Three-Dimensional Limb Lengthening after Total Knee Arthroplasty in a Simulation Study.

Objectives: Limb lengthening after total knee arthroplasty (TKA) has been reported in some cases, all of which were evaluated using two-dimensional images. To our knowledge, no case has been evaluated using three-dimensional (3D) images. We investigated 3D limb lengthening after TKA.Methods: We simulated 100 varus knees using 3D templating software. Virtual TKA was performed to maintain the original joint line by conducting a measured-resection technique. We examined the relationships of 3D distance between the femoral head center and ankle center before and after TKA, degree of hip-knee-ankle angle (HKA) improvement, and degree of flexion contracture angle improvement.Results: All cases showed limb lengthening (average, 9.46.0mm). The coefficients of correlation with limb lengthening and the degree of HKA improvement and the degree of flexion contracture angle improvement were good (0.730 and 0.751, respectively). The correlation between the degree of total improvement (the degree of HKA improvement+the degree of flexion contracture angle improvement) and limb lengthening was strong (r=0.896).Conclusion: The expected limb lengthening when performing measured-resection TKA is expressed as 0.58x(the degree of HKA improvement+the degree of flexion contracture angle improvement) mm and is a useful index.