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Winnock de Grave P, Luyckx T, Van Criekinge T, Müller JH, Ollivier B, Van Eecke E, LiArno S, Faizan A, Claeys K. Inverse kinematic alignment accommodates native coronal knee alignment better in comparison to adjusted mechanical alignment and restricted kinematic alignment. Knee Surg Sports Traumatol Arthrosc 2023; 31:3765-3774. [PMID: 36781450 DOI: 10.1007/s00167-023-07326-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Accepted: 01/25/2023] [Indexed: 02/15/2023]
Abstract
PURPOSE The purpose was to determine the proportion of native non-arthritic knees that fit within the target zones of adjusted mechanical alignment (aMA), restricted kinematic alignment (rKA), and inverse kinematic alignment (iKA), and to estimate adjustments in native coronal alignment to bring outlier knees within the respective target zones. The hypothesis was that the target zone of iKA, compared to the target zones of aMA and rKA, accommodates a higher proportion of native non-arthritic knees. METHODS The study used measurements obtained from a computed tomography (CT) scan database (SOMA, Stryker) of 972 healthy knees (Caucasian, 586; Asian, 386). Hip knee ankle (HKA) angle, medial proximal tibial angle (MPTA) and lateral distal femoral angle (LDFA) were used to estimate the proportions of knees within the patient-specific alignment target zones; and to estimate theoretical adjustments of MPTA, LDFA and soft tissue balance (HKA) to bring outlier knees within target zones. Theoretical adjustments to bring outlier knees within the alignment target zones of aMA, rKA and iKA were calculated by subtracting the native coronal alignment angles (MPTAnative, LDFAnative and HKAnative) from angles on the nearest target zone border (MPTAtarget, LDFAtarget and HKAtarget). RESULTS Patients were aged 59.8 ± 15.8 years with a BMI of 25.0 ± 4.4 kg/m2. The HKA angles were between 168° and 186°, MPTA between 78° and 98° and LDFA between 79° and 93°. Of the 972 knees, 81 (8%) were in the aMA target zone, 530 (55%) were in the rKA target zone, and 721 (74%) were in the iKA target zone. Adjustments of MPTA, LDFA and HKA angle to bring outlier knees within the target zones, were, respectively, 90, 91 and 28% for aMA, 45, 28 and 25% for rKA, and 25, 23 and 7% for iKA. CONCLUSIONS There is considerable variability in native knee coronal alignment that corresponds to different proportions of the restricted patient-specific alignment target zones for TKA. Although extension of the MPTA and LDFA target zones with rKA accommodate native knee alignment better than aMA, up to 25% would require adjustment of native HKA angle. By also extending the HKA angle target zone into varus, iKA accommodates a greater proportion (93%) of native limb alignment. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Philip Winnock de Grave
- Department Orthopaedic Surgery, AZ Delta Roeselare, Brugsesteenweg 90, 8800, Roeselare, Belgium.
- Department Rehabilitation Sciences, KU Leuven, Spoorwegstraat 12, 8200, Brugge, Belgium.
