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Ho JPY, Park SY, Nam HS, Cho JH, Lee YS. The use of an anatomic tibial baseplate in total knee arthroplasty optimizes coverage without compromising rotation: A propensity-matched evaluation. Knee 2023; 45:35-45. [PMID: 37774563 DOI: 10.1016/j.knee.2023.09.003] [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: 07/06/2023] [Revised: 08/16/2023] [Accepted: 09/17/2023] [Indexed: 10/01/2023]
Abstract
BACKGROUND The aims of this study were (1) to compare in vivo coverage and rotational alignment of 2 tibial component designs: anatomic and symmetrical; and (2) to determine if coronal deformity and tibial torsion were related to rotation and coverage. METHODS Postoperative CT scans of 200 propensity score-matched patients who underwent TKA with either an anatomic (ATC) or symmetrical tibia component (STC) were analyzed. Rotation was measured using four axes: surgical transepicondylar axis (sTEA), Berger's protocol, medio-lateral (ML) axis and posterior borders of the tibial plateau, while coverage was assessed by measuring fit and surface area. The relationship between coronal deformity, tibial torsion, rotation, and coverage was investigated. RESULTS Overall, STCs had more internal rotation when measured using the sTEA (-0.6° ± 3.5 vs 0.5° ± 3.6, p = 0.03), Berger's protocol (-21.6° ± 7.1 vs -17.9° ± 6.2, p = 0.000) and ML axes (2.9° ± 3.9 vs 8.1° ± 5.1, p = 0.000) compared to ATCs. STCs also had more posteromedial underhang (-3.3 mm ± 2.4 mm vs -1.7 mm ± 2.5 mm, p = 0.000) but smaller change in tibial torsion postoperatively (-18.4° ± 9.9° vs -13.1° ± 9.4°, p = 0.000). Tibial torsion was more pronounced in valgus than varus knees both preoperative (-25.4° ± 6.5° vs -20.2° ± 9.3°, p = 0.02) and postoperatively (-19.7° ± 7.2° vs -14.7° ± 10.3°, p = 0.04), but there was no difference in postoperative tibial torsion between ATCs and STCs in this subgroup. CONCLUSION The use of an anatomic tibial baseplate optimizes coverage by reducing posterolateral overhang and posteromedial underhang. It also achieved better rotational profiles compared to STCs. However, it resulted in a larger change in tibial torsion after TKA.
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Affiliation(s)
- Jade Pei Yuik Ho
- Department of Orthopaedic Surgery, Seoul National University College of Medicine, Seoul National University Bundang Hospital, South Korea; Department of Orthopaedic Surgery, Kuala Lumpur General Hospital, Malaysia
| | - Seong Yun Park
- Department of Orthopaedic Surgery, Seoul National University College of Medicine, Seoul National University Bundang Hospital, South Korea
| | - Hee Seung Nam
- Department of Orthopaedic Surgery, Seoul National University College of Medicine, Seoul National University Bundang Hospital, South Korea
| | - Joon Hee Cho
- Department of Orthopaedic Surgery, Seoul National University College of Medicine, Seoul National University Bundang Hospital, South Korea
| | - Yong Seuk Lee
- Department of Orthopaedic Surgery, Seoul National University College of Medicine, Seoul National University Bundang Hospital, South Korea.
