Are contemporary femoral components sizing and design likely to affect functional results in TKA? A mathematical model of an implanted knee to predict knee forces

A. Tecame, M. Ferrari, B. Violante, G. Calafiore, R. Papalia, P. Adravanti

Research output: Contribution to journalArticle

Abstract

Purpose: This study is aimed to investigate the effects of the choice of femoral and tibial components on several mechanical outputs that might be associated with total knee replacement surgery outcomes using a validated computational model: the Kansas knee simulator. Methods: Two models from the same range of implants were taken into account: Model 1, the femoral component fitted the femoral epiphysis, with physiological positioning of the articulating surface using a 10-mm-thick tibial component, and in Model 2, the femoral component was 4 mm smaller than in Model 1, and a 14-mm-thick tibial component was used with a similar tibial resection and the tibio-femoral joint line was 4 mm more proximal to compensate the increased posterior bone resection and maintain proper soft-tissue tension in flexion. Changes in reaction forces and contact pressures between the components, changes in extensor muscle forces and changes in patello-femoral joint kinematics during walking gait have been studied. Results: While the computational model predicted that most kinematic and kinetic outputs, including tibio-femoral and patello-femoral joint motions, contact forces, pressures and areas, were similar for Model 1 and Model 2, and a dramatic difference has been found in the extensor muscle forces necessary to flex and extend the knee. To reproduce the same knee motion with a knee reconstructed as in Model 2, a patient would need to generate approximately 40% greater extensor muscle force throughout the gait cycle in order to do so. Conclusion: As a consequence of such a large increase in the extensor muscle force, the knee motions would probably be compromised and, subsequently, a patient with a knee reconstructed as in Model 2 would be less likely to be able to reproduce normal knee function and therefore more likely to report poor outcome.

Original languageEnglish
Pages (from-to)289-297
Number of pages9
JournalMusculoskeletal Surgery
Volume102
Issue number3
DOIs
Publication statusPublished - Dec 1 2018

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Thigh
Knee
Theoretical Models
Muscles
Joints
Gait
Biomechanical Phenomena
Pressure
Knee Replacement Arthroplasties
Epiphyses
Walking
Bone and Bones

Keywords

  • Extensor muscle
  • Gap size
  • Joint line
  • Kansas knee simulator
  • Knee kinematic mathematical model
  • TKA

ASJC Scopus subject areas

  • Surgery
  • Orthopedics and Sports Medicine

Cite this

Are contemporary femoral components sizing and design likely to affect functional results in TKA? A mathematical model of an implanted knee to predict knee forces. / Tecame, A.; Ferrari, M.; Violante, B.; Calafiore, G.; Papalia, R.; Adravanti, P.

In: Musculoskeletal Surgery, Vol. 102, No. 3, 01.12.2018, p. 289-297.

Research output: Contribution to journalArticle

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