Kinematic alignment produces near-normal knee motion but increases contact stress after total knee arthroplasty: A case study on a single implant design

Background: Kinematically aligned total knee arthroplasty (TKA) is of increasing interest because this method might improve postoperative patient satisfaction. In kinematic alignment the femoral component is implanted in a slightly more valgus and internally rotated position, and the tibial component is implanted in a slightly more varus and internally rotated position, than in mechanical alignment. However, the biomechanics of kinematically aligned TKA remain largely unknown. The aim of this study was to compare the kinematics and contact stresses of mechanically and kinematically aligned TKAs. Methods: A musculoskeletal computer simulation was used to determine the effects of mechanically or kinematically aligned TKA. Knee kinematics were examined for mechanically aligned, kinematically aligned, and kinematically aligned outlier models. Patellofemoral and tibiofemoral contact forces were measured using finite element analysis. Results: Greater femoral rollback and more external rotation of the femoral component were observed with kinematically aligned TKA than mechanically aligned TKA. However, patellofemoral and tibiofemoral contact stresses were increased in kinematically aligned TKA. Conclusions: These findings suggest that kinematically aligned TKA produces near-normal knee kinematics, but that concerns for long-term outcome might arise because of high contact stresses. (C) 2015 Elsevier B.V. All rights reserved.