{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,4]],"date-time":"2026-07-04T15:27:50Z","timestamp":1783178870020,"version":"3.54.6"},"reference-count":23,"publisher":"Wiley","issue":"9","license":[{"start":{"date-parts":[[2023,3,22]],"date-time":"2023-03-22T00:00:00Z","timestamp":1679443200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2023,3,22]],"date-time":"2023-03-22T00:00:00Z","timestamp":1679443200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/www.springernature.com\/gp\/researchers\/text-and-data-mining"},{"start":{"date-parts":[[2023,3,22]],"date-time":"2023-03-22T00:00:00Z","timestamp":1679443200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/www.springernature.com\/gp\/researchers\/text-and-data-mining"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Knee surg. sports traumatol. arthrosc."],"published-print":{"date-parts":[[2023,9]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Purpose<\/jats:title><jats:p>The purpose of this study was to investigate the position of the femur relative to the tibia throughout range of motion in the osteoarthritic knee to evaluate knee kinematics and assess its relationship with the degree of varus deformity.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>In this study, 116 preoperative knees with varus deformity were evaluated using a navigation system. The internal\u2013external, anteroposterior, and mediolateral positions of the femur relative to the tibia were measured at maximum extension, 15\u00b0, 30\u00b0, 45\u00b0, 60\u00b0, 90\u00b0, 105\u00b0, and 120\u00b0, and maximum flexion angles. From these parameters, two\u2010dimensional translation of the surgical epicondylar axis was projected onto the tibial axial plane, and the femoral movement was evaluated relative to the tibia. In addition, the knees were retrospectively classified into three groups according to their degrees of preoperative hip\u2013knee\u2013ankle angle: mild (&lt;\u200910\u00b0), moderate (10\u00b0\u201320\u00b0), and severe (&gt;\u200920\u00b0). Then, the differences in each parameter between these groups were investigated. The Steel\u2013Dwass test was performed to identify the difference among three groups. Statistical significance was set at <jats:italic>p<\/jats:italic> values\u2009&lt;\u20090.05.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>There was a significant difference in the anteroposterior position of the femur relative to the tibia among the three groups, especially from extension to early flexion (<jats:italic>p<\/jats:italic>\u2009&lt;\u20090.05). The anteroposterior position at knee extension deviated posteriorly according to the progression of varus deformity. Rotational and mediolateral translation were not significantly different among the groups. Normal knee kinematics were diminished in almost all cases in each group. In addition, anterior paradoxical motion of the femur during early knee flexion was observed in 45.6% (<jats:italic>n<\/jats:italic>\u2009=\u200926), 57.1% (<jats:italic>n<\/jats:italic>\u2009=\u200928), and 80.0% (<jats:italic>n<\/jats:italic>\u2009=\u20098) of cases in the mild, moderate, and severe groups, respectively. The anteroposterior position of the femur relative to the tibia at knee extension was significantly more posterior in patients with than in those without anterior paradoxical motion (<jats:italic>p<\/jats:italic>\u2009&lt;\u20090.0001).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>The anteroposterior position of the femur relative to the tibia changed according to the progression of varus deformity in osteoarthritic knees, especially from knee extension to early flexion. Posterior deviation of the femur at knee extension induced its anteroposterior movement relative to the tibia, resulting in anterior paradoxical motion.<\/jats:p><\/jats:sec><jats:sec><jats:title>Level of evidence<\/jats:title><jats:p>III.<\/jats:p><\/jats:sec>","DOI":"10.1007\/s00167-023-07363-6","type":"journal-article","created":{"date-parts":[[2023,3,22]],"date-time":"2023-03-22T04:02:36Z","timestamp":1679457756000},"page":"3898-3905","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":8,"title":["Progression of varus deformity in osteoarthritic knees induces anterior paradoxical motion of the femur during early knee flexion"],"prefix":"10.1002","volume":"31","author":[{"given":"Tomofumi","family":"Kinoshita","sequence":"first","affiliation":[{"name":"<!--<label>1<\/label>--> Department of Orthopedic Surgery Ehime University Graduate School of Medicine Shitsukawa 791\u20100295 Toon Ehime Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3601-639X","authenticated-orcid":false,"given":"Kazunori","family":"Hino","sequence":"additional","affiliation":[{"name":"<!--<label>1<\/label>--> Department of Orthopedic Surgery Ehime University Graduate School of Medicine Shitsukawa 791\u20100295 Toon Ehime Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tatsuhiko","family":"Kutsuna","sequence":"additional","affiliation":[{"name":"<!--<label>1<\/label>--> Department of Orthopedic Surgery Ehime University Graduate School of Medicine Shitsukawa 791\u20100295 Toon Ehime Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kunihiko","family":"Watamori","sequence":"additional","affiliation":[{"name":"<!--<label>1<\/label>--> Department of Orthopedic Surgery Ehime University Graduate School of Medicine Shitsukawa 791\u20100295 Toon Ehime Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Takashi","family":"Tsuda","sequence":"additional","affiliation":[{"name":"<!--<label>1<\/label>--> Department of Orthopedic Surgery Ehime University Graduate School of Medicine Shitsukawa 791\u20100295 Toon Ehime Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Masaki","family":"Takao","sequence":"additional","affiliation":[{"name":"<!--<label>1<\/label>--> Department of Orthopedic Surgery Ehime University Graduate School of Medicine Shitsukawa 791\u20100295 Toon Ehime Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2023,3,22]]},"reference":[{"key":"e_1_2_8_2_2","doi-asserted-by":"publisher","DOI":"10.1097\/01.blo.0000138956.04316.ac"},{"key":"e_1_2_8_3_2","doi-asserted-by":"publisher","DOI":"10.1002\/art.10573"},{"key":"e_1_2_8_4_2","doi-asserted-by":"publisher","DOI":"10.1097\/00003086\u2010199811000\u201000009"},{"key":"e_1_2_8_5_2","doi-asserted-by":"publisher","DOI":"10.1097\/01.blo.0000092986.12414.b5"},{"key":"e_1_2_8_6_2","doi-asserted-by":"publisher","DOI":"10.1002\/jor.24613"},{"key":"e_1_2_8_7_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.arth.2014.12.027"},{"key":"e_1_2_8_8_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.knee.2015.11.015"},{"key":"e_1_2_8_9_2","unstructured":"KakoulidisP PanagiotidouS ProfitiliotisG PapavasiliouK TsiridisE TopalisCMedial pivot design does not yield superior results compared to posterior\u2010stabilised total knee arthroplasty: a 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November 2022","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"22 February 2023","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"22 March 2023","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"Kazunori Hino received research support from Teijin Nakashima Medical. The research was performed at Ehime University Graduate School of Medicine.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Conflict of interest"}},{"value":"This study did not receive any funding from external sources.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Funding"}},{"value":"This study was approved by the institutional review board of Ehime University (Identification Number: 1411020).","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethical approval"}},{"value":"All patients provided written informed consent.","order":5,"name":"Ethics","group":{"name":"EthicsHeading","label":"Informed consent"}}]}}