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Tiefenboeck S, Sesselmann S, Taylor D, Forst R, Seehaus F. Preoperative planning of total knee arthroplasty: reliability of axial alignment using a three-dimensional planning approach. Acta Radiol 2021; 63:1051-1061. [PMID: 34229468 DOI: 10.1177/02841851211029076] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Preoperative templating of total knee arthroplasty (TKA) can nowadays be performed three-dimensionally with software solutions using computed tomography (CT) datasets. Currently there is no consensus concerning the axial orientation of TKA components in three-dimensional (3D) planning. PURPOSE To assess intra-/inter-observer reliability of detection of different bony landmarks in planning axial component alignment using axial CT images and 3D reconstructions. MATERIAL AND METHODS Intra- and inter-observer reliability of determination of four predefined axial femoral and tibial axes was calculated using data from CT scans. Axes determination was performed on the axial slices and on the 3D reconstruction using preoperative planning software. In summary, 61 datasets were analyzed by one medical student (intra-observer reliability) and 15 datasets were analyzed by four different observers independently (inter-observer reliability). RESULTS For the femur, clinical epicondylar axis and posterior condylar axis showed the best reliability with an inter-observer variability of 0.7° and 0.5°, respectively. For the tibia, posterior condylar axis provided best reliability (inter-observer variability: 1.7°). Overall variability was greater for tibial than for femoral axes. Reliability of axis determination was more accurate using axial CT slices rather than 3D reconstructions. CONCLUSION The femoral clinical epicondylar axis is highly reliable. Landmarks for the tibia are not as easily identifiable as for the femur. The tibial posterior condylar axis presents the axis with highest reliability. Based on these results, clinical epicondylar axis for orientation of the femoral TKA component and posterior condylar axis for the tibial implant, both defined on axial slices can be recommended.
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Affiliation(s)
- Stefan Tiefenboeck
- Department of Orthopaedic Surgery, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Stefan Sesselmann
- Institute for Medical Engineering, Ostbayerische Technische Hochschule Amberg-Weiden, Weiden, Germany
| | - Dominic Taylor
- Department of Orthopaedic Surgery, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Raimund Forst
- Department of Orthopaedic Surgery, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Frank Seehaus
- Department of Orthopaedic Surgery, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
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Ismailidis P, Kremo V, Mündermann A, Müller-Gerbl M, Nowakowski AM. Total knee arthroplasty: posterior tibial slope influences the size but not the rotational alignment of the tibial component. Knee Surg Sports Traumatol Arthrosc 2020; 28:3899-3905. [PMID: 32030500 DOI: 10.1007/s00167-020-05875-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2019] [Accepted: 01/21/2020] [Indexed: 11/28/2022]
Abstract
PURPOSE The reasons leading to rotational tibial malalignment in total knee arthroplasties (TKAs) remain unclear. A previous cadaver study has shown an increase in internal rotation of the anatomical tibial axis (ATA) after the tibial cut. This study investigates the influence of tibial slope on the ATA and the size of the resected tibial surface. METHODS CT scans of 20 cadaver knees were orientated in a standardized coordinate system and used to determine the position of the centres of rotation of the medial and lateral tibial articular surfaces and, hence, of the ATA, after a virtual resection of 6 mm with 0°, 3.5°, 7° and 10° slope, respectively. Furthermore, at each slope, the radii of the medial and lateral tibial articular surfaces after resection were calculated. RESULTS Compared to resection of 6 mm with 0° slope, a slope of 3.5° resulted in a mean external rotation of the ATA of 0.9° (SD, 1.5°; P = 0.025). A slope of 7° resulted in a mean external rotation of the ATA of 1.0° (SD 2.0°; P = 0.030) and a slope of 10° had no influence on the rotation of the ATA. The radii of the medial and lateral articular surfaces of the cut tibiae were larger than those of the uncut tibia (P < 0.001). CONCLUSION Differences in the posterior tibial slope should not contribute to a rotational malalignment when using the ATA to align the prosthetic tibial plateau. Although statistically significant, the change in ATA with increasing slope was negligible.
