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Three-dimensional limb lengthening after total knee arthroplasty in a simulation study.

Takaaki Ohmori1, Tamon Kabata1, Yoshitomo Kajino1

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Summary

Three-dimensional (3D) analysis reveals that measured-resection total knee arthroplasty (TKA) consistently results in limb lengthening, correlating with improved hip-knee-ankle angle and reduced flexion contracture.

Keywords:
3-dimensional limb lengtheningFlexion contractureHKAsimulation studytotal knee arthroplasty

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Area of Science:

  • Orthopedic surgery
  • Biomechanical engineering
  • Medical imaging

Background:

  • Limb lengthening after total knee arthroplasty (TKA) is a known complication.
  • Previous evaluations relied on two-dimensional (2D) imaging.
  • No studies have utilized three-dimensional (3D) imaging to assess TKA-induced limb lengthening.

Purpose of the Study:

  • To investigate and quantify 3D limb lengthening following TKA.
  • To establish the relationship between TKA and limb length changes using 3D analysis.
  • To determine if limb lengthening correlates with improvements in lower limb alignment and knee function.

Main Methods:

  • Simulated 100 varus knees using 3D templating software.
  • Performed virtual TKA using a measured-resection technique to preserve the native joint line.
  • Analyzed 3D changes in the distance between the femoral head and ankle centers, hip-knee-ankle (HKA) angle, and flexion contracture angle.

Main Results:

  • All simulated TKAs resulted in limb lengthening, averaging 9.4 ± 6.0 mm.
  • Significant positive correlations were found between limb lengthening and improvements in HKA angle (r=0.730) and flexion contracture (r=0.751).
  • A strong correlation (r=0.896) was observed between total limb lengthening and the combined improvement in HKA and flexion contracture.

Conclusions:

  • Measured-resection TKA consistently leads to limb lengthening.
  • Limb lengthening following TKA can be predicted using the formula: 0.58 × (HKA improvement + flexion contracture improvement) mm.
  • This formula provides a useful index for anticipating limb length changes during TKA surgery.