| | - Thomas Luyckx
- Department Orthopaedic Surgery, AZ Delta Roeselare, Brugsesteenweg 90, 8800, Roeselare, Belgium
- Department Orthopaedic Surgery, UZ Leuven, Herestraat 49, 3000, Louvain, Belgium
| | - Tamaya Van Criekinge
- Department Orthopaedic Surgery, AZ Delta Roeselare, Brugsesteenweg 90, 8800, Roeselare, Belgium
- Department Rehabilitation Sciences, KU Leuven, Spoorwegstraat 12, 8200, Brugge, Belgium
| | | | - Britt Ollivier
- Department Orthopaedic Surgery, AZ Delta Roeselare, Brugsesteenweg 90, 8800, Roeselare, Belgium
- Department Orthopaedic Surgery, UZ Leuven, Herestraat 49, 3000, Louvain, Belgium
| | - Eduard Van Eecke
- Department Orthopaedic Surgery, AZ Delta Roeselare, Brugsesteenweg 90, 8800, Roeselare, Belgium
- Department Orthopaedic Surgery, UZ Leuven, Herestraat 49, 3000, Louvain, Belgium
| | - Sally LiArno
- Stryker, 325 Corporate Drive, Mahwah, NJ, 07621, USA
| | - Ahmad Faizan
- Stryker, 325 Corporate Drive, Mahwah, NJ, 07621, USA
| | - Kurt Claeys
- Department Rehabilitation Sciences, KU Leuven, Spoorwegstraat 12, 8200, Brugge, Belgium
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Beckers L, Müller JH, Daxhelet J, Saffarini M, Aït-Si-Selmi T, Bonnin MP. Sexual dimorphism and racial diversity render bone-implant mismatch inevitable after off-the-shelf total knee arthroplasty: a systematic review and meta-analysis. Knee Surg Sports Traumatol Arthrosc 2022; 30:809-821. [PMID: 33512544 DOI: 10.1007/s00167-021-06447-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Accepted: 01/11/2021] [Indexed: 01/15/2023]
Abstract
PURPOSE The purpose of this systematic review and meta-analysis was to investigate the variability in femoral geometric ratios among knees of different sexes and races, and to appreciate whether the observed variability is accommodated by commonly implanted total knee arthroplasty (TKA) components. The hypothesis was that the anthropometric studies report considerable variability of femoral geometric ratios among sexes and races. METHODS This systematic review and meta-analysis was performed according to the Preferred Reporting Items for Systematic reviews and Meta-analyses (PRISMA) criteria. Two authors independently conducted an electronic search using MEDLINE® and Embase® on 6 July 2020 for clinical studies reporting on femoral geometric ratios among sexes and races. Femoral geometric ratios were graphically represented as means and 2 standard deviations, and compared to those of 13 commonly implanted femoral components. RESULTS A total of 15 studies were identified that reported on a combined total of 2627 knees; all reported the aspect ratio, and 2 also reported the asymmetry ratio and trapezoidicity ratio. Men had wider knees than women, and compared to Caucasian knees, Arabian and Indian knees were wider, while East Asian were narrower. There were no differences in asymmetry ratio between men and women, nor among Caucasian and East Asian knees. Men had more trapezoidal knees than women, and East Asian knees were more trapezoidal than Caucasian knees. The commonly implanted femoral components accommodated less than a quarter of the geometric variability observed among sexes and races. CONCLUSION Anthropometric studies reported considerable sexual dimorphism and racial diversity of femoral geometric ratios. Since a surgeon generally only uses one or a few TKA brands, bone-implant mismatch remains unavoidable in a large proportion of knees. These findings support the drive towards personalized medicine, and accurate bone-implant fit may only be achievable through customisation of implants, though the clinical benefits of custom TKA remain to be confirmed. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Lucas Beckers
- Ramsay Santé, Centre Orthopédique Santy, Hôpital Privé Jean Mermoz, Lyon, France
| | | | - Jeremy Daxhelet
- Ramsay Santé, Centre Orthopédique Santy, Hôpital Privé Jean Mermoz, Lyon, France
| | - Mo Saffarini
- ReSurg SA, Rue Saint-Jean 22, 1260, Nyon, Switzerland.
