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Session: Poster session 2 (Odd numbers)
Session starts: Friday 27 January, 10:00
Presentation starts: 10:00

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Dionne Brandsma (University of Twente)
Periklis Tzanetis (University of Twente)
René Fluit (University of Groningen)
Bart Koopman (University of Twente)
Nico Verdonschot (University of Twente; Radboud University Medical Center)

Abstract:
Pre-operative knee flexion contracture in patients undergoing total knee arthroplasty (TKA) is a risk factor for post-operative flexion contracture associated with undesirable surgical outcomes such as restricted range of motion and knee instability [1]. Osteophyte formation [2] and changes in the posterior tibial slope (PTS) [3] in osteoarthritic knees may contribute to flexion contracture. However, the effects of these morphological changes are not well understood. The aim of this study is to investigate the effect of PTS on the tibiofemoral joint kinematics and ligament and muscle forces using a musculoskeletal modeling approach. A patient-specific musculoskeletal knee model will be developed using a previously established framework [4] to represent the pre-operative knee comprising the osteophytic femoral and tibial bones. The PTS will be the only varying parameter in the model, while all other variables, such as the muscle and ligament attachment sites and their slack lengths will remain unchanged throughout the entire study. The PTS in the pre-operative knee will be determined based on anatomical landmarks located at the proximal tibia. The PTS will be varied from -9° up to 3° with increments of 3° compared to the baseline by rotating the tibial plateau in the sagittal plane of the patient-specific anatomical frame. We will capture the effect of PTS on the tibiofemoral joint kinematics, ligament and muscle forces during an unloaded knee extension simulation from 60° to 0°. Differences in the simulated outcomes will be quantified using the root-mean-square deviation and Pearson’s correlation coefficient. This study aims to provide a better understanding of the impact of changes in bone morphology on the pre-operative flexion contracture in osteoarthritic knees using patient-specific musculoskeletal modeling. The outcomes of this study could be valuable in the pre-operative planning of TKA and may assist surgeons to optimize their surgical decision-making approach to correcting flexion contracture. 1. Su, J Bone Joint Surg Br, 94:112–5, 2012. 2. Leie et al, J Orthop, 19:76–83, 2020. 3. Mochizuki et al, PLoS One, 13:e0202488, 2018. 4. Marra et al, J Biomech Eng, 137:020904, 2015.