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Affiliation(s)
- Petros Ismailidis
- Department of Orthopaedics and Traumatology, University Hospital of Basel, Spitalstrasse 21, 4031, Basel, Switzerland. .,Department of Clinical Research, University of Basel, Schanzenstrasse 55, 4056, Basel, Switzerland. .,Department of Biomedical Engineering, University of Basel, Gewerbestrasse 14, 4123, Allschwil, Switzerland.
| | - Valerie Kremo
- Department of Biomedicine, University of Basel, Pestalozzistrasse 20, 4056, Basel, Switzerland
| | - Annegret Mündermann
- Department of Orthopaedics and Traumatology, University Hospital of Basel, Spitalstrasse 21, 4031, Basel, Switzerland.,Department of Clinical Research, University of Basel, Schanzenstrasse 55, 4056, Basel, Switzerland.,Department of Biomedical Engineering, University of Basel, Gewerbestrasse 14, 4123, Allschwil, Switzerland
| | - Magdalena Müller-Gerbl
- Department of Biomedicine, University of Basel, Pestalozzistrasse 20, 4056, Basel, Switzerland
| | - Andrej Maria Nowakowski
- Department of Biomedicine, University of Basel, Pestalozzistrasse 20, 4056, Basel, Switzerland.,Department of Orthopaedics and Traumatology, Hospital of Uster, Brunnenstrasse 42, Postfach, 8610, Uster, Switzerland
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Liu X, Guo S, Li S, Cao Y, Xiang C. [Progress in the method of tibial prosthesis rotation alignment in total knee arthroplasty]. ZHONGGUO XIU FU CHONG JIAN WAI KE ZA ZHI = ZHONGGUO XIUFU CHONGJIAN WAIKE ZAZHI = CHINESE JOURNAL OF REPARATIVE AND RECONSTRUCTIVE SURGERY 2020; 34:1200-1204. [PMID: 32929917 DOI: 10.7507/1002-1892.201911058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Objective To summarize the methods of tibial prosthesis rotation alignment in total knee arthroplasty, and provide reference for clinicians to select and further study the methods of tibial prosthesis rotation alignment. Methods The advantages and disadvantages of various tibial prosthesis rotation alignment methods were analyzed and summarized by referring to the relevant literature at home and abroad in recent years. Results There are many methods for tibial prosthesis rotation alignment, including reference to relevant anatomical landmarks, range of motion (ROM) technique, computer-assisted navigation, and personalized osteotomy. The inner one-third of the tibial tuberosity is a more accurate reference anatomical landmark, but the obesity, severe knee deformity and dysplasia have impacts on the precise placement of the tibial prosthesis. ROM technique do not need to refer to the anatomical landmark of the tibia, and aren't affected by landmark variation. It can be used for severe knee valgus deformity and the landmarks that are difficult to identify. However, it may cause internal rotation of tibial prosthesis. Computer- assisted navigation and personalized osteotomy can achieve more accurate alignment in sagittal, coronal, and rotational alignment of femoral prosthesis. However, due to the lack of reliable anatomical landmarkers related to tibia fixation, it is still controversial whether it can help the alignment of tibial prosthesis rotation. Conclusion The surgeon should master the methods of rotation and alignment of tibial prosthesis, make preoperative plans, select appropriate alignment methods for different patients, and achieve individualization. Meanwhile, several anatomical landmarkers should be referred to properly during the operation, which can be used to detect the correct placement of tibial prosthesis and avoid large rotation error.
