Increased Flexion Position of the Femoral Component Reduces the Flexion Gap in Total Knee Arthroplasty

Overview

Journal Knee Surg Sports Traumatol Arthrosc

Publisher Wiley

Specialties Emergency Medicine
General Surgery
Orthopedics

Date 2011 Oct 25

PMID 22020960

Citations 14

Authors

Georg Matziolis

Robert Hube

Carsten Perka

Doerte Matziolis

Affiliations

Soon will be listed here.

Abstract

Background: The symmetry and equality of the flexion and extension gap are essential for successful endoprosthetic knee arthroplasty. Cruciate ligament sparing endoprosthetic designs are implanted with a measured resection technique, so that the posterior bone resection corresponds to the posterior condyle thickness. However, this correlation only applies if the sagittal alignment is set at 0°. The aim of the present study was therefore to investigate the extent to which the flexion gap is influenced by a flexed implantation of the femoral component.

Methods: The implant geometry of all available sizes of the knee systems Columbus, e.motion (Aesculap), PFC Sigma (DePuy), Natural Knee II, Innex, Nexgen LPS Flex and Gender (Zimmer), and TC Plus (Smith & Nephew) was recorded. Based on this data, a virtual implantation of the femoral component with a sagittal alignment between 0° and 5° of flexion was simulated. The resulting flexion gaps were calculated depending on the component alignment. The relationships between component alignment (in degrees) and flexion gap (in mm) were documented for every implant.

Results: The narrowing of the flexion gap with increasing flexion was more or less linear in the range investigated and was dependent on the system used and the implant size. A narrowing of the flexion gap by 1 mm resulted from 2° (1.9°-2.3°) flexion in the e.motion prosthesis, 1.9° (1.6°-2.4°) in the Columbus, 1.6° (1.5°-1.8°) in the PFC Sigma, 2.0° (1.7°-2.4°) in the Nexgen LPS Flex and Gender, 1.7° (1.6°-1.8°) in the Innex, 2.2° (1.5°-2.6°) in the TC Plus and 2.0° (2.0°-2.1°) in the Natural Knee.

Conclusions: Even a small flexion of the femoral component leads to a reduction of the flexion gap and thus potentially to limited mobility in the measured resection technique. On the other hand, in navigation-assisted implantation, slight flexion of the component can possibly be used to adjust the flexion gap smoothly.

Level Of Evidence: II.

Citing Articles

Does mild flexion of the femoral prosthesis in total knee arthroplasty result in better early postoperative outcomes?.

Zhou H, Wu Z, Chen X, Zhang L, Zhang J, Hidig S BMC Musculoskelet Disord. 2023; 24(1):711.

PMID: 37674188 PMC: 10483864. DOI: 10.1186/s12891-023-06840-w.

Intentional Femoral Component Flexion - A Method to Balance the Flexion-extension Gap in Navigated Total Knee Replacement.

Govardhan P, Harigovindarao G J Orthop Case Rep. 2020; 10(5):37-42.

PMID: 33312977 PMC: 7706447. DOI: 10.13107/jocr.2020.v10.i05.1830.

Femoral flexion position is a highly variable factor in total knee arthroplasty: an analysis of 593 conventionally aligned total knee replacements.

Koenen P, Ates D, Pfeiffer T, Bouillon B, Bathis H Knee Surg Sports Traumatol Arthrosc. 2019; 28(4):1014-1022.

PMID: 31131420 DOI: 10.1007/s00167-019-05548-6.

Flexing and downsizing the femoral component is not detrimental to patellofemoral biomechanics in posterior-referencing cruciate-retaining total knee arthroplasty.

Marra M, Strzelczak M, Heesterbeek P, van de Groes S, Janssen D, Koopman B Knee Surg Sports Traumatol Arthrosc. 2018; 26(11):3377-3385.

PMID: 29560510 PMC: 6208942. DOI: 10.1007/s00167-018-4900-z.

Pre-operative templating for knee arthroplasty shows low accuracy with standard X-rays.

Ooka N, Campos A, da Fonseca V, Rodrigues L, Filho E, Franco J Int Orthop. 2018; 42(6):1275-1282.

PMID: 29333586 DOI: 10.1007/s00264-018-3764-7.

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