| | - Tarik Aït-Si-Selmi
- Ramsay Santé, Centre Orthopédique Santy, Hôpital Privé Jean Mermoz, Lyon, France
| | - Michel P Bonnin
- Ramsay Santé, Centre Orthopédique Santy, Hôpital Privé Jean Mermoz, Lyon, France
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Yanagisawa K, Watanabe T, Koga H, Sekiya I, Muneta T, Jinno T. Do the distal femur and the proximal tibia have narrower aspect ratios in smaller knees? : A morphological analysis of osteoarthritic knees in the Japanese population using computed tomography. Knee 2021; 33:84-92. [PMID: 34600225 DOI: 10.1016/j.knee.2021.08.023] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Revised: 06/08/2021] [Accepted: 08/25/2021] [Indexed: 02/02/2023]
Abstract
BACKGROUND Whether the distal femur and the proximal tibia have narrower aspect ratios in smaller knees has not been clarified. The purpose of this study was to confirm the dimensional characteristics of the distal femur and the proximal tibia using a novel method for consistently determining knee size. METHODS A total of 220 Japanese osteoarthritic knees (160 female and 60 male knees) were analyzed using computed tomography. The mediolateral (ML) and the anteroposterior (AP) dimensions of the distal femur (fML, fAP) and the proximal tibia (tML, tAP) were measured. The aspect ratios (ML/AP) of the distal femur (fML/fAP) and the proximal tibia (tML/tAP) were assessed against the product of AP × ML as a consistent determination of knee size. RESULTS The fML/fAP ratios positively correlated with knee size (fAP × fML) (r = 0.420, p < 0.001), only in the combined cohort, attributable to the narrower aspect ratios of female knees. No correlations were found between the tML/tAP ratios and knee size (tAP × tML) among females, males, nor all subjects (p = 0.299, 0.994, and 0.996, respectively). Aspect ratio correlations to knee size diverged between the three knee size indices, AP, ML, and AP × ML. CONCLUSIONS AP × ML was the meaningful option for knee size indexing in our morphological analyses. The distal femur, but not the proximal tibia, was found to have a narrower aspect ratio in female knees in the Japanese population.
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Affiliation(s)
- Katsuaki Yanagisawa
- Department of Orthopaedic Surgery, Tokyo Medical and Dental University Hospital, 1-5-45 Yushima, Bunkyo-ku, Tokyo 113-8510, Japan.
| | - Toshifumi Watanabe
- Department of Orthopaedic Surgery, Tokyo Medical and Dental University Hospital, 1-5-45 Yushima, Bunkyo-ku, Tokyo 113-8510, Japan; Department of Orthopaedic Surgery, Dokkyo Medical University Saitama Medical Center, 2-1-50 Minami-Koshigaya, Koshigaya, Saitama 343-8555, Japan.
| | - Hideyuki Koga
- Department of Orthopaedic Surgery, Tokyo Medical and Dental University Hospital, 1-5-45 Yushima, Bunkyo-ku, Tokyo 113-8510, Japan.
| | - Ichiro Sekiya
- Department of Orthopaedic Surgery, Tokyo Medical and Dental University Hospital, 1-5-45 Yushima, Bunkyo-ku, Tokyo 113-8510, Japan.
| | - Takeshi Muneta
- Department of Orthopaedic Surgery, Tokyo Medical and Dental University Hospital, 1-5-45 Yushima, Bunkyo-ku, Tokyo 113-8510, Japan
| | - Tetsuya Jinno
- Department of Orthopaedic Surgery, Dokkyo Medical University Saitama Medical Center, 2-1-50 Minami-Koshigaya, Koshigaya, Saitama 343-8555, Japan.
