Navigation-based femorotibial rotation pattern correlated with flexion angle after total knee arthroplasty

To investigate whether intraoperative kinematics obtained by navigation systems can be divided into several kinematic patterns and to assess the correlation between the intraoperative kinematics with maximum flexion angles before and after total knee arthroplasty (TKA). Fifty-four posterior-stabilised (PS) TKA implanted using an image-free navigation system were evaluated. At registration and after implantation, tibial internal rotation angles at maximum extension, 30A degrees, 45A degrees, 60A degrees, 90A degrees, and maximum flexion were collected. The rotational patterns were divided into four groups and were examined the correlation with maximum flexion before and after operation. Tibial internal rotation from 90A degrees of flexion to maximum flexion at registration was correlated with maximum flexion angles pre- and postoperatively. The four groups showed statistically different kinematic patterns. The group with tibial external rotation up to 90A degrees of flexion, following tibial internal rotation at registration, achieved better flexion angles, compared to those of another groups (126.7A degrees A A +/- A 12.0A degrees, p < 0.05). The group with tibial external rotation showed the worst flexion angles (80.0A degrees A A +/- A 40.4A degrees, p < 0.05). Furthermore, the group with limited extension showed worse flexion angles (111.6A degrees A A +/- A 8.9A degrees, p < 0.05). Navigation-based kinematic patterns found at registration predict postoperative maximum flexion angle in PS TKA. Navigation-based kinematics can be useful information during TKA surgery. Diagnostic studies, development of diagnostic criteria in a consecutive series of patients and a universally applied "gold" standard, Level II.