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Affiliation(s)
- Xin Liu
- Department of Orthopedics, the Second Affiliated Hospital of Shanxi Medical University, Taiyuan Shanxi, 030001, P.R.China
| | - Shengjie Guo
- Department of Orthopedics, the Second Affiliated Hospital of Shanxi Medical University, Taiyuan Shanxi, 030001, P.R.China
| | - Shuaijie Li
- Department of Orthopedics, the Second Affiliated Hospital of Shanxi Medical University, Taiyuan Shanxi, 030001, P.R.China
| | - Yanwei Cao
- Department of Orthopedics, the Second Affiliated Hospital of Shanxi Medical University, Taiyuan Shanxi, 030001, P.R.China
| | - Chuan Xiang
- Department of Orthopedics, the Second Affiliated Hospital of Shanxi Medical University, Taiyuan Shanxi, 030001, P.R.China
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Kawaguchi K, Inui H, Taketomi S, Yamagami R, Nakazato K, Tanaka S. Intraoperative Tibial Anteroposterior Axis Could Not Be Replicated After Tibial Osteotomy in Total Knee Arthroplasty. J Arthroplasty 2019; 34:2371-2375. [PMID: 31253450 DOI: 10.1016/j.arth.2019.05.058] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2019] [Revised: 05/14/2019] [Accepted: 05/29/2019] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND We evaluated the effect of the anteroposterior (AP) axis of the proximal tibia defined at the cutting surface using an image-free navigation system in total knee arthroplasty. METHODS This prospective study included 68 patients (79 knees) who underwent total knee arthroplasty. The tibial AP axis was registered in the navigation system with reference to Akagi's line, connecting the middle of the posterior cruciate ligament to the medial border of the patellar tendon attachment at the tibial joint surface. After proximal tibial osteotomy, the AP axis was replicated as the AP(O) axis. We measured the difference between the AP axis defined at the joint surface and the AP(O) axis defined at the osteotomy surface. RESULTS The AP(O) axis at the osteotomy surface internally rotated 2.0° to the AP axis at the joint surface, and the AP(O) axis outlier (difference to AP axis: >3°) occurred in 54% (43 knees). In the >3° malrotation group, internal malrotation occurred in 37% (30 knees) and external malrotation occurred in 17% (13 knees). In the outlier analysis, the left knees were significantly found in the internal outlier group. CONCLUSION The tibial AP axis, connecting the middle of the posterior cruciate ligament to the medial border of the patellar tendon attachment defined at the tibial joint surface, could not be replicated at the tibial osteotomy surface. If the tibial components were set depending only on the AP axis defined at the osteotomy surface, the tibial components could internally rotate and have more outliers, especially in the left knees.
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Affiliation(s)
- Kohei Kawaguchi
- Department of Orthopaedics, Tokyo University Hospital, Bunkyo Ward, Tokyo, Japan
| | - Hiroshi Inui
- Department of Orthopaedics, Tokyo University Hospital, Bunkyo Ward, Tokyo, Japan
| | - Shuji Taketomi
- Department of Orthopaedics, Tokyo University Hospital, Bunkyo Ward, Tokyo, Japan
| | - Ryota Yamagami
- Department of Orthopaedics, Tokyo University Hospital, Bunkyo Ward, Tokyo, Japan
| | - Keiu Nakazato
- Department of Orthopaedics, Tokyo University Hospital, Bunkyo Ward, Tokyo, Japan
| | - Sakae Tanaka
- Department of Orthopaedics, Tokyo University Hospital, Bunkyo Ward, Tokyo, Japan
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Mahmood FF, Holloway NJ, Deakin AH, Clarke JV, Picard F. A new landmark for measuring tibial component rotation after total knee arthroplasty. Knee 2019; 26:779-786. [PMID: 30926225 DOI: 10.1016/j.knee.2018.09.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2017] [Revised: 08/25/2018] [Accepted: 09/01/2018] [Indexed: 02/02/2023]
Abstract
BACKGROUND Existing methods for assessment of total knee arthroplasty (TKA) component rotation on computed tomography (CT) scans are complex, especially in relation to the tibial component. Anecdotal evidence from our practice pointed towards a potential new landmark. The study aims were to check the prevalence of this landmark, define tibial component rotation in relation to it and demonstrate its reliability. METHODS Two hundred and eleven CTs undertaken following TKA were reviewed for presence of the landmark. A protocol to measure tibial component rotation in relation to this landmark was developed and the rotation measured using this method and Berger's protocol. Thirty one of the 211 CT scans were measured twice by two observers. Reliability was calculated using the Intraclass Correlation Coefficient (ICC). RESULTS The new landmark of a flat area on the lateral cortex of the tibia inferior to the tibial component was identified on all scans. Median tibial component rotation measured using our protocol was 0.0° ± 5.4° and -9.2° ± 5.5° using Berger's protocol. Intra-observer reliability with the new method was excellent (ICCs of 0.899 and 0.871) and inter-observer reliability was good (ICCs of 0.734 and 0.836). CONCLUSIONS The new landmark had a very high prevalence and could be used to define tibial component rotation. This measurement of tibial component rotation had acceptable reliability. This landmark has potential for use in the radiological assessment of tibial component rotation following TKA. Further work is required to determine its relationship to anatomical structures and symptoms of tibial component mal-rotation.
