Does total knee arthroplasty modify flexion axis of the knee?

• Published in: Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA Vol. 22; no. 8; pp. 1728 - 1735
• Main Authors: Iacono, F., Bruni, D., Bignozzi, S., Colle, F., Marcacci, M.
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer Berlin Heidelberg 01.08.2014; Springer Nature B.V
• Subjects: Aged; Aged, 80 and over; Ankle; Arthroplasty, Replacement, Knee; Biomechanical Phenomena; Bone Malalignment - physiopathology; Bone Malalignment - surgery; Female; Humans; Joint replacement surgery; Kinematics; Knee; Knee Joint - physiopathology; Knee Joint - surgery; Male; Medicine; Medicine & Public Health; Middle Aged; Orthopedics; Osteoarthritis, Knee - physiopathology; Osteoarthritis, Knee - surgery; Patients; Prospective Studies; Range of Motion, Articular; Software; Surgery, Computer-Assisted; Delaware; United States > US; Italy; Functional flexion axis; Total knee arthroplasty; Varus alignment; Computer-assisted surgery
• ISSN: 0942-2056; 1433-7347
• DOI: 10.1007/s00167-014-3054-x

Purpose To prospectively investigate whether preoperative functional flexion axis in patients with osteoarthritis- and varus-alignment changes after total knee arthroplasty and whether a correlation exists both between preoperative functional flexion axis and native limb deformity. Methods A navigated total knee arthroplasty was performed in 108 patients using a specific software to acquire passive joint kinematics before and after implant positioning. The knee was cycled through three passive range of motions, from 0° to 120°. Functional flexion axis was computed using the mean helical axis algorithm. The angle between the functional flexion axis and the surgical transepicondylar axis was determined on frontal ( α F ) and axial ( α A ) plane. The pre- and postoperative hip-knee-ankle angle, related to femur mechanical axis, was determined. Results Postoperative functional flexion axis was different from preoperative only on frontal plane, while no differences were found on axial plane. No correlation was found between preoperative α A and native limb deformity, while a poor correlation was found in frontal plane, between α F and preoperative hip-knee-ankle angle. Conclusions Total knee arthroplasty affects functional flexion axis only on frontal plane while has no effect on axial plane. Preoperative functional flexion axis is in a more varus position respect to the transepicondylar axis both in pre- and postoperative conditions. Moreover, the position of the functional axis on frontal plane in preoperative conditions is dependent on native limb alignment, while on axial plane is not dependent on the amount of preoperative varus deformity. Level of evidence IV.