Effect of component mal-rotation on knee loading in total knee arthroplasty using multi-body dynamics modeling under a simulated walking gait

Mal-rotation of the components in total knee arthorplasty (TKA) is a major cause of postoperative complications, with an increased propensity for implant loosening or wear leading to revision. A musculoskeletal multi-body dynamics model was used to perform a parametric study of the effects of the rotational mal-alignments in TKA on the knee loading under a simulated walking gait. The knee contact forces were found to be more sensitive to variations in the varus-valgus rotation of both the tibial and the femoral components and the internal-external rotation of the femoral component in TKA. The varus-valgus mal-rotation of the tibial or femoral component and the internal-external mal-rotation of the femoral component with a 5° variation were found to affect the peak medial contact force by 17.8-53.1%, the peak lateral contact force by 35.0-88.4% and the peak total contact force by 5.2-18.7%. Our findings support the clinical observations that a greater than 3° internal mal-rotation of the femoral component may lead to unsatisfactory pain levels and a greater than 3° varus mal-rotation of the tibial component may lead to medial bone collapse. These findings determined the quantitative effects of the mal-rotation of the components in TKA on the contact load. The effect of such mal-rotation of the components of TKA on the kinematics would be further addressed in future studies.