Intraoperative posterior movement of the tibia at 90° of flexion predicts worse postoperative flexion angles in cruciate-substituting total knee arthroplasty

Purpose

To investigate the correlation between intraoperative tibiofemoral anteroposterior changes at 90° of flexion and postoperative maximum flexion angles in navigated cruciate-substituting TKA. The hypothesis of this study was that intraoperative tibiofemoral anteroposterior changes at 90° of flexion indirectly reflect posterior cruciate ligament (PCL) function and associate with postoperative maximum flexion angles.

Methods

Fifty-five consecutive patients with varus osteoarthritis treated with primary TKA were retrospectively analysed. All patients received the same type of implant, placed with an image-free navigation system. The PCL was retained, and cruciate-substituting inserts were used in all cases. The mean follow-up was 44 ± 8 months. The preoperative and postoperative kinematics were measured intraoperatively with a navigation system, and the preoperative and postoperative tibiofemoral anteroposterior positions at 90° of flexion were determined. The correlation between intraoperative anteroposterior position changes and postoperative maximum flexion angles was investigated. The correlation between the change of anteroposterior position and tibiofemoral rotational angles was also assessed.

Results

The intraoperative anteroposterior position change was −1.7 ± 3.4 mm (a positive value indicates tibial posterior shift). Flexion angle improvement was negatively correlated with intraoperative change of tibiofemoral anteroposterior position (R² = 0.17, p < 0.005). Postoperative maximum flexion angles were also negatively correlated with intraoperative change of tibiofemoral anteroposterior position (R² = 0.09, p < 0.05). The postoperative amount of tibial internal rotation was positively correlated with the preoperative amount (R² = 0.60, p < 0.0001); however, the intraoperative anteroposterior position change was not correlated with the postoperative amount of tibial internal rotation (n.s.).

Conclusion

A navigation system may be able to indirectly evaluate PCL function and predict the postoperative flexion angles in cruciate-substituting TKA. Intraoperative posterior movement of the tibia at 90° of flexion predicts worse postoperative flexion angles in cruciate-substituting TKA.

Level of evidence

Level 3, retrospective comparative study.