Bi-cruciate stabilized total knee arthroplasty can reduce the risk of knee instability associated with posterior tibial slope

作者：Hada Masaru; Mizu uchi Hideki^*; Okazaki Ken; Kaneko Takao; Murakami Koji; Ma Yuan; Hamai Satoshi; Nakashima Yasuharu

来源：Knee Surgery, Sports Traumatology, Arthroscopy, 2018, 26(6): 1709-1716.

DOI：10.1007/s00167-017-4718-0

• Total knee arthroplasty
• Posterior tibial slope
• Knee instability
• Computer simulation
• Bi-cruciate stabilized type

The purpose of this study was to evaluate the relationship between posterior tibial slope and knee kinematics in bi-cruciate stabilized (BCS) total knee arthroplasty (TKA), which has not been previously reported.
This computer simulation study evaluated Journey 2 BCS components (Smith & Nephew, Inc., Memphis, TN, USA) implanted in a female patient to simulate weight-bearing stair climbing. Knee kinematics, patellofemoral contact forces, and quadriceps forces during stair climbing (from 86A degrees to 6A degrees of flexion) were computed in the simulation. Six different posterior tibial slope angles (0A degrees-10A degrees) were simulated to evaluate the effect of posterior tibial slope on knee kinematics and forces.
At 65A degrees of knee flexion, no anterior sliding of the tibial component occurred if the posterior tibial slope was less than 10A degrees. Anterior contact between the anterior aspect of the tibial post- and the femoral component was observed if the posterior tibial slope was 6A degrees or more. An increase of 10A degrees in posterior tibial slope (relative to 0A degrees) led to a 4.8% decrease in maximum patellofemoral contact force and a 1.2% decrease in maximum quadriceps force.
BCS TKA has a wide acceptable range of posterior tibial slope for avoiding knee instability if the posterior tibial slope is less than 10A degrees. Surgeons should prioritize avoiding adverse effects over trying to achieve positive effects such as decreasing patellofemoral contact force and quadriceps force by increasing posterior tibial slope. Our study helps surgeons determine the optimal posterior tibial slope during surgery with BCS TKA; posterior tibial slope should not exceed 10A degrees in routine clinical practice.

• 出版日期2018-6