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.

Questions/purposes 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.

Clinical Relevance If validated computer modeling can aid surgeons to predict the effects of individual implant alignment variations in TKA kinematics, a more personalized approach to implant positioning during TKA can be implemented.