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Maciąg BM, Kordyaczny T, Żarnovsky K, Budzińska M, Jegierski D, Łapiński M, Maciąg GJ, Stolarczyk A. Curve-on-curve technique does not improve tibial coverage in total knee arthroplasty in comparison to tibial tuberosity technique with use of anatomical implants: randomized controlled trial. Arch Orthop Trauma Surg 2023; 143:5901-5907. [PMID: 37000268 PMCID: PMC10064952 DOI: 10.1007/s00402-023-04857-3] [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: 09/23/2022] [Accepted: 03/18/2023] [Indexed: 04/01/2023]
Abstract
INTRODUCTION During the last years, main attention while performing total knee replacement was paid to femoral component alignment; however, there is still lack of studies concerning tibial baseplate rotational alignment, especially in terms of anatomical designs of knee prosthesis. Some recent studies proved that tibial baseplate malrotation might be a cause of knee pain and patients' dissatisfaction. The aim of this study was to compare tibial component rotation and its coverage on the tibial plateau achieved with curve-on-curve and tibial tuberosity techniques (t-t technique) with use of anatomic knee designs with asymmetric tibial baseplate. MATERIALS AND METHODS A total of 88 patients were randomly assigned in a 1:1 ratio to undergo total knee arthroplasty with use of the PERSONA PS (Zimmer Biomet) knee design with an asymmetric baseplate. The rotation of the tibial component was assessed and performed with two different techniques: curve-on-curve technique and tibial tuberosity technique. Tibial component rotation was measured on computed tomography (CT) scans using the method suggested by Benazzo et al. and designed for asymmetrical implants. For the measurement of the tibial bone coverage, the component surface area was outlined and measured on a proper CT section, then the tibial cut surface area was outlined and measured on a section just below the cement level. Pre- and post-operative range of motion was measured by another independent researcher 12 months post-operatively during follow-up visit. RESULTS There was a statistically significant difference between both groups in median value of tibial rotation angle: 7° (interquartile range (IQR) = 0-12) in curve-on-curve technique group vs 2° (IQR-1-7) in tibial tuberosity technique group, probability value (p) = 0.0041, with values above 0 meaning external rotation of the component. There was no statistically significant difference between both groups in terms of range of motion (ROM) with average values of 124.3° ± 13.0° for curve-on-curve technique and 125.6° ± 12.8° for t-t technique with p = 0.45. There was a statistically insignificant difference between both groups in terms of coverage percentage in slight favor for curve-on-curve technique (85.9 ± 4.2 vs 84.5 ± 4.8, p = 0.17). CONCLUSION In this study, no difference between the groups in terms of tibial bone coverage and range of motion was proved, even though both techniques differed significantly with values of tibial rotation. Future studies should be focused on influence of specific values of tibial rotation on patient-reported outcomes and survivorship of anatomic knee implants.
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Affiliation(s)
- Bartosz M Maciąg
- Department of Orthopedics and Rehabilitation, Medical University of Warsaw, Międzyleski Specialist Hospital, 2 Bursztynowa St., 04-749, Warsaw, Poland.
| | - Tomasz Kordyaczny
- Department of Orthopedics and Rehabilitation, Medical University of Warsaw, Międzyleski Specialist Hospital, 2 Bursztynowa St., 04-749, Warsaw, Poland
| | - Krystian Żarnovsky
- Department of Orthopedics and Rehabilitation, Medical University of Warsaw, Międzyleski Specialist Hospital, 2 Bursztynowa St., 04-749, Warsaw, Poland
| | - Martyna Budzińska
- Department of Orthopedics and Rehabilitation, Medical University of Warsaw, Międzyleski Specialist Hospital, 2 Bursztynowa St., 04-749, Warsaw, Poland
| | - Dawid Jegierski
- Department of Orthopedics and Rehabilitation, Medical University of Warsaw, Międzyleski Specialist Hospital, 2 Bursztynowa St., 04-749, Warsaw, Poland
| | - Marcin Łapiński
- Department of Orthopedics and Rehabilitation, Medical University of Warsaw, Międzyleski Specialist Hospital, 2 Bursztynowa St., 04-749, Warsaw, Poland
| | - Grzegorz J Maciąg
- Department of Orthopedics and Rehabilitation, Medical University of Warsaw, Międzyleski Specialist Hospital, 2 Bursztynowa St., 04-749, Warsaw, Poland
| | - Artur Stolarczyk
- Department of Orthopedics and Rehabilitation, Medical University of Warsaw, Międzyleski Specialist Hospital, 2 Bursztynowa St., 04-749, Warsaw, Poland
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Xin L, Xingjia M, Shengjie G, Yanwei C, Shuaijie L, Chuan X. Comparison of Tibial Tubercle Landmark Technique and Range of Motion Technique in Primary Total Knee Arthroplasty: A Retrospective Cohort Study. Orthop Surg 2022; 14:3159-3170. [PMID: 36238972 PMCID: PMC9732623 DOI: 10.1111/os.13486] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Revised: 08/02/2022] [Accepted: 08/09/2022] [Indexed: 12/14/2022] Open
Abstract