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Affiliation(s)
- Fahd F Mahmood
- Department of Orthopaedics, Golden Jubilee National Hospital, Agamemnon Street, Clydebank, West Dunbartonshire G81 4DY, UK
| | - Nicholas J Holloway
- Department of Orthopaedics, Golden Jubilee National Hospital, Agamemnon Street, Clydebank, West Dunbartonshire G81 4DY, UK
| | - Angela H Deakin
- Department of Orthopaedics, Golden Jubilee National Hospital, Agamemnon Street, Clydebank, West Dunbartonshire G81 4DY, UK
| | - Jon V Clarke
- Department of Orthopaedics, Golden Jubilee National Hospital, Agamemnon Street, Clydebank, West Dunbartonshire G81 4DY, UK
| | - Frederic Picard
- Department of Orthopaedics, Golden Jubilee National Hospital, Agamemnon Street, Clydebank, West Dunbartonshire G81 4DY, UK.
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Ohmori T, Kabata T, Kajino Y, Inoue D, Taga T, Yamamoto T, Takagi T, Yoshitani J, Ueno T, Ueoka K, Tsuchiya H. A proposed new rotating reference axis for the tibial component after proximal tibial resection in total knee arthroplasty. PLoS One 2018; 13:e0209317. [PMID: 30571784 PMCID: PMC6301685 DOI: 10.1371/journal.pone.0209317] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2017] [Accepted: 12/04/2018] [Indexed: 11/20/2022] Open
Abstract
Purpose During total knee arthroplasty, few rotating reference axes can be reliably used after tibial resection. We speculated that a line that passes through the lateral edge of the posterior cruciate ligament (PCL) at its tibial attachment after resection and the most prominent point of the tibial tubercle [after-tibial resection (ATR) line] will provide a good reference axis. In this study, we aimed to evaluate the association between ATR and Akagi’s lines. Materials and methods In this case–control simulation study, we retrospectively evaluated 38 patients with varus knee and 28 patients with valgus knee. We defined the reference cutting plane as 10 mm distal from the lateral articular surface of the tibia in varus group and as 7 mm distal from the medial articular surface in the valgus group. We measured angles between Akagi’s line and the ATR line (ATR line angle) as well as between Akagi’s line and 1/3 Akagi’s line (1/3 Akagi’s line angle), which passes through the midpoint of PCL and the medial third of the patellar tendon. We used paired t-tests to determine the significance of differences between these angles, with p < 0.05 indicating statistical significance. Intra- and interclass correlation coefficients for the reproducibility of 1/3 Akagi’s line angle and ATR line angle were analyzed by two surgeons. Results We found that 1/3 Akagi’s line angle was 10.2° ± 1.3° in the varus group and 10.9° ± 1.3° in the valgus group (p = 0.017). The ATR line was positioned externally compared with Akagi’s line in all patients. Mean ATR line angles at 0°, 3° and 7° posterior slopes were 6.1° ± 1.9°, 5.8° ± 2.0° and 6.0° ± 1.7° in the varus group and 6.3° ± 2.3°, 6.2° ± 2.3° and 5.4° ± 2.1° in the valgus group, respectively. There were no significant differences in the ATR line angle between the varus and valgus groups. (p = 0.34–0.67) Intra- and interclass correlation coefficients for the reproducibility of 1/3 Akagi’s line angle were 0.936 and 0.986 and those for the reproducibility of ATR line angle were 0.811 and 0.839. Conclusions The ATR line was positioned between Akagi’s line and 1/3 Akagi’s line in all patients and was a valid option for evaluating rotational tibial alignment after tibial resection.
