Influence of tibial component posterior slope on in vivo knee kinematics in fixed-bearing total knee arthroplasty

The relation between prosthesis component kinematics and posterior slope of the tibial component in total knee arthroplasty is much debated. Three-dimensional kinematics of the replaced knee was obtained by video fluoroscopy in 23 knees treated by cruciate-retaining or cruciate-substituting arthroplasty. Relative position and orientation of the metal components were calculated in stair ascending, getting up from and sitting down on a chair, and single step up-and-down. Significant correlations were found between tibial component posterior slope and anteroposterior position of tibiofemoral lateral contact and between this slope and maximum knee flexion. These correlations were task and design specific. However, the average of the tibiofemoral contact positions over all three motor tasks was slightly posterior to the midline of the tibial base plate, reaching at most 84% of its anteroposterior dimension. Performing a posterior slope of the tibial cut does not put total knee arthroplasty with high conforming designs at higher risk of failure, even when large posterior inclinations need to be achieved