Relationship between intraoperative knee kinematics assessed by navigation system and patient-reported outcomes of bicruciate-stabilized total knee arthroplasty.

Abstract

This study aimed to determine the relationship between intraoperative kinematics using a navigation system and clinical outcomes of bicruciate-stabilized total knee arthroplasty (BCS-TKA). The study tested the hypothesis that reproducing native knee kinematics would result in favorable clinical outcomes. The cohort included 67 knees in 57 patients who underwent BCS-TKA using a navigation system, which automatically recorded tibial rotation angle to the femur from 0° to 120° of passive knee flexion. Patient-reported outcomes were assessed preoperatively and 1 year postoperatively using the 2011 Knee Society Score (KSS). Correlations among KSS subjective domains were assessed using Spearman's correlation coefficient. Based on the 1-year postoperative Symptom score, the patients were divided into a lowest-quartile group and an other-quartiles group. The Mann-Whitney U test was used to evaluate differences between the groups. Tibial rotational kinematics after BCS-TKA showed internal rotation in early knee flexion and gradual internal rotation during deep knee flexion with slight external rotation in mid-flexion. Significant differences were found between pre- and 1-year postoperative subjective domain scores. At 1 year postoperatively, Symptom score correlated with Satisfaction (r = 0.5, P < 0.001) and Functional activities (r = 0.4, P < 0.001). Tibial rotational kinematics showed significantly less tibial internal rotation during early knee flexion (0-30°) in the lowest quartile group. Intraoperative tibial internal rotation during early knee flexion may influence postoperative symptom severity after BCS-TKA. Future research should assess the impact of intraoperative adjustments on tibial rotation and postoperative symptoms.