{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,1]],"date-time":"2026-06-01T20:37:31Z","timestamp":1780346251255,"version":"3.54.1"},"reference-count":25,"publisher":"Wiley","issue":"6","license":[{"start":{"date-parts":[[2015,3,13]],"date-time":"2015-03-13T00:00:00Z","timestamp":1426204800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2015,3,13]],"date-time":"2015-03-13T00:00:00Z","timestamp":1426204800000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/www.springer.com\/tdm"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Knee surg. sports traumatol. arthrosc."],"published-print":{"date-parts":[[2015,6]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Purpose<\/jats:title><jats:p>To investigate the factors affecting intraoperative kinematics, as measured with a navigation system, and their effect on maximum flexion angles during total knee arthroplasty (TKA).<\/jats:p><\/jats:sec><jats:sec><jats:title>Method<\/jats:title><jats:p>One hundred posterior stabilised (PS) TKAs performed using an image\u2010free navigation system were evaluated. Tibial internal rotation angles at maximum extension, 30\u00b0, 45\u00b0, 60\u00b0, 90\u00b0, and maximum flexion were collected at registration and after implantation. The varus angles from the coronal mechanical axis were also collected. The rotational patterns were divided into four groups to investigate whether flexion contracture and varus deformity affected the kinematic patterns, and correlated with the maximum pre\u2010 and post\u2010operative flexion angles.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>At registration, the flexion angles at maximum extension differed significantly between the kinematic groups; the flexion angle at maximum extension at registration was negatively correlated with the pre\u2010operative maximum flexion angle (<jats:italic>R<\/jats:italic><jats:sup>2<\/jats:sup> = 0.226, <jats:italic>p<\/jats:italic> &lt; 0.0001) and the post\u2010operative maximum flexion angle (<jats:italic>R<\/jats:italic><jats:sup>2<\/jats:sup> = 0.059, <jats:italic>p<\/jats:italic> = 0.0167). Varus deformity at registration also differed significantly between the kinematic groups; varus deformity at registration was negatively correlated with the pre\u2010operative maximum flexion angle (<jats:italic>R<\/jats:italic><jats:sup>2<\/jats:sup> = 0.087, <jats:italic>p<\/jats:italic> = 0.0036) and post\u2010operative maximum flexion angle (<jats:italic>R<\/jats:italic><jats:sup>2<\/jats:sup> = 0.101, <jats:italic>p<\/jats:italic> = 0.0027).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Navigation\u2010based measurements in patients undergoing PS TKA indicated that pre\u2010operative flexion contracture and varus deformity are negatively correlated with both pre\u2010 and post\u2010operative maximum flexion angles. The results may improve the ease with which surgeons can interpret intraoperative kinematics, by providing a multi\u2010dimensional perspective. With further knowledge regarding intraoperative kinematics, it might be possible to improve surgical approach, prosthesis design, and clinical outcomes.<\/jats:p><\/jats:sec><jats:sec><jats:title>Level of evidence<\/jats:title><jats:p>II.<\/jats:p><\/jats:sec>","DOI":"10.1007\/s00167-015-3572-1","type":"journal-article","created":{"date-parts":[[2015,3,12]],"date-time":"2015-03-12T05:37:22Z","timestamp":1426138642000},"page":"1741-1747","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":17,"title":["Factors affecting intraoperative kinematic patterns and flexion angles in navigated total knee arthroplasty"],"prefix":"10.1002","volume":"23","author":[{"given":"Kazunari","family":"Ishida","sequence":"first","affiliation":[{"name":"Department of Orthopaedic Surgery Kobe Kaisei Hospital 3\u201011\u201015, Shinohara\u2010Kita, Nada 657\u20100068 Kobe 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