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Affiliation(s)
- Takaaki Ohmori
- Department of Orthopaedic Surgery, Kanazawa University Hospital Takaramachi13-1 Kanazawa Ishikawa Japan
| | - Tamon Kabata
- Department of Orthopaedic Surgery, Kanazawa University Hospital Takaramachi13-1 Kanazawa Ishikawa Japan
- * E-mail:
| | - Yoshitomo Kajino
- Department of Orthopaedic Surgery, Kanazawa University Hospital Takaramachi13-1 Kanazawa Ishikawa Japan
| | - Daisuke Inoue
- Department of Orthopaedic Surgery, Kanazawa University Hospital Takaramachi13-1 Kanazawa Ishikawa Japan
| | - Tadashi Taga
- Department of Orthopaedic Surgery, Kanazawa University Hospital Takaramachi13-1 Kanazawa Ishikawa Japan
| | - Takashi Yamamoto
- Department of Orthopaedic Surgery, Kanazawa University Hospital Takaramachi13-1 Kanazawa Ishikawa Japan
| | - Tomoharu Takagi
- Department of Orthopaedic Surgery, Kanazawa University Hospital Takaramachi13-1 Kanazawa Ishikawa Japan
| | - Junya Yoshitani
- Department of Orthopaedic Surgery, Kanazawa University Hospital Takaramachi13-1 Kanazawa Ishikawa Japan
| | - Takuro Ueno
- Department of Orthopaedic Surgery, Kanazawa University Hospital Takaramachi13-1 Kanazawa Ishikawa Japan
| | - Ken Ueoka
- Department of Orthopaedic Surgery, Kanazawa University Hospital Takaramachi13-1 Kanazawa Ishikawa Japan
| | - Hiroyuki Tsuchiya
- Department of Orthopaedic Surgery, Kanazawa University Hospital Takaramachi13-1 Kanazawa Ishikawa Japan
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Valkering KP, Tuinebreijer WE, Sunnassee Y, van Geenen RCI. Multiple reference axes should be used to improve tibial component rotational alignment: a meta-analysis. J ISAKOS 2018. [DOI: 10.1136/jisakos-2018-000214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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van Houten AH, Kosse NM, Wessels M, Wymenga AB. Measurement techniques to determine tibial rotation after total knee arthroplasty are less accurate than we think. Knee 2018; 25:663-668. [PMID: 29871786 DOI: 10.1016/j.knee.2018.05.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2018] [Revised: 04/10/2018] [Accepted: 05/08/2018] [Indexed: 02/02/2023]
Abstract
BACKGROUND The present study assessed the inter- and intra-observer reliability of tibial and femoral rotation measures after total knee arthroplasty (TKA), and evaluated the correlation between these measurement techniques and their clinical relevance. METHODS Femoral rotation and tibial rotation were determined on 42 2D CT-scans made three-months after TKA. Reliability of the radiological measurements (including Berger's method, the anatomical tibial axis and the tibial tuberosity trochlear-groove) was assessed with 15 randomly selected patients measured twice by three observers. Functional outcomes were scored one-year postoperatively with the KSS, VAS pain, VAS satisfaction, KOOS, and Kujala. RESULTS The inter- and intra-observer reliability of the rotational measurements ranged from good to excellent (ICC 0.67-0.98). Tibial rotation measured with the Berger technique was most reliable (ICC inter = 0.91; ICC intra = 0.96). No strong correlations were found between the different rotational measures or the clinical outcomes and rotational outliers. CONCLUSIONS Tibial rotation is most reliable measured with the technique described by Berger. There were no strong correlations found between the different tibial rotation measures or between the clinical outcomes and the rotational outliers. Further research is needed to gain more insight into optimal positioning and measuring rotation in TKA for clinical practice.
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Affiliation(s)
- A H van Houten
- Department of Orthopaedic Surgery, Sint Maartenskliniek Nijmegen, The Netherlands.
