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      Effect of Posterior Femoral Condylar Offset and Posterior Tibial Slope on Maximal Flexion Angle of the Knee in Posterior Cruciate Ligament Sacrificing Total Knee Arthroplasty

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          Abstract

          Purpose

          To evaluate the effect of femoral condylar offset and posterior tibial slope on maximal flexion angle of the knee in posterior cruciate ligament (PCL)-sacrificing total knee arthroplasty (TKA, Medial-Pivot Knee System).

          Materials and Methods

          Forty-five knees in 35 patients who could be followed up more than 1 year after PCL-sacrificing TKA were evaluated retrospectively. We measured and analyzed the preoperative and postoperative maximal flexion angle, posterior femoral condylar offset difference, posterior femoral condylar offset ratio difference, and tibial slope.

          Results

          The mean maximal flexion angle after TKA was 118.44°±9.8° and significantly related to postoperative tibial slope (11.78°±6.2°) in correlation analysis (R=0.451, p=0.002). There was no statistical relationship between the postoperative maximal flexion angle and the posterior femoral condylar offset difference (3.24±3.862 mm, R=0.105, p=0.493) and posterior femoral condylar offset ratio difference (0.039±0.029 mm, R=-0.163, p=0.284).

          Conclusions

          The maximal flexion angle of the knee after PCL-sacrificing TKA was significantly related to the postoperative tibial slope. Therefore, posterior tibial slope can be considered as a factor that affects maximal flexion angle after PCL-sacrificing TKA.

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          Most cited references30

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          Fluoroscopic analysis of the kinematics of deep flexion in total knee arthroplasty. Influence of posterior condylar offset.

          Our purpose was to determine the mechanism which allows the maximum knee flexion in vivo after a posterior-cruciate-ligament (PCL)-retaining total knee arthroplasty. Using three-dimensional computer-aided design videofluoroscopy of deep squatting in 29 patients, we determined that in 72% of knees, direct impingement of the tibial insert posteriorly against the back of the femur was the factor responsible for blocking further flexion. In view of this finding we defined a new parameter termed the 'posterior condylar offset'. In 150 consecutive arthroplasties of the knee, the magnitude of posterior condylar offset was found to correlate with the final range of flexion.
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            Predicting range of movement after knee replacement: the importance of posterior condylar offset and tibial slope.

            We have attempted to quantify the influence of clinical, radiological and prosthetic design factors upon flexion following knee replacement. Our study examined the outcome following 101 knee replacements performed in two prospective randomized trials using similar cruciate retaining implants. Multivariate analyses, after adjusting for age, sex, diagnosis and the type of prosthesis revealed that the only significant correlates for range of movement at 12 months were the difference in posterior condylar offset ratio (p < 0.001), tibial slope (p < 0.001) and preoperative range of movement (p = 0.025). We found a moderate correlation between 12-month range of movement and posterior tibial slope (R = 0.58) and the difference of post femoral condylar offset (i.e, post-operative minus preoperative posterior condylar offset, R = 0.65). Posterior condylar offset had the greatest impact upon final range of movement highlighting this as an important consideration for the operating surgeon at pre-operative templating when choosing both the design and size of the femoral component.
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              The influence of tibial slope on maximal flexion after total knee arthroplasty.

              Many surgeons believe that increasing the tibial slope in total knee arthroplasty (TKA) is beneficial with regard to maximal postoperative flexion. Review of the clinical literature, however, does not confirm this hypothesis, neither does it give an answer to the question of how much flexion gain can be expected per degree extra tibial slope. The purpose of this study was, therefore, to evaluate and quantify the influence of tibial slope on maximal postoperative flexion in contemporary posterior cruciate ligament (PCL)-retaining TKA. Twenty-one cadaver simulations of a standard PCL-retaining TKA were studied while reproducing identical deep flexion femorotibial kinematics as documented by three-dimensional computer-aided videofluoroscopy from patients with well-functioning TKAs of the same design. In each knee the tibial component was consecutively implanted with 0 degrees posterior slope, 4 degrees posterior slope, and 7 degrees posterior slope. Maximal flexion was recorded for each configuration. Average maximal flexion at 0 degrees tibial slope was 104 degrees, and increased significantly to 112 degrees when the same knees were implanted with 4 degrees tibial slope. Increasing the slope further to 7 degrees again significantly improved average maximal flexion to 120 degrees. When postoperative radiographic tibial slope was compared to maximal flexion, an average gain of 1.7 degrees flexion for every degree extra tibial slope was noted. Increasing the tibial slope in PCL-retaining TKA does indeed improve maximal flexion before tibial insert impingement occurs against the femoral bone. The surgeon can expect an average gain of 1.7 degrees flexion for every degree extra tibial slope.
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                Author and article information

                Journal
                Knee Surg Relat Res
                Knee Surg Relat Res
                KSRR
                Knee Surgery & Related Research
                The Korean Knee Society
                2234-0726
                2234-2451
                June 2013
                29 May 2013
                : 25
                : 2
                : 54-59
                Affiliations
                Department of Orthopedic Surgery, Hanyang University College of Medicine, Guri, Korea.
                Author notes
                Correspondence to: Jong-Heon Kim, MD. Department of Orthopedic Surgery, Hanyang University Guri Hospital, 153 Gyeongchun-ro, Guri 471-701, Korea. Tel: +82-31-560-2313, Fax: +82-31-557-8781, jhkim111@ 123456hanyang.ac.kr
                Article
                10.5792/ksrr.2013.25.2.54
                3671116
                23741699
                14e4541b-da91-406d-bd0e-f5ad0835c490
                Copyright © 2013 KOREAN KNEE SOCIETY

                This is an open access article distributed under the terms of the Creative Commons Attribution Non-Commercial License ( http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                : 20 September 2012
                : 13 March 2013
                : 10 April 2013
                Categories
                Original Article

                Surgery
                maximal flexion angle,posterior femoral offset,posterior femoral offset ratio,posterior tibial slope,cruciate-sacrificing total knee arthroplasty

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