University of Twente Student Theses


The impact of posterior tibial slope on knee biomechanics as predictor of flexion contracture in total knee arthroplasty

Brandsma, D.S. (2022) The impact of posterior tibial slope on knee biomechanics as predictor of flexion contracture in total knee arthroplasty.

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Abstract:Pre-operative knee flexion contracture in patients undergoing total knee arthroplasty (TKA) is a risk factor for post-operative flexion contracture associated with undesirable surgical outcomes such as restricted range of motion and knee instability. Osteophyte formation and variations of the posterior tibial slope (PTS) in osteoarthritic knees may contribute to flexion contracture. However, the effects of these morphological changes are not well understood. This study aims to investigate the effect of PTS on the tibiofemoral (TF) joint kinematics and ligament and muscle forces using a musculoskeletal modeling approach. A patient-specific musculoskeletal knee model was developed using a previously established framework to represent the pre-operative knee comprising the osteophytic femoral and tibial bones. The PTS was the only varying parameter in the model, while all other variables, such as the muscle and ligament attachment sites and their slack lengths remained unchanged throughout the entire study. The PTS in the pre-operative knee was determined based on anatomical landmarks located at the proximal tibia. The PTS was varied from -9° up to 6° with increments of 3° compared to the baseline by rotating the tibial plateau in the sagittal plane of the patient-specific anatomical frame. We captured the effect of PTS on the TF joint kinematics, quadriceps muscle activity and ligament and contact forces during an unloaded knee extension simulation from 60° to 0°. Differences in the simulated outcomes were quantified using the root-mean-square deviation. A greater PTS (by +6°) resulted in increased forces of the anterior cruciate ligament (ACL), posterior capsule (PC), deep medial collateral ligament (dMCL), and superficial medial collateral ligament (sMCL) in extension of the knee by +44.3%, +18.6%, +49.8%, and +119.3% respectively. The TF compressive and shear forces and the muscle activity of the quadriceps increased in extension as well and the tibia was translated more anteriorly with respect to the femur for larger slope angles. The results show a possible contribution to flexion contracture. Surgeons should carefully consider the angle of the tibial cut in TKA to avoid residual flexion contracture.
Item Type:Essay (Bachelor)
Faculty:ET: Engineering Technology
Subject:44 medicine
Programme:Biomedical Technology BSc (56226)
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