OBJECTIVE There is not a standard for rotational alignment of the tibial component in total knee arthroplasty (TKA). For now, the most commonly methods are tibial-tubercle -landmark technique (TTL) and range-of-motion technique (ROM). The study is aimed to compare clinical outcomes and radiographic data of patients who undergone primary TKA with TTL or ROM technique. METHODS This single-surgeon retrospective cohort study includes 60 patients with TTL technique and 60 with ROM technique from December 2017 to January 2019. All patients were evaluated clinically using Hospital for Special Surgery Knee Score (HSS), Feller patellar score, visual analogue scale (VAS) and maximum knee flexion and extension angle before and after surgery at both 6 months and 12 months postoperatively. Radiographic data contain hip-knee-ankle angle (HKA), mechanical lateral distal femoral angle (mLDFA), mechanical medial proximal tibial angle (mMPTA), posterior slope angle (PSA) on pre and postoperative X-ray and rotation angle of femoral component (relative to surgical trans-epicondylar axis) and tibial component (relative to surgical trans-epicondylar axis, tibial posterior condylar line and Akagi') on postoperative computed tomography (CT) scan. Clinical outcomes and radiological data were compared between the two groups. RESULTS One hundred twenty patients (120 knees) were enrolled in this study, including 38 males and 82 females, aged from 58 to 78, with an average of 65.7 years. There was no significant difference in demographics and preoperative X-ray data between the two groups (P > 0. 05). Clinical scores of the TTL group were better than those in the ROM group at 6 and 12 months after surgery, when comparing HSS (83.57 ± 5.00 vs 75.90 ± 4.89, F = 59.004, P < 0.001; 90.53 ± 4.31 vs 82.83 ± 4.98, F = 54.509, P < 0.001), Feller patellar score (21.43 ± 2.54 vs 19.10 ± 2.52, F = 14.864, P = 0.001; 26.27 ± 1.98 vs 23.20 ± 2.31, F = 42.204, P < 0.001) and VAS (3.70 ± 0.62 vs 4.38 ± 0.92, F = 14.508, P = 0.001; 2.10 ± 0.90 vs 2.79 ± 0.80, F = 11.554, P = 0.002). But there was no significant difference in the flexion and extension angle between the two groups. In imaging evaluation, no statistical difference was found in pre- and postoperative HKA, mLDFA, mMPTA and PSA. Rotational angles of tibial component only did relative to Akagi' have statistical difference in two groups (2.33 ± 4.3 vs 4.41 ± 3.2, t = 2.143, P < 0.05) (Positive value represented external rotation). CONCLUSION The results of our study showed that both methods were reliable, and TTL technique provided better clinical scores and larger external angle of tibial component, compared to ROM technique.
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Affiliation(s)
- Liu Xin
- Department of Orthopaedic SurgeryThe Second Hospital of Shanxi Medical UniversityTaiyuanChina
| | - Mao Xingjia
- Department of Orthopaedic SurgeryThe Second Hospital of Shanxi Medical UniversityTaiyuanChina
| | - Guo Shengjie
- Department of Orthopaedic SurgeryThe Second Hospital of Shanxi Medical UniversityTaiyuanChina
| | - Cao Yanwei
- Department of Orthopaedic SurgeryThe Second Hospital of Shanxi Medical UniversityTaiyuanChina
| | - Li Shuaijie
- Department of Orthopaedic SurgeryThe Second Hospital of Shanxi Medical UniversityTaiyuanChina
| | - Xiang Chuan
- Department of Orthopaedic SurgeryThe Second Hospital of Shanxi Medical UniversityTaiyuanChina
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Jin Y, Li P, Yang Y, Zeng X, Shen H, Zhang L, Tsai TY, Chen J. A New Reference Axis for Tibial Component Rotation in Total Knee Arthroplasty: A Three-dimensional Computed Tomography Analysis. Front Surg 2022; 9:872533. [PMID: 35574544 PMCID: PMC9091956 DOI: 10.3389/fsurg.2022.872533] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Accepted: 03/28/2022] [Indexed: 11/26/2022] Open
Abstract
The purpose of this study was to introduce a new reference axis for tibial rotation in total knee arthroplasty (TKA) and verify its reliability. A consecutive series of 80 knees that underwent TKA from 2018 to 2020 as well as 80 healthy knees were analyzed using a three-dimensional tibial model. A coordinate system was established based on the standard TKA tibial cut. The line connecting the lateral-tibial eminence and the medial 1/3rd of the tibial tubercle or the medial border of the tibial tubercle was identified as the lateral eminence line (LE line) and the medial lateral eminence line (MLE line), respectively. To evaluate the reliability of the new reference axis, Akagi's line, the medial third of the tibial tubercle (1/3 line) was compared with the LE and MLE lines by measuring the angle between the lines and the Z-axis. In the coronal view, the intersection angle (TPA), which is composed of the line connecting the center of the medial and lateral tibial plateau with the Z-axis, was measured. The mean angle between Akagi's line and the Z-axis in the healthy group and the osteoarthritis (OA) group was 87.57 ± 3.48° and 87.61 ± 3.47°, respectively. The mean angle between the LE line and Z-axis in the healthy and OA groups was 87.15 ± 4.13° and 86.78 ± 3.95°, respectively. A weak correlation was found between the TPA and Akagi's line and the 1/3 line. A moderate correlation was observed between the TPA and LE lines. There were no significant differences between the healthy and OA groups (P > 0.05) in any of the four reference axes. The LE line showed excellent intra- and inter-observer reliability and reproducibility. The novel and easily drawn LE line is a preferable option for tibial component rotational alignment in TKA.
