Does Posterior Tibial Slope Influence Knee Kinematics in Medial Stabilized TKA?

Background: During total knee arthroplasty (TKA), one of the key alignment factors to pay attention to is the posterior tibial slope (PTS). The PTS clearly influences the kinematics of the knee joint but must be adapted to the coupling degree of the specific TKA design. So far, there is hardly any literature including clear recommendations for how surgeons should choose the PTS in a medial stabilized (MS) TKA. The aim of the present study is to investigate the effects of different degrees of PTS on femorotibial kinematics in MS TKA. Materials and Methods: An MS TKA was performed in seven fresh-frozen human specimens successively with 0 degrees, 3 degrees, and 6 degrees of PTS. After each modification, weight-bearing deep knee flexion (30-130 degrees) was performed, and femorotibial kinematics were analyzed. Results: A lateral femoral rollback was observed for all three PTS modifications. With an increasing PTS, the tibia was shifted more anteriorly on the lateral side (0 degrees PTS anterior tibial translation -9.09 (+/- 9.19) mm, 3 degrees PTS anterior tibial translation -11.03 (+/- 6.72) mm, 6 degrees PTS anterior tibial translation 11.86 (+/- 9.35) mm). No difference in the tibial rotation was found for the different PTS variants. All PTS variants resulted in internal rotation of the tibia during flexion. With a 3 degrees PTS, the design-specific medial rotation point was achieved more accurately. Conclusions: According to our findings, we recommend a PTS of 3 degrees when implanting the MS prosthesis used in this study.