Cardiff University | Prifysgol Caerdydd ORCA
Online Research @ Cardiff 
WelshClear Cookie - decide language by browser settings

The relationship between alignment, function and loading in total knee replacement: In-vivo analysis of a unique patient population

Williams, David ORCID:, Metcalfe, Andrew, Madete, June, Whatling, Gemma ORCID:, Kempshall, Peter, Forster, Mark, Lyons, Kathleen and Holt, Cathy ORCID: 2020. The relationship between alignment, function and loading in total knee replacement: In-vivo analysis of a unique patient population. Journal of Biomechanics 112 , 110042. 10.1016/j.jbiomech.2020.110042

[thumbnail of 1-s2.0-S0021929020304668-main.pdf]
PDF - Published Version
Available under License Creative Commons Attribution.

Download (2MB) | Preview


The purpose of this study was to quantify the effect of total knee replacement (TKR) alignment on in-vivo knee function and loading in a unique patient cohort who have been identified as having a high rate of component mal-alignment. Post-TKR (82.4 ± 6.7 months), gait analysis was performed on 25 patients (27 knees), to calculate knee kinematics and kinetics. For a step activity, video fluoroscopic analysis quantified in-vivo implant kinematics. Frontal plane lower-limb alignment was defined by the Hip-Knee-Ankle angle (HKA) measured on long leg static X-rays. Transverse plane component rotation was calculated from computed tomography scans. Sagittal plane alignment was defined by measuring the flexion angle of the femoral component and the posterior tibial slope angle (PTSA). For gait analysis, a more varus HKA correlated with increased peak and dynamic joint kinetics, predicting 47.6% of Knee Adduction Angular Impulse variance. For the step activity, during step-up and single leg loaded, higher PTSA correlated with a posterior shift in medial compartment Anterior-Posterior (AP) translation. During step-down, higher PTSA correlated with reduced lateral compartment AP translation with a posterior shift in AP translation in both compartments. A more varus HKA correlated with a more posterior medial AP translation and inter-component rotation was related to transverse plan range of motion. This in-vivo study found that frontal plane lower-limb alignment had a significant effect on joint forces during gait but had minimal influence on in-vivo implant kinematics for step activity. PTSA was found to influence in-vivo TKR translations and is therefore an important surgical factor.

Item Type: Article
Date Type: Publication
Status: Published
Schools: Engineering
Subjects: R Medicine > RD Surgery
T Technology > TA Engineering (General). Civil engineering (General)
T Technology > TJ Mechanical engineering and machinery
Additional Information: This is an open access article under the terms of the CC-BY Attribution 4.0 International license.
Publisher: Elsevier
ISSN: 0021-9290
Funders: Orthopaedic Research UK, Versus Arthritis
Date of First Compliant Deposit: 15 October 2020
Date of Acceptance: 1 September 2020
Last Modified: 05 May 2023 19:19

Citation Data

Cited 3 times in Scopus. View in Scopus. Powered By Scopus® Data

Actions (repository staff only)

Edit Item Edit Item


Downloads per month over past year

View more statistics