Influence of limb alignment on mediolateral loading in total knee replacement: in vivo measurements in five patients

Malalignment after total knee replacement could cause overloading of the implant bearing as well as of the bone itself, leading to osteolysis and early loosening. To quantify the stresses the implant has to withstand and to define a safe zone of limb alignment, the total contact forces as well as their mediolateral distribution have to be determined. Analytical gait data and mathematical models have been used for this purpose. We performed this study to determine in vivo loads of five patients after implantation of an instrumented tibial baseplate.

Five patients with osteoarthritis of the knee received total knee replacement. The tibial component was instrumented with strain gauges for the measurement of three forces and three moments. The signals from the gauges were transferred telemetrically to an external receiver. At twelve months after surgery, postoperative measurements were obtained with the patients walking at a self-selected comfortable speed across a level walkway. Peak axial and medial forces of fifteen to twenty gait cycles were averaged and reported as a percent of individual body weight.

During the stance phase of the gait cycle, two maxima of the axial force occurred. Typical values were 215% of body weight at the first peak and 266% of body weight at the second peak. The medial load share was typically 73% at the first axial force peak and 65% at the second axial force peak. Analysis of inter-individual variations revealed a linear correlation with limb alignment. A deviation of 1° varus from neutral alignment increased the medial load share by 5%.

Consistent with the results of previous studies, we found that the force transferred by the medial compartment was usually greater than that transferred by the lateral compartment. Concerning the design of total knee replacements, an asymmetric tibial component with a larger medial contact area could possibly reduce peak contact stress on the bone and improve fixation of the implant. Mediolateral load distribution was quantified and correlated with limb alignment, thereby permitting the effects of malalignment after total knee replacement to be estimated.