Effect of rotational prosthetic alignment variation on tibiofemoral contact pressure distribution and joint kinematics in total knee replacement

Proc Inst Mech Eng H. 2017 Nov;231(11):1034-1047. doi: 10.1177/0954411917727564. Epub 2017 Aug 18.


In total knee replacement surgery, implant alignment is one of the most important criteria for successful long-term clinical outcome. During total knee replacement implantation, femoral and tibial alignment are determined through appropriate bone resections, which could vary based on patient anatomy, implant design and surgical technique and further influence loading conditions and clinical outcomes. The current research focused on three critical alignment parameters for total knee replacement insertion: femoral component internal/external (I/E) rotation, varus-valgus tibiofemoral angulation and posterior tibial slope. A computational finite element model of total knee replacement implant was developed and validated comparing with kinematic outputs generated from experimentally simulated knee joint motion. The FE model was then used to assess 12 different alignment scenarios based on previous case reports. Postoperative knee kinematics and joint contact pressure during simulated gait motion were assessed. According to the parametric study, FE model cases with femoral rotation revealed extra tibial I/E rotation in the predefined direction but negligible change in tibial anterior-posterior translation; cases with increased tibial slope showed notably increased tibial external rotation and anterior translation; cases with varus tibiofemoral angle presented slightly more tibial external rotation, whereas cases with valgus angle presented an observable increase in tibial internal rotation at the middle phase of the gait cycle. Finally, the response surface obtained from the postprocessing study demonstrated good statistical correlation with existing case study results, providing reliable estimation of peak tibiofemoral contact pressure affected by combinations of alignment parameters. The observations indicate that femoral external alignment should be favored clinically for enhanced patellar tracking and reduced contact pressure concentration for better long-term performance. Posterior tibial slope enables deep knee flexion. Extra femoral internal rotation as well as tibiofemoral varus-valgus alignment could be avoided in surgery due to deficiency in patellar tracking and high pressure concentration.

Keywords: Instron-Stanmore knee simulator; Total knee replacement; finite element analysis; implant alignment.

MeSH terms

  • Arthroplasty, Replacement, Knee*
  • Biomechanical Phenomena
  • Femur*
  • Finite Element Analysis
  • Humans
  • Joint Prosthesis*
  • Mechanical Phenomena*
  • Pressure*
  • Rotation*
  • Tibia*