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Beckers L, Müller JH, Daxhelet J, Ratano S, Saffarini M, Aït-Si-Selmi T, Bonnin MP. Considerable inter-individual variability of tibial geometric ratios renders bone-implant mismatch unavoidable using off-the-shelf total knee arthroplasty: a systematic review and meta-analysis. Knee Surg Sports Traumatol Arthrosc 2021; 31:1284-1298. [PMID: 34075491 DOI: 10.1007/s00167-021-06623-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Accepted: 05/21/2021] [Indexed: 01/25/2023]
Abstract
PURPOSE The purpose of this systematic review and meta-analysis was to investigate the variability in tibial geometric ratios among knees of different sexes and races to determine whether commercially-available tibial baseplates accommodate the morphologic diversity. The hypothesis was that anthropometric studies report considerable variability of tibial geometric ratios among sexes and races. METHODS This systematic review and meta-analysis was performed according to the preferred reporting items for systematic reviews and meta-analyses (PRISMA) criteria. Two authors independently conducted an electronic search using MEDLINE® and Embase® on 28 January 2021 for clinical studies reporting on tibial geometric ratios. Tibial geometric ratios, as reported by the clinical studies, were represented by plotting their means and two standard deviations for comparison to two symmetric and two asymmetric commercially-available tibial baseplates. RESULTS A total of 27 articles that reported on a combined total of 20,944 knees were eligible for data extraction. Variation in tibial aspect ratios was equal among sexes. The greatest variation in aspect ratio was observed among East Asians, followed by Caucasians, African-Americans, Indian and Middle Easterns. The variation in tibial asymmetry ratio was larger among men compared to women. The greatest variation in asymmetry ratio was observed among African-Americans, followed by Caucasians, East Asians, Indian and Middle Easterns. Bone-implant mismatch of > 3 mm overhang or > 4 mm under-coverage with four commercially-available tibial baseplates occurred in large proportions of knees due to variations in aspect ratio (in 17-100% of knees) and asymmetry ratio (in 7-100% of knees). CONCLUSION Anthropometric studies reported considerable inter-individual variability of tibial geometric ratios, which exceeded effects of sexual dimorphism and racial diversity. Bone-implant mismatch may be unavoidable in a large proportion of knees, when considering that a surgeon generally only uses one or a few TKA brands. These findings support the drive towards patient-specific implants to potentially achieve accurate bone-implant fit by implant customisation. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Lucas Beckers
- Centre Orthopédique Santy, Ramsay Santé, Hôpital Privé Jean Mermoz, Lyon, France
| | | | - Jeremy Daxhelet
- Centre Orthopédique Santy, Ramsay Santé, Hôpital Privé Jean Mermoz, Lyon, France
| | - Salvatore Ratano
- Centre Orthopédique Santy, Ramsay Santé, Hôpital Privé Jean Mermoz, Lyon, France
| | - Mo Saffarini
- ReSurg SA, Rue Saint-Jean 22, 1260, Nyon, Switzerland.
| | - Tarik Aït-Si-Selmi
- Centre Orthopédique Santy, Ramsay Santé, Hôpital Privé Jean Mermoz, Lyon, France
| | - Michel P Bonnin
- Centre Orthopédique Santy, Ramsay Santé, Hôpital Privé Jean Mermoz, Lyon, France
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Taylor CE, Henninger HB, Bachus KN. Cortical and medullary morphology of the tibia. Anat Rec (Hoboken) 2020; 304:507-517. [PMID: 32585072 DOI: 10.1002/ar.24479] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Revised: 04/28/2020] [Accepted: 05/07/2020] [Indexed: 12/17/2022]
Abstract
Bone resorption caused by stress shielding and insufficient bone-implant contact continues to be problematic for orthopedic endoprostheses that utilize osseointegration (OI) for skeletal fixation. Morphologic analyses have helped combat this issue by defining anatomic parameters to optimize endoprosthesis loading by maximizing bone-implant contact. These studies have not typically included diaphyseal medullary morphology, as this region is not pertinent to total joint replacement. To the contrary, percutaneous OI endoprostheses for prosthetic limb attachment are placed in the diaphysis of the long bone. This study examined the cortical and medullary morphology of 116 fresh-frozen human cadaveric tibia using computed tomography. Anatomic landmarks were selected and custom MATLAB scripts were used to analyze the cross-sectional cortical and medullary morphology normalized to biomechanical length (BML). BML measured the distance between the tibial plateau and the tibial plafond. Properties such as cortical thickness, medullary diameter, and circularity of the medullary canal were quantified. We tested the influence of sex and laterality on morphology, and examined variations along the length of the bone. Results showed that while both sex and laterality impacted the location of anatomic landmarks, only sex influenced cross-sectional morphology. Overall, morphology significantly affected shape along the length of the bone for all examined properties except medullary circularity. This analysis found that distal to 35% BML, the canal is conducive to a circular implant, with medullary diameter ranging from 13 to 32 mm between 20 and 80% BML. A large size range is necessary for sufficient implant contact in order to accommodate residual limb length after amputation.
