ArticleKnee surgery, sports traumatology, arthroscopy : official journal of the ESSKA2018
Flexing and downsizing the femoral component is not detrimental to patellofemoral biomechanics in posterior-referencing cruciate-retaining total knee arthroplasty.
Article in Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA, 2018. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 19 papers, 1 of them a synthesis that pooled it.
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Who cites it
19 citing papers in PubMed, 1 synthesis or guideline pooled it.
- Femoral component sagittal alignment and its influence on short-term outcomes in total knee arthroplasty: a systematic review.BMC musculoskeletal disorders · 2026Pooled it
- The length of lateral radiographs significantly impacts the measurement of the femoral intramedullary axis in patients undergoing total knee arthroplasty.Arthroplasty (London, England) · 2026Article
- Impact of femoral component flexion on gap balancing in varus knees using robotic technology: a comparative study of single-radius and multi-radius designs.Journal of robotic surgery · 2025Observational
- Inducible Displacement of Cementless Femoral and Tibial Components Throughout Weight-bearing Flexion.Arthroplasty today · 2025Article
- Influence of femoral component downsizing on knee extension and resultant extension gap in TKA.Journal of clinical orthopaedics and trauma · 2025Article
- Anterior femoral offset is a flawed measurement of patellofemoral overstuffing.Archives of orthopaedic and trauma surgery · 2024Article
- Exploration of the Advanced VIVOBioengineering (Basel, Switzerland) · 2024Article
- Does mild flexion of the femoral prosthesis in total knee arthroplasty result in better early postoperative outcomes?BMC musculoskeletal disorders · 2023Article
- Excessive flexed position of the femoral component causes abnormal kinematics and joint contact/ ligament forces in total knee arthroplasty.Scientific reports · 2023Article
- Biomechanical Effect of Coronal Alignment and Ligament Laxity in Total Knee Arthroplasty: A Simulation Study.Frontiers in bioengineering and biotechnology · 2022Article
- [Research progress of anterior femoral notching in total knee arthroplasty].Zhongguo xiu fu chong jian wai ke za zhi = Zhongguo xiufu chongjian waike zazhi = Chinese journal of reparative and reconstructive surgery · 2021Article
- Intraoperative patellar maltracking and postoperative radiographic patellar malalignment were more frequent in cases of complete medial collateral ligament release in cruciate-retaining total knee arthroplasty.Knee surgery & related research · 2021Article
- Undercoverage of lateral trochlear resection is correlated with the tibiofemoral alignment parameters in kinematically aligned TKA: a retrospective clinical study.BMC musculoskeletal disorders · 2021Article
- Flexible versus standard intramedullary rod in posterior stabilized primary total knee arthroplasty: protocol for a randomized controlled trial.Journal of orthopaedic surgery and research · 2020Article
- Gender difference in bowing of the sagittal femoral morphology measurement using magnetic resonance imaging.Surgical and radiologic anatomy : SRA · 2020Article
- Optimal Sagittal Insertion Depth and Direction of Femoral Intramedullary Rod in Total Knee Arthroplasty in Chinese Osteoarthritis Patients.Orthopaedic surgery · 2020Article
- Patellar osteolysis after total knee arthroplasty with patellar resurfacing: a potentially underappreciated problem.Arthroplasty today · 2019Article
- Effect of Femoral Component Flexion in Robotic-Assisted Total Knee Arthroplasty on Retrograde Intramedullary Nail Sagittal Trajectory Angulation.JB & JS open accessArticle
- Intentional Femoral Component Flexion - A Method to Balance the Flexion-extension Gap in Navigated Total Knee Replacement.Journal of orthopaedic case reportsArticle
Corrections and comments
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Authors and funding
8 authors.
Funding
Abstract
purposeWhen downsizing the femoral component to prevent mediolateral overhang, notching of the anterior femoral cortex may occur, which could be solved by flexing the femoral component. In this study, we investigated the effect of flexion of the femoral component on patellar tendon moment arm, patellofemoral forces and kinematics in posterior-referencing CR-TKA. Our hypothesis was that flexion of the femoral component increases the patellar tendon moment arm, reduces the patellofemoral forces and provides stable kinematics.
methodsA validated musculoskeletal model of CR-TKA was used. The flexion of the femoral component was increased in four steps (0°, 3°, 6°, 9°) using posterior referencing, and different alignments were analysed in combination with three implant sizes (3, 4, 5). A chair-rising trial was analysed using the model, while simultaneously estimating quadriceps muscle force, patellofemoral contact force, tibiofemoral and patellofemoral kinematics.
resultsCompared to the reference case (size 4 and 0° flexion), for every 3° of increase in flexion of the femoral component the patellar tendon moment arm increased by 1% at knee extension. The peak quadriceps muscle force and patellofemoral contact force decreased by 2%, the patella shifted 0.8 mm more anteriorly and the remaining kinematics remained stable, with knee flexion. With the smaller size, the patellar tendon moment arm decreased by 6%, the quadriceps muscle force and patellofemoral contact force increased by 8 and 12%, and the patellar shifted 5 mm more posteriorly. Opposite trends were found with the bigger size.
conclusionFlexing the femoral component with posterior referencing reduced the patellofemoral contact forces during a simulated chair-rising trial with a patient-specific musculoskeletal model of CR-TKA. There seems to be little risk when flexing and downsizing the femoral component, compared to when using a bigger size and neutral alignment. These findings provide relevant information to surgeons who wish to prevent anterior notching when downsizing the femoral component.
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