| | - N M Kosse
- Sint Maartenskliniek Research, Sint Maartenskliniek Nijmegen, The Netherlands
| | - M Wessels
- Department of Radiology, Sint Maartenskliniek Nijmegen, The Netherlands
| | - A B Wymenga
- Department of Orthopaedic Surgery, Sint Maartenskliniek Nijmegen, The Netherlands
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Effects of tibial baseplate shape on rotational alignment in total knee arthroplasty: three-dimensional surgical simulation using osteoarthritis knees. Arch Orthop Trauma Surg 2018; 138:105-114. [PMID: 29075841 DOI: 10.1007/s00402-017-2828-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2017] [Indexed: 10/18/2022]
Abstract
INTRODUCTION Placement of tibial component is expected to fulfill both maximum surface coverage and recommended anterior-posterior (AP) alignment in total knee arthroplasty (TKA). The purpose of this study is to evaluate the effect of the tibial baseplate shape on AP axis. MATERIALS AND METHODS Virtual surgery of TKA was performed with three-dimensional bone models reconstructed from 77 osteoarthritis varus knees. Two differently designed tibial baseplates, symmetrically and anatomically, were set to the cut surface under posterior slopes of 0°, 3°, and 7°. The AP axes were defined by connecting the geometrical center of the cut surface with the medial edge (axis MED) and medial 1/3 (axis 1/3MED) of patella tendon attachment. We evaluated the overhang rates as well as the most fitting AP axis which passes through the geometric center. RESULTS Overhang rates when aligned to axis MED were 12-25% for the symmetrical-type group and 13-22% for the anatomical-type group. Overhang rates when aligned to axis 1/3MED were 42-48% for the symmetrical-type group and 3-7% for the anatomical-type group. The most fitting AP axis of tibial baseplate was located 2.5° external to axis MED for the symmetrical-type group and around 3.3° internal to axis 1/3MED for the anatomical-type group. CONCLUSIONS Symmetrically or anatomically designed tibial baseplates have their own favored AP axis and specific performance on coverage. When aligned to axis 1/3MED, anatomically designed tibial baseplates will effectively lower the mismatch rates compared to a symmetrically designed tibial baseplate. Orthopaedic surgeons are expected to place the tibial components to the cut surface during TKA with full understanding of the features between different baseplate designs, AP axes, and posterior slopes for an ideal tibial rotational position.
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Ushio T, Mizu-Uchi H, Okazaki K, Ma Y, Kuwashima U, Iwamoto Y. The Anteroposterior Axis of the Proximal Tibia Can Change After Tibial Resection in Total Knee Arthroplasty: Computer Simulation Using Asian Osteoarthritis Knees. J Arthroplasty 2017; 32:1006-1012. [PMID: 27776906 DOI: 10.1016/j.arth.2016.09.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2016] [Revised: 08/26/2016] [Accepted: 09/08/2016] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND We evaluated the effect of cutting surface on the anteroposterior (AP) axis of the proximal tibia using a 3-dimensional (3D) bone model to ensure proper tibial rotational alignment in total knee arthroplasty. METHODS 3D bone models were reconstructed from the preoperative computed tomography data of 93 Japanese osteoarthritis knees with varus deformity. The AP axis was defined as the perpendicular bisector of the medial and lateral condylar centers in a 3D coordinate system. Bone cutting of the proximal tibia was performed with various tibial posterior slopes (0°, 3°, 7°) to the mechanical axis, and we compared the AP axes before and after bone cutting. RESULTS The AP axis before bone cutting crossed a point at about 16% (one-sixth) of the distance from the medial edge of the patellar tendon at its tibial attachment. The AP axis after bone cutting was significantly internally rotated at all posterior slopes: 4.1° at slope 0°, 3.0° at slope 3°, and 2.1° at slope 7°. The percentages of cases with differences of more than 3° or 5° were 66.7% and 34.4% at slope 0°, 53.8% and 24.7% at slope 3°, and 38.3% and 11.8% at slope 7°, respectively. CONCLUSION The AP axis of the proximal tibia may be rotated internally after resection of the proximal tibia in total knee arthroplasty. Hence, surgeons should recognize the effect of changes in the cutting surface on rotational alignment of the proximal tibia.