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Affiliation(s)
- Yan Jin
- Department of Orthopedics, PLA General Hospital of Southern Theatre Command, Guangzhou, China
- Guangdong Key Lab of Orthopedic Technology and Implant, General Hospital of Southern Theater Command of PLA, The First School of Clinical Medicine, Southern Medical University, Guangzhou, China
| | - Pingyue Li
- Department of Orthopedics, PLA General Hospital of Southern Theatre Command, Guangzhou, China
- Guangdong Key Lab of Orthopedic Technology and Implant, General Hospital of Southern Theater Command of PLA, The First School of Clinical Medicine, Southern Medical University, Guangzhou, China
- *Correspondence: Pingyue Li
| | - Yiming Yang
- Department of Orthopedics, PLA General Hospital of Southern Theatre Command, Guangzhou, China
- Guangdong Key Lab of Orthopedic Technology and Implant, General Hospital of Southern Theater Command of PLA, The First School of Clinical Medicine, Southern Medical University, Guangzhou, China
| | - Xianli Zeng
- Department of Orthopedics, PLA General Hospital of Southern Theatre Command, Guangzhou, China
- Guangdong Key Lab of Orthopedic Technology and Implant, General Hospital of Southern Theater Command of PLA, The First School of Clinical Medicine, Southern Medical University, Guangzhou, China
| | - Hongyuan Shen
- Department of Orthopedics, PLA General Hospital of Southern Theatre Command, Guangzhou, China
- Guangdong Key Lab of Orthopedic Technology and Implant, General Hospital of Southern Theater Command of PLA, The First School of Clinical Medicine, Southern Medical University, Guangzhou, China
| | - Lihang Zhang
- Department of Orthopedics, PLA General Hospital of Southern Theatre Command, Guangzhou, China
- Guangdong Key Lab of Orthopedic Technology and Implant, General Hospital of Southern Theater Command of PLA, The First School of Clinical Medicine, Southern Medical University, Guangzhou, China
| | - Tsung-Yuan Tsai
- Shanghai Key Laboratory of Orthopaedic Implants, Department of Orthopaedic Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine; School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, China
- Engineering Research Center of Clinical Translational Digital Medicine, Ministry of Education, Beijing, China
| | - Jiarong Chen
- Department of Orthopedics, PLA General Hospital of Southern Theatre Command, Guangzhou, China
- Guangdong Key Lab of Orthopedic Technology and Implant, General Hospital of Southern Theater Command of PLA, The First School of Clinical Medicine, Southern Medical University, Guangzhou, China
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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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Lu Y, Ren X, Liu B, Xu P, Hao Y. Tibiofemoral rotation alignment in the normal knee joints among Chinese adults: a CT analysis. BMC Musculoskelet Disord 2020; 21:323. [PMID: 32446307 PMCID: PMC7245925 DOI: 10.1186/s12891-020-03300-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Accepted: 04/17/2020] [Indexed: 11/24/2022] Open
Abstract
Background Consensus on tibial rotation in total knee arthroplasty (TKA) remains controversial. The present study aimed to investigate the closest anatomical reference to surgical epicondylar axis (SEA) among 10 tibial markers in Chinese adults. Methods This study included examination of 122 normal lower extremities. Briefly, 10 axes were drawn on the axial sections: transverse axis of tibia (TAT), axis of medial edge of patellar tendon (MEPT), axis of medial 1/3 of patellar tendon attachment (M1/3), Akagi line, Insall line, axis of medial border of tibial tubercle (MBTT), and axis of anterior border of the tibia 1–4 (ATC1–4). The mean angles between TAT and SEA and that between other axes and the line perpendicular to SEA were measured. Pairwise differences among the 10 tibial axes were examined by applying one-way analysis of variance (ANOVA) and paired t-test. Results In all the knees, the mean angles of M1/3, Akagi line, Insall line, MBTT, ATC1, ATC2, ATC3, and ATC4 axes were compared to the line perpendicular to the projected SEA and found to be 10.2 ± 5.1°, 1.4 ± 5.0°, 11.9 ± 5.4°, 3.6 ± 4.8°, 12.0 ± 6.9°, 7.2 ± 8.6°, 7.1 ± 10.4°, and 6.6 ± 13.5° external rotation, respectively, and the MEPT axis was 1.6 ± 4.5° internal rotation. The mean angle for TAT was 4.1 ± 5.3° external rotation. The M1/3 and Insall line were significantly more externally rotated than Akagi line, MEPT, MBTT, TAT, ATC2, ATC3, and ATC4 axes. No significant differences were noted between the TAT axis and the MBTT axis and among the ATC2, ATC3, and ATC4 axes. Conclusion The Akagi line, MBTT, and TAT showed good consistency with SEA in the axial femorotibial alignment with knee in extension. The middle segment of the anterior tibial crest also demonstrated good alignment consistency with SEA for the axial femorotibial alignment. Hence, these markers can be used as reliable references for rotational alignment of the tibial component in TKA.
