ArticleScientific reports2023
Excessive flexed position of the femoral component causes abnormal kinematics and joint contact/ ligament forces in total knee arthroplasty.
Article in Scientific reports, 2023. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 11 papers.
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Who cites it
11 citing papers in PubMed.
- Enhancing total knee arthroplasty outcomes: the role of individualized femoral sagittal alignment in robotic-assisted surgery - A randomized controlled trial.Journal of orthopaedic surgery and research · 2024Trial
- Magnitude of intraoperative femoral rotational adjustment from the initial plan is associated with slower early recovery after robotic-assisted functional-alignment TKA.Journal of robotic surgery · 2026Article
- Radiographic Evaluation of Distal Femoral Sagittal Morphology Following Imageless Robotic-Assisted Total Knee Arthroplasty Using Functional Alignment.Journal of clinical medicine · 2026Article
- Unrestricted kinematic alignment on the sagittal plane: Posterior tibial slope and combined flexion do not have boundaries to respect in terms of short-term clinical outcomes and safety.Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA · 2026Article
- Effect of sagittal alignment on patient outcomes following total knee replacement: A systematic review and correlation analysis.Journal of experimental orthopaedics · 2026Review
- Analysis of posterolateral and anterolateral laxity in varus knees undergoing robotic assisted total knee arthroplasty.Journal of robotic surgery · 2026Article
- Posterior femoral condylar morphology following mechanical vs. kinematic alignment using a medial-pivot implant designed for mechanical alignment: A CT-based comparative study.Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA · 2026Article
- Component placement angles in total knee arthroplasty affect mid- to long-term clinical results: an average 8-year follow-up study.Archives of orthopaedic and trauma surgery · 2025Article
- Accuracy and Early Outcomes of Patient-Specific TKA Using Inertial-Based Cutting Guides: A Pilot Study.Medicina (Kaunas, Lithuania) · 2025Article
- Beyond the coronal plane in robotic total knee arthroplasty-Part 1: Variations in tibial slope and distal femoral flexion do not affect outcomes.Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA · 2025Article
- Proposing a precision-enhancing method for sagittal plane alignment during total knee arthroplasty.BMC musculoskeletal disorders · 2025Article
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Authors and funding
7 authors.
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No grant is acknowledged in the PubMed record.
Abstract
Poor clinical outcomes are reported in excessive flexion of the femoral component in total knee arthroplasty (TKA), but their mechanisms have not yet been elucidated. This study aimed to investigate the biomechanical effect of flexion of the femoral component. Cruciate-substituting (CS) and posterior-stabilised (PS) TKA were reproduced in a computer simulation. The femoral component was then flexed from 0° to 10° with anterior reference, keeping the implant size and the extension gap. Knee kinematics, joint contact, and ligament forces were evaluated in deep-knee-bend activity. When the femoral component was flexed 10° in CS TKA, paradoxical anterior translation of the medial compartment was observed at mid-flexion. The PS implant was best stabilised with a 4° flexion model in mid-flexion range. The medial compartment contact force and the medial collateral ligament (MCL) force increased with the flexion of the implant. There were no remarkable changes in the patellofemoral contact force or quadriceps in either implant. In conclusions, excessive flexion of the femoral component yielded abnormal kinematics and contact/ligament forces. Avoiding excessive flexion and maintaining mild flexion of the femoral component would provide better kinematics and biomechanical effects in CS and PS TKA.
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