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Affiliation(s)
- Tetsuro Ushio
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, Higashi-ku, Fukuoka, Japan
| | - Hideki Mizu-Uchi
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, Higashi-ku, Fukuoka, Japan
| | - Ken Okazaki
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, Higashi-ku, Fukuoka, Japan
| | - Yuan Ma
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, Higashi-ku, Fukuoka, Japan
| | - Umito Kuwashima
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, Higashi-ku, Fukuoka, Japan
| | - Yukihide Iwamoto
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, Higashi-ku, Fukuoka, Japan
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Risk factors for tibial implant malpositioning in total knee arthrosplasty-consecutive series of one thousand, four hundred and seventeen cases. INTERNATIONAL ORTHOPAEDICS 2016; 41:749-756. [PMID: 27738829 DOI: 10.1007/s00264-016-3307-z] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/22/2016] [Accepted: 09/25/2016] [Indexed: 10/20/2022]
Abstract
PURPOSE Total knee arthroplasty (TKA) malalignment may result in pain and limited range of motion. The present study assessed the influence of different surgeon's and patient's related factors on the post-operative tibial tray coronal alignment. METHODS The charts and the x-rays of a continuous prospective series of 1417 TKAs operated upon between 1987 and 2015 were retrospectively reviewed. The long-leg AP views were performed at two months post-op and the tibial mechanical angle of the tibial tray was measured. Three groups were defined: varus (≤87° n = 167), valgus (≥93° n = 55) and well alignment (88° to 92° n = 1195). The influence of several pre-operative and peri-operative factors was investigated: surgeon handedness and experience (junior or senior), previous tibial osteotomies, Ahlbäck stage of osteoarthritits, pre-operative alignment, height and weight, age at surgery, approach (medial, lateral or tibial tubercle osteotomy), generation of implants, tray fixation, size of the tray and stem lenght. Univariate then multivariate analysis were performed to find out any correlation. RESULTS Multivariate analysis showed a strong correlation between varus alignment of the tibial tray and pre-operative varus of the lower limb (p = 0.037), increased BMI (p = 0.016) and operated side opposite to the dominant surgeon's arm (p = 0.006). In a similar way a strong correlation was found between valgus alignment and pre-operative valgus of the limb (p = 0.026). CONCLUSION Poor alignment of the tibial tray after TKA was associated with pre-operative malalignment of the lower limb, increased BMI and an index knee which was opposite to surgeon's dominant arm.
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Palanisami D, Iyyampillai G, Shanmugam S, Natesan R, S R. Individualised distal femoral cut improves femoral component placement and limb alignment during total knee replacement in knees with moderate and severe varus deformity. INTERNATIONAL ORTHOPAEDICS 2016; 40:2049-2054. [PMID: 26847399 DOI: 10.1007/s00264-016-3123-5] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/28/2015] [Accepted: 01/14/2016] [Indexed: 11/28/2022]
Abstract
AIM Our aim was to determine the variation in valgus correction angle and the influence of individualised distal femoral cut on femoral component placement and limb alignment during total knee replacement (TKR) in knees with varus deformity. MATERIALS AND METHODS The study was done prospectively in two stages. In the first stage, the valgus correction angle (VCA) was calculated in long-limb radiographs of 227 patients and correlated with pre-operative parameters of femoral bowing, neck-shaft angle and hip-knee-ankle angle. In the second part comprising of 240 knees with varus deformity, 140 (group 1) had the distal femoral cut individualised according to the calculated VCA, while the remaining 100 knees (group 1) were operated with a fixed distal femoral cut of 5°. The outcome of surgery was studied by grouping the knees as varus <10°, 10-15° and >15°. RESULTS Of the 227 limbs analysed in stage I, 70 knees (31 %) had a VCA angle outside 5-7°. Coronal bowing (p < 0.001), neck-shaft angle (p < 0.001) and preoperative deformity (p < 0.001) significantly influenced VCA. Results of the second phase of the study showed a significant improvement in both femoral component placement and postoperative alignment when VCA was individualised in the groups of knees with varus 10-15° (p 0.002) and varus >15° (p 0.002). CONCLUSION Valgus correction angle is highly variable and is influenced by femoral bowing, neck-shaft angle and pre-operative deformity. Individualisation of VCA is preferable in patients with moderate and severe varus deformity. LEVEL OF EVIDENCE Level 2.
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Affiliation(s)
| | - Geethan Iyyampillai
- Department of Orthopaedic Surgery, Ganga Hospital, 313, Metupalayam Road, Coimbatore, 641043, India
| | - Sivaraj Shanmugam
- Department of Orthopaedic Surgery, Ganga Hospital, 313, Metupalayam Road, Coimbatore, 641043, India
| | - Rajkumar Natesan
- Department of Orthopaedic Surgery, Ganga Hospital, 313, Metupalayam Road, Coimbatore, 641043, India
| | - Rajasekaran S
- Department of Orthopaedic Surgery, Ganga Hospital, 313, Metupalayam Road, Coimbatore, 641043, India.
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