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Affiliation(s)
- Carolyn E Taylor
- Department of Orthopaedics, University of Utah, Salt Lake City, Utah, USA
- Department of Biomedical Engineering, University of Utah, Salt Lake City, Utah, USA
| | - Heath B Henninger
- Department of Orthopaedics, University of Utah, Salt Lake City, Utah, USA
- Department of Biomedical Engineering, University of Utah, Salt Lake City, Utah, USA
| | - Kent N Bachus
- Department of Orthopaedics, University of Utah, Salt Lake City, Utah, USA
- Department of Biomedical Engineering, University of Utah, Salt Lake City, Utah, USA
- Department of Veterans Affairs, Salt Lake City, Utah, USA
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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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Ishii Y, Noguchi H, Sato J, Ishii H, Todoroki K, Toyabe SI. Tibial component coverage and rotational alignment accuracy after mobile-bearing total knee arthroplasty. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2018; 28:1143-1149. [PMID: 29428984 DOI: 10.1007/s00590-018-2155-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/06/2018] [Accepted: 02/06/2018] [Indexed: 11/28/2022]
Abstract
BACKGROUND Tibial component coverage (TCC) and tibial rotational angle (TRA) have been studied simultaneously in simulations, but not in clinical studies after total knee arthroplasty (TKA). The purposes of this study were (1) to evaluate TCC and rotational setting postoperatively in mobile-bearing TKA patients and (2) to compare the results with previously published simulation data. METHODS We prospectively examined 100 patients who underwent primary TKA using the LCS® Total Knee System (LCS) posterior cruciate ligament-substituting prosthesis. Clinical outcomes, TCC (coverage area of the tibial component over the tibia), and TRA (relative to the femoral transepicondylar axis (TEA)) were assessed. Quantitative three-dimensional computed tomography was used to assess TCC and TRA. All values are expressed as median (25th percentile, 75th percentile) using minus (-) for internal and plus (+) for external rotation. RESULTS Hospital for Special Surgery scores improved from 46 (36, 50) preoperatively to 92 (90, 92) postoperatively. TRA showed a median divergence of - 2.0° (- 4.75°, + 2.74°). All knees were located within 10° of the TEA (range - 10.0° to + 9.7°). The median TCC of the knees was 82.7% (80.6, 84.7%), and there were no knees that hung over the tibial component in any direction. CONCLUSIONS The LCS prosthesis had good clinical outcomes, comparable TCC, and improved TRA as compared to previous reports, as all knees were located within 10° of the TEA. Simultaneous optimization of both TCC and TRA may contribute to the excellent long-term outcomes that have been observed with this system. LEVEL OF EVIDENCE Level II, Prognostic study.
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Affiliation(s)
- Yoshinori Ishii
- Ishii Orthopaedic and Rehabilitation Clinic, 1089 Shimo-Oshi, Gyoda, Saitama, 361-0037, Japan.