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Affiliation(s)
- Yufeng Lu
- Osteonecrosis and Joint Reconstruction Ward, Department of Joint Surgery, Honghui Hospital, Xi'an Jiaotong University, Xi'an, Shaanxi, 710054, P.R. China
| | - Xiaoyu Ren
- Osteonecrosis and Joint Reconstruction Ward, Department of Joint Surgery, Honghui Hospital, Xi'an Jiaotong University, Xi'an, Shaanxi, 710054, P.R. China
| | - Benyin Liu
- Department of Radiology and Imaging Sciences, Honghui Hospital, Xi'an Jiaotong University, Xi'an, Shaanxi, 710054, P.R. China
| | - Peng Xu
- Osteonecrosis and Joint Reconstruction Ward, Department of Joint Surgery, Honghui Hospital, Xi'an Jiaotong University, Xi'an, Shaanxi, 710054, P.R. China
| | - Yangquan Hao
- Osteonecrosis and Joint Reconstruction Ward, Department of Joint Surgery, Honghui Hospital, Xi'an Jiaotong University, Xi'an, Shaanxi, 710054, P.R. China.
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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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9
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Meier M, Webb J, Collins JE, Beckmann J, Fitz W. Do modern total knee replacements improve tibial coverage? Knee Surg Sports Traumatol Arthrosc 2018; 26:3219-3229. [PMID: 29372284 DOI: 10.1007/s00167-018-4836-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2017] [Accepted: 01/08/2018] [Indexed: 11/27/2022]
Abstract
PURPOSE The purpose of the present study is to compare newer designs of various symmetric and asymmetric tibial components and measure tibial bone coverage using the rotational safe zone defined by two commonly utilized anatomic rotational landmarks. METHODS Computed tomography scans (CT scans) of one hundred consecutive patients scheduled for total knee arthroplasty were obtained pre-operatively. A virtual proximal tibial cut was performed and two commonly used rotational axes were added for each image: the medio-lateral axis (ML-axis) and the medial 1/3 tibial tubercle axis (med-1/3-axis). Different symmetric and asymmetric implant designs were then superimposed in various rotational positions for best cancellous and cortical coverage. The images were imported to a public domain imaging software, and cancellous and cortical bone coverage was computed for each image, with each implant design in various rotational positions. RESULTS One single implant type could not be identified that provided the best cortical and cancellous coverage of the tibia, irrespective of using the med-1/3-axis or the ML-axis for rotational alignment. However, it could be confirmed that the best bone coverage was dependent on the selected rotational landmark. Furthermore, improved bone coverage was observed when tibial implant positions were optimized between the two rotational axes. CONCLUSIONS Tibial coverage is similar for symmetric and asymmetric designs, but depends on the rotational landmark for which the implant is designed. The surgeon has the option to improve tibial coverage by optimizing placement between the two anatomic rotational alignment landmarks, the medial 1/3 and the ML-axis. Surgeons should be careful assessing intraoperative rotational tibial placement using the described anatomic rotational landmarks to optimize tibial bony coverage without compromising patella tracking. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Malin Meier
- University of Ulm, Helmholzstraße 16, 89081, Ulm, Germany
| | - Jonathan Webb
- Mayo Clinic Health System in Eau Claire, Luther Campus Clinic, 1400 Bellinger Street, Eau Claire, WI, 54703, USA
| | - Jamie E Collins
- Orthopedic Surgery, Harvard Medical School, Brigham and Women's Hospital, 75 Francis Street, Boston, MA, 02115, USA
| | | | - Wolfgang Fitz
- Orthopedic Surgery, Harvard Medical School, Brigham and Women's Hospital, 75 Francis Street, Boston, MA, 02115, USA.
