Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2024 Apr 15:12:1352794.
doi: 10.3389/fbioe.2024.1352794. eCollection 2024.

Posterior tibial slope influences joint mechanics and soft tissue loading after total knee arthroplasty

Ning Guo  1 , Colin R Smith  2 , Pascal Schütz  1 , Adam Trepczynski  3 , Philippe Moewis  3 , Philipp Damm  3 , Allan Maas  4   5 , Thomas M Grupp  4   5 , William R Taylor  1 , Seyyed Hamed Hosseini Nasab  1
Affiliations

Posterior tibial slope influences joint mechanics and soft tissue loading after total knee arthroplasty

Ning Guo et al. Front Bioeng Biotechnol. .

Abstract

As a solution to restore knee function and reduce pain, the demand for Total Knee Arthroplasty (TKA) has dramatically increased in recent decades. The high rates of dissatisfaction and revision makes it crucially important to understand the relationships between surgical factors and post-surgery knee performance. Tibial implant alignment in the sagittal plane (i.e., posterior tibia slope, PTS) is thought to play a key role in quadriceps muscle forces and contact conditions of the joint, but the underlying mechanisms and potential consequences are poorly understood. To address this biomechanical challenge, we developed a subject-specific musculoskeletal model based on the bone anatomy and precise implantation data provided within the CAMS-Knee datasets. Using the novel COMAK algorithm that concurrently optimizes joint kinematics, together with contact mechanics, and muscle and ligament forces, enabled highly accurate estimations of the knee joint biomechanics (RMSE <0.16 BW of joint contact force) throughout level walking and squatting. Once confirmed for accuracy, this baseline modelling framework was then used to systematically explore the influence of PTS on knee joint biomechanics. Our results indicate that PTS can greatly influence tibio-femoral translations (mainly in the anterior-posterior direction), while also suggesting an elevated risk of patellar mal-tracking and instability. Importantly, however, an increased PTS was found to reduce the maximum tibio-femoral contact force and improve efficiency of the quadriceps muscles, while also reducing the patellofemoral contact force (by approximately 1.5% for each additional degree of PTS during walking). This study presents valuable findings regarding the impact of PTS variations on the biomechanics of the TKA joint and thereby provides potential guidance for surgically optimizing implant alignment in the sagittal plane, tailored to the implant design and the individual deficits of each patient.

Keywords: TKA; knee mechanics; posterior tibial slope; soft tissue loading; subject-specific modelling.

PubMed Disclaimer

Conflict of interest statement

Author AM and TG were employed by Aesculap AG. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

FIGURE 1
FIGURE 1
Steps towards constructing the Subject-Specific Musculoskeletal Model.
FIGURE 2
FIGURE 2
Tibio-femoral kinematics and kinetics during walking. Shaded areas show ± 1 standard deviation of the five activity trials.
FIGURE 3
FIGURE 3
Tibio-femoral kinematics and kinetics during squatting. Shaded areas show ± 1 standard deviation of the five activity trials.
FIGURE 4
FIGURE 4
The impact of different PTS angles on tibiofemoral joint kinematics and kinetics during walking. Note: The shift in PTS was subtracted from the implant flexion to solely capture alterations in the knee flexion angle.
FIGURE 5
FIGURE 5
Tibiofemoral contact area (TFCA), and tibiofemoral mean contact pressure (TFCP) during walking (left). Centre of Pressure (CoP) at second FTotal peak (52% cycle) (right).
FIGURE 6
FIGURE 6
Variation of muscle and ligament forces with different PTSs during walking.
FIGURE 7
FIGURE 7
The impact of different PTS angles on tibiofemoral joint kinematics and kinetics during squatting. Note: The shift in PTS was subtracted from the implant flexion to solely capture alterations in the knee flexion angle.
See this image and copyright information in PMC

Similar articles

See all similar articles

Cited by

References

    1. Acker S., Li R., Murray H., John P. S., Banks S., Mu S., et al. (2011). Accuracy of single-plane fluoroscopy in determining relative position and orientation of total knee replacement components. J. Biomechanics 44 (4), 784–787. 10.1016/j.jbiomech.2010.10.033 - DOI - PubMed
    1. Alaia M. J., Cohn R. M., Strauss E. J. (2014). Patellar instability. Bull. Hosp. Jt. Dis. 72 (1), 6–17. - PubMed
    1. Arnold E. M., Ward S. R., Lieber R. L., Delp S. L. (2010). A model of the lower limb for analysis of human movement. Ann. Biomed. Eng. 38 (2), 269–279. 10.1007/s10439-009-9852-5 - DOI - PMC - PubMed
    1. Ayers D. C., Yousef M., Zheng H., Yang W., Franklin P. D. (2022). The prevalence and predictors of patient dissatisfaction 5-years following primary total knee arthroplasty. J. Arthroplasty 37, S121–S128. 10.1016/j.arth.2022.02.077 - DOI - PubMed
    1. Bellemans J., Robijns F., Duerinckx J., Banks S., Vandenneucker H. (2005). The influence of tibial slope on maximal flexion after total knee arthroplasty. Knee Surg. Sports Traumatol. Arthrosc. 13 (3), 193–196. 10.1007/s00167-004-0557-x - DOI - PubMed