| | - Hideo Noguchi
- Ishii Orthopaedic and Rehabilitation Clinic, 1089 Shimo-Oshi, Gyoda, Saitama, 361-0037, Japan
| | - Junko Sato
- Ishii Orthopaedic and Rehabilitation Clinic, 1089 Shimo-Oshi, Gyoda, Saitama, 361-0037, Japan
| | - Hana Ishii
- Kouseiren Takaoka Hospital, 5-10 Eirakutyo Takaoka, Toyama, 933-8555, Japan
| | - Koji Todoroki
- Ishii Orthopaedic and Rehabilitation Clinic, 1089 Shimo-Oshi, Gyoda, Saitama, 361-0037, Japan
| | - Shin-Ichi Toyabe
- Niigata University Crisis Management Office, Niigata University Hospital, Niigata University Graduate School of Medical and Dental Sciences, 1 Asahimachi Dori Niigata, Niigata, 951-8520, Japan
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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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Nakamura S, Tian Y, Tanaka Y, Kuriyama S, Ito H, Furu M, Matsuda S. The effects of kinematically aligned total knee arthroplasty on stress at the medial tibia: A case study for varus knee. Bone Joint Res 2017; 6:43-51. [PMID: 28077396 PMCID: PMC5301901 DOI: 10.1302/2046-3758.61.bjr-2016-0090.r1] [Citation(s) in RCA: 53] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2016] [Accepted: 11/21/2016] [Indexed: 12/13/2022] Open
Abstract
OBJECTIVES Little biomechanical information is available about kinematically aligned (KA) total knee arthroplasty (TKA). The purpose of this study was to simulate the kinematics and kinetics after KA TKA and mechanically aligned (MA) TKA with four different limb alignments. MATERIALS AND METHODS Bone models were constructed from one volunteer (normal) and three patients with three different knee deformities (slight, moderate and severe varus). A dynamic musculoskeletal modelling system was used to analyse the kinematics and the tibiofemoral contact force. The contact stress on the tibial insert, and the stress to the resection surface and medial tibial cortex were examined by using finite element analysis. RESULTS In all bone models, posterior translation on the lateral side and external rotation in the KA TKA models were greater than in the MA TKA models. The tibiofemoral force at the medial side was increased in the moderate and severe varus models with KA TKA. In the severe varus model with KA TKA, the contact stress on the tibial insert and the stress to the resection surface and to the medial tibial cortex were increased by 41.5%, 32.2% and 53.7%, respectively, compared with MA TKA, and the bone strain at the medial side was highest among all models. CONCLUSION Near normal kinematics was observed in KA TKA. However, KA TKA increased the contact force, stress and bone strain at the medial side for moderate and severe varus knee models. The application of KA TKA for severe varus knees may be inadequate.Cite this article: S. Nakamura, Y. Tian, Y. Tanaka, S. Kuriyama, H. Ito, M. Furu, S. Matsuda. The effects of kinematically aligned total knee arthroplasty on stress at the medial tibia: A case study for varus knee. Bone Joint Res 2017;6:43-51. DOI: 10.1302/2046-3758.61.BJR-2016-0090.R1.
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Affiliation(s)
- S Nakamura
- Department of Orthopedic Surgery, Kyoto University, Graduate School of Medicine, 54 Shogoinkawaharacho, Sakyo-ku, Kyoto 606-8507, Japan
| | - Y Tian
- Department of Orthopedic Surgery, Kyoto University, Graduate School of Medicine, 54 Shogoinkawaharacho, Sakyo-ku, Kyoto 606-8507, Japan
| | - Y Tanaka
- Department of Orthopedic Surgery, Kyoto University, Graduate School of Medicine, 54 Shogoinkawaharacho, Sakyo-ku, Kyoto 606-8507, Japan
| | - S Kuriyama
- Department of Orthopedic Surgery, Kyoto University, Graduate School of Medicine, 54 Shogoinkawaharacho, Sakyo-ku, Kyoto 606-8507, Japan
| | - H Ito
- Department of Orthopedic Surgery, Kyoto University, Graduate School of Medicine, 54 Shogoinkawaharacho, Sakyo-ku, Kyoto 606-8507, Japan
| | - M Furu
- Department of Orthopedic Surgery, Kyoto University, Graduate School of Medicine, 54 Shogoinkawaharacho, Sakyo-ku, Kyoto 606-8507, Japan
| | - S Matsuda
- Department of Orthopedic Surgery, Kyoto University, Graduate School of Medicine, 54 Shogoinkawaharacho, Sakyo-ku, Kyoto 606-8507, Japan
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Miyatake N, Sugita T, Aizawa T, Sasaki A, Maeda I, Kamimura M, Fujisawa H, Takahashi A. Comparison of intraoperative anthropometric measurements of the proximal tibia and tibial component in total knee arthroplasty. J Orthop Sci 2016; 21:635-9. [PMID: 27380729 DOI: 10.1016/j.jos.2016.06.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2015] [Revised: 05/25/2016] [Accepted: 06/07/2016] [Indexed: 02/09/2023]
Abstract
BACKGROUND Precise matching of the tibial component and resected bony surfaces and proper rotational implanting of the tibial component are crucial for successful total knee arthroplasty. We aimed to analyze the exact anthropometric proximal tibial data of Japanese patients undergoing total knee arthroplasty and correlate the measurements with the dimensions of current total knee arthroplasty systems. METHODS A total of 703 knees in 566 Japanese patients who underwent total knee arthroplasty for osteoarthritis were included. The bone resection in the proximal tibia was performed perpendicular to the tibial axis in the frontal plane. Measurements of the proximal tibia were intraoperatively obtained after proximal tibial preparation. RESULTS There were significant positive correlations between the lateral anteroposterior and medial anteroposterior and mediolateral dimensions. A progressive decrease in the mediolateral/lateral anteroposterior ratio with an increasing lateral anteroposterior dimension or the mediolateral/anteroposterior ratio with an increasing anteroposterior dimension was observed. The lateral anteroposterior dimension was smaller than the medial anteroposterior dimension by a mean of 4.8 ± 2.0 mm. The proximal tibia exhibited asymmetry between the lateral and medial plateaus. A comparison of the morphological data and dimensions of the implants, one of which was a symmetric tibial component (NexGen) and the others were asymmetric (Genesis II and Persona), indicated that an asymmetric tibial component could be beneficial to maximize tibial plateau coverage. CONCLUSIONS This study provided important reference data for designing a proper tibial component for Japanese people. The proximal tibial cut surface was asymmetric. There was wide dispersion in the lateral anteroposterior, medial anteroposterior, and mediolateral dimensions depending on the patient. Our data showed that the tibial components of the Genesis II and Persona rather than that of the NexGen may be preferable for Japanese people because of their asymmetric design.
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Affiliation(s)
- Naohisa Miyatake
- Department of Orthopedic Surgery, Tohoku Orthopedic Clinic, 4-9-22 Kamiyagari, Izumi-ku, Sendai-city 981-3121, Japan
| | - Takehiko Sugita
- Department of Orthopedic Surgery, Tohoku Orthopedic Clinic, 4-9-22 Kamiyagari, Izumi-ku, Sendai-city 981-3121, Japan.
| | - Toshimi Aizawa
- Department of Orthopedic Surgery, Tohoku University Graduate School of Medicine, 1-1 Seiryo-machi, Aoba-ku, Sendai-city 980-8574, Japan
| | - Akira Sasaki
- Department of Orthopedic Surgery, Tohoku Orthopedic Clinic, 4-9-22 Kamiyagari, Izumi-ku, Sendai-city 981-3121, Japan
| | - Ikuo Maeda
- Department of Orthopedic Surgery, Tohoku Orthopedic Clinic, 4-9-22 Kamiyagari, Izumi-ku, Sendai-city 981-3121, Japan
| | - Masayuki Kamimura
- Department of Orthopedic Surgery, Tohoku University Graduate School of Medicine, 1-1 Seiryo-machi, Aoba-ku, Sendai-city 980-8574, Japan
| | - Hirokazu Fujisawa
- Department of Orthopedic Surgery, Tohoku University Graduate School of Medicine, 1-1 Seiryo-machi, Aoba-ku, Sendai-city 980-8574, Japan
| | - Atsushi Takahashi
- Department of Orthopedic Surgery, Tohoku University Graduate School of Medicine, 1-1 Seiryo-machi, Aoba-ku, Sendai-city 980-8574, Japan
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