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Amanatullah DF, Ollivier MP, Pallante GD, Abdel MP, Clarke HD, Mabry TM, Taunton MJ. Reproducibility and Precision of CT Scans to Evaluate Tibial Component Rotation. J Arthroplasty 2017; 32:2552-2555. [PMID: 28434699 DOI: 10.1016/j.arth.2017.01.040] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2016] [Revised: 01/17/2017] [Accepted: 01/23/2017] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Component rotation likely plays a greater role on the survivorship and outcomes of total knee arthroplasties than is currently known. Our goal was to evaluate the precision, interobserver reliability, and intrarater reliability of tibial component rotation as measured by computed tomography (CT) scan, regardless of measurement technique. METHODS Three fellowship-trained, academic arthroplasty surgeons independently measured tibial component rotation on CT scans of 62 total knee arthroplasties using their methods of choice. Measurements were repeated at least 2 weeks after the initial measurement. The precision of the measurements was assessed using a formal 8-step protocol as the gold standard. Intraclass correlation coefficients (ICCs) were calculated to evaluate precision, interobserver agreement, and intrarater reliability RESULTS: The interobserver agreement between the 3 surgeons for tibial component rotation was also moderate (ICC = 0.52). The intrarater reliability of tibial rotation was excellent (ICC = 0.81). Comparison of surgeons' measurement to a validated gold standard revealed only moderate precision for tibial component rotation (ICC = 0.64). CONCLUSION Practicing surgeons measuring tibial rotation were internally consistent, but failed to demonstrate satisfactory precision and interobserver agreement. We support the adoption of standardized criteria for the measurement of tibial component rotation on CT scans.
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Affiliation(s)
- Derek F Amanatullah
- Department of Orthopaedic Surgery, Stanford Hospital and Clinics, Redwood City, California; Department of Orthopaedic Surgery, Mayo Clinic, Rochester, Minnesota
| | | | - Graham D Pallante
- Department of Orthopaedic Surgery, Mayo Clinic, Rochester, Minnesota
| | - Matthew P Abdel
- Department of Orthopaedic Surgery, Mayo Clinic, Rochester, Minnesota
| | - Henry D Clarke
- Department of Orthopaedic Surgery, Mayo Clinic, Phoenix, Arizona
| | - Tad M Mabry
- Department of Orthopaedic Surgery, Mayo Clinic, Rochester, Minnesota
| | - Michael J Taunton
- Department of Orthopaedic Surgery, Mayo Clinic, Rochester, Minnesota
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11
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The Chitranjan S. Ranawat Award : No Difference in 2-year Functional Outcomes Using Kinematic versus Mechanical Alignment in TKA: A Randomized Controlled Clinical Trial. Clin Orthop Relat Res 2017; 475:9-20. [PMID: 27113595 PMCID: PMC5174030 DOI: 10.1007/s11999-016-4844-x] [Citation(s) in RCA: 149] [Impact Index Per Article: 21.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Neutral mechanical alignment (MA) in total knee arthroplasty (TKA) aims to position femoral and tibial components perpendicular to the mechanical axis of the limb. In contrast, kinematic alignment (KA) attempts to match implant position to the prearthritic anatomy of the individual patient with the aim of improving functional outcome. However, comparative data between the two techniques are lacking. QUESTIONS/PURPOSES In this randomized trial, we asked: (1) Are 2-year patient-reported outcome scores enhanced in patients with KA compared with an MA technique? (2) How does postoperative component alignment differ between the techniques? (3) Is the proportion of patients undergoing reoperation at 2 years different between the techniques? METHODS Ninety-nine primary TKAs in 95 patients were randomized to either MA (n = 50) or KA (n = 49) groups. A pilot study of 20 TKAs was performed before this trial using the same patient-specific guides positioning in kinematic alignment. In the KA group, patient-specific cutting blocks were manufactured using individual preoperative MRI data. In the MA group, computer navigation was used to ensure neutral mechanical alignment accuracy. Postoperative alignment was assessed with CT scan, and functional scores (including the Oxford Knee Score, WOMAC, and the Forgotten Joint Score) were assessed preoperatively and at 6 weeks, 6 months, and 1 and 2 years postoperatively. No patients were lost to followup. We set sample size at a minimum of 45 patients per treatment arm based on a 5-point improvement in the mean Oxford Knee Score (OKS; the previously reported minimum clinically significant difference for the OKS in TKA), a pooled SD of 8.3, 80% power, and a two-sided significance level of 5%. RESULTS We observed no difference in 2-year change scores (postoperative minus preoperative score) in KA versus MA patients for the OKS (mean 21, SD 8 versus 20, SD 8, least square means 1.0, 95% confidence interval [CI], -1.4 to 3.4, p = 0.4), WOMAC score (mean 38, SD 18 versus 35, SD 8, least square means 3, 95% CI, -3.2 to 8.9, p = 0.3), or Forgotten Joint score (28 SD 37 versus 28, SD 28, least square means 0.8, 95% CI, -9.1-10.7, p = 0.8). Postoperative hip-knee-ankle axis was not different between groups (mean KA 0.4° varus SD 3.5 versus MA 0.7° varus SD 2.0), but in the KA group, the tibial component was a mean 1.9° more varus than the MA group (95% CI, 0.8°-3.0°, p = 0.003) and the femoral component in 1.6° more valgus (95% CI, -2.5° to -0.7°, p = 0.003). Complication rates were not different between groups. CONCLUSIONS We found no difference in 2-year patient-reported outcome scores in TKAs implanted using the KA versus an MA technique. The theoretical advantages of improved pain and function that form the basis of the design rationale of KA were not observed in this study. Currently, it is unknown whether the alterations in component alignment seen with KA will compromise long-term survivorship of TKA. In this study, we were unable to demonstrate an advantage to KA in terms of pain or function that would justify this risk. LEVEL OF EVIDENCE Level I, therapeutic study.
