The rotational patterns were divided into four groups to investigate whether flexion contracture and varus deformity affected the kinematic patterns, and correlated with the maximum pre- and post-operative flexion angles.

Results

At registration, the flexion angles at maximum extension differed significantly between the kinematic groups; the flexion angle at maximum extension at registration was negatively correlated with the pre-operative maximum flexion angle (R ² = 0.226, p < 0.0001) and the post-operative maximum flexion angle (R ² = 0.059, p = 0.0167). Varus deformity at registration also differed significantly between the kinematic groups; varus deformity at registration was negatively correlated with the pre-operative maximum flexion angle (R ² = 0.087, p = 0.0036) and post-operative maximum flexion angle (R ² = 0.101, p = 0.0027).

Conclusion

Navigation-based measurements in patients undergoing PS TKA indicated that pre-operative flexion contracture and varus deformity are negatively correlated with both pre- and post-operative maximum flexion angles. The results may improve the ease with which surgeons can interpret intraoperative kinematics, by providing a multi-dimensional perspective. With further knowledge regarding intraoperative kinematics, it might be possible to improve surgical approach, prosthesis design, and clinical outcomes.

Level of evidence

II.