Component alignment cannot fully explain total knee arthroplasty [TKA] performance with regards to patient reported outcomes and pain. Patient specific variations in musculoskeletal anatomy are one explanation for this. Computational simulations allow for the impact of component alignment and variable patient specific musculoskeletal anatomy on dynamics to be studied across populations. This study aims to determine if simulated dynamics correlate with Patient Reported Outcomes.

Landmarking of key anatomical points and 3D registration of implants was performed on 96 segmented post-operative CT scans of TKAs. A cadaver rig validated platform for generating patient specific rigid body musculoskeletal models was used to assess the resultant motions. Resultant dynamics were segmented and tested for differentiation with and correlation to a 6 month postoperative Knee injury and Osteoarthritis Outcome Score (KOOS).

Significant negative correlations were found between the postoperative KOOS symptoms score and the rollback occurring in midflexion (p<0.001), quadriceps force in mid flexion (p=0.025) and patella tilt throughout flexion (p=0.009, p=0.005, p=0.010 at 10°, 45° and 90° of flexion). A significant positive correlation was found between lateral shift of the patella through flexion and the symptoms score. (p=0.012) Combining a varus/valgus angular change from extension to full flexion between 0° and 4° (long leg axis) and measured rollback of no more than 6mm without roll forward forms a ‘kinematic safe zone’ of outcomes in which the postoperative KOOS score is 11.5 points higher (p=0.013).

The study showed statistically significant correlations between kinematic factors in a simulation of postoperative TKR and post-operative KOOS scores. The presence of a ‘kinematic safe zone’ in the data suggests a patient specific optimisation target for any given individual patient and the opportunity to preoperatively determine a patient specific alignment target.