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Yang G, Wang Z, Wen X, Jiang Z, Qi X, Yang C. The relationship between the midpoints connecting the tibial attachments of the anterior and posterior cruciate ligaments and the transepicondylar axis: In vivo three-dimensional measurement in the Chinese population. Knee 2016; 23:777-84. [PMID: 27329992 DOI: 10.1016/j.knee.2016.05.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2015] [Revised: 03/18/2016] [Accepted: 05/10/2016] [Indexed: 02/02/2023]
Abstract
BACKGROUND To determine the relationship between the midpoints connecting the tibial attachments of the anterior and posterior cruciate ligament (ACL and PCL, APCL line) and the transepicondylar axis (TEA) in normal healthy Chinese, as well as the comparison with other rotational lines. METHODS Left knees of 17 male and 15 female healthy Chinese volunteers were scanned by magnetic resonance imaging (MRI) and computer tomography (CT) respectively. 3D contours of each knee, the tibial attachments of ACL, PCL, the medial and lateral collateral ligaments were reconstructed separately from CT and MRI data. Using an iterative closest point algorithm, we superimposed them individually. The APCL line, the tibial posterior condylar line (PC line), the medial third of the tibial tubercle (1/3 line), the Akagi's line, and the midsulcus of the tibial spine (Midsulcus line), the clinical and surgical TEA (CTEA and STEA) were determined. The paired intersection angles of them were measured. RESULTS The mean angle CTEA with APCL line, Akagi's line, Midsulcus line, 1/3 line, and PC line, respectively, was 90.3°±2.9°, 95.0°±3.0°, 94.0°±3.9°, 102.4°±2.7°, and 87.1°±3.0°. The APCL-CTEA was significant different than other angles (p<0.001). The mean angle STEA to the above lines, respectively, was 94.8°±3.1°, 99.4°±3.1°, 98.5°±4.0°, 106.9°±2.9°, and 91.6°±3.2°. The PC line-STEA was significantly different than other angles (p<0.05). CONCLUSIONS APCL line was the closest perpendicular to the CTEA in normal Chinese subjects comparing with other rotational lines.
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Affiliation(s)
- Guang Yang
- Department of Orthopedic Surgery, The First Hospital of Jilin University, Changchun, China
| | - Zhuo Wang
- Department of Radiology, The First Hospital of Jilin University, Changchun, China
| | - Xiaoyu Wen
- Department of Hepatology, The First Hospital of Jilin University, Changchun, China
| | - Zhengang Jiang
- School of Computer Science and Technology, Changchun University of Science and Technology, Changchun, China
| | - Xin Qi
- Department of Orthopedic Surgery, The First Hospital of Jilin University, Changchun, China
| | - Chen Yang
- Department of Orthopedic Surgery, The First Hospital of Jilin University, Changchun, China.
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Steinbrück A, Schröder C, Woiczinski M, Müller T, Müller PE, Jansson V, Fottner A. Influence of tibial rotation in total knee arthroplasty on knee kinematics and retropatellar pressure: an in vitro study. Knee Surg Sports Traumatol Arthrosc 2016; 24:2395-401. [PMID: 25577221 DOI: 10.1007/s00167-015-3503-1] [Citation(s) in RCA: 43] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2014] [Accepted: 01/02/2015] [Indexed: 10/24/2022]
Abstract
PURPOSE Although continuous improvements have been made, there is still a considerable amount of unsatisfied patients after total knee arthroplasty (TKA). A main reason for this high percentage is anterior knee pain, which is supposed to be provoked by post-operative increased retropatellar peak pressure. Since rotational malalignment of the implant is believed to contribute to post-operative pain, the aim of this study was to examine the influence of tibial component rotation on knee kinematics and retropatellar pressure. METHODS Eight fresh-frozen knee specimens were tested in a weight-bearing knee rig after fixed-bearing TKA under a loaded squat from 20° to 120° of flexion. To examine tibial components with different rotations, special inlays with 3° internal rotation and 3° external rotation were produced and retropatellar pressure distribution was measured with a pressure-sensitive film. The kinematics of the patella and the femorotibial joint were recorded with an ultrasonic-based motion analysis system. RESULTS Retropatellar peak pressure decreased significantly from 3° internal rotation to neutral position and 3° external rotation of the tibial component (8.5 ± 2.3 vs. 8.2 ± 2.4 vs. 7.8 ± 2.5 MPa). Regarding knee kinematics femorotibial rotation and anterior-posterior translation, patella rotation and tilt were altered significantly, but relative changes remained minimal. CONCLUSION Changing tibial rotation revealed a high in vitro influence on retropatellar peak pressure. We recommend the rotational alignment of the tibial component to the medial third of the tibial tuberosity or even more externally beyond that point to avoid anterior knee pain after TKA.
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Affiliation(s)
- Arnd Steinbrück
- Department of Orthopedic Surgery, Physical Medicine and Rehabilitation, University Hospital of Munich (LMU), Campus Grosshadern, Marchioninistr. 15, 81377, Munich, Germany.
| | - Christian Schröder
- Department of Orthopedic Surgery, Physical Medicine and Rehabilitation, University Hospital of Munich (LMU), Campus Grosshadern, Marchioninistr. 15, 81377, Munich, Germany
| | - Matthias Woiczinski
- Department of Orthopedic Surgery, Physical Medicine and Rehabilitation, University Hospital of Munich (LMU), Campus Grosshadern, Marchioninistr. 15, 81377, Munich, Germany
| | - Tatjana Müller
- Department of Orthopedic Surgery, Physical Medicine and Rehabilitation, University Hospital of Munich (LMU), Campus Grosshadern, Marchioninistr. 15, 81377, Munich, Germany
| | - Peter E Müller
- Department of Orthopedic Surgery, Physical Medicine and Rehabilitation, University Hospital of Munich (LMU), Campus Grosshadern, Marchioninistr. 15, 81377, Munich, Germany
| | - Volkmar Jansson
- Department of Orthopedic Surgery, Physical Medicine and Rehabilitation, University Hospital of Munich (LMU), Campus Grosshadern, Marchioninistr. 15, 81377, Munich, Germany
| | - Andreas Fottner
- Department of Orthopedic Surgery, Physical Medicine and Rehabilitation, University Hospital of Munich (LMU), Campus Grosshadern, Marchioninistr. 15, 81377, Munich, Germany
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Feczko PZ, Pijls BG, van Steijn MJ, van Rhijn LW, Arts JJ, Emans PJ. Tibial component rotation in total knee arthroplasty. BMC Musculoskelet Disord 2016; 17:87. [PMID: 26883741 PMCID: PMC4756521 DOI: 10.1186/s12891-016-0940-z] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2015] [Accepted: 02/10/2016] [Indexed: 11/23/2022] Open
Abstract
Background Both the range of motion (ROM) technique and the tibial tubercle landmark (TTL) technique are frequently used to align the tibial component into proper rotational position during total knee arthroplasty (TKA). The aim of the study was to assess the intra-operative differences in tibial rotation position during computer-navigated primary TKA using either the TTL or ROM techniques. The ROM technique was hypothesized to be a repeatable method and to produce different tibial rotation positions compared to the TTL technique. Methods A prospective, observational study was performed to evaluate the antero-posterior axis of the cut proximal tibia using both the ROM and the TTL technique during primary TKA without postoperative clinical assessment. Computer navigation was used to measure this difference in 20 consecutive knees of 20 patients who underwent a posterior stabilized total knee arthroplasty with a fixed-bearing polyethylene insert and a patella resurfacing. Results The ROM technique is a repeatable method with an interclass correlation coefficient (ICC2) of 0.84 (p < 0.001). The trial tibial baseplate was on average 4.56 degrees externally rotated compared to the tubercle landmark. This difference was statistically significant (p = 0.028). The amount of maximum intra-operative flexion and the pre-operative mechanical axis were positively correlated with the magnitude of difference between the two methods. Conclusions It is important for the orthopaedic surgeon to realise that there is a significant difference between the TTL technique and ROM technique when positioning the tibial component in a rotational position. This difference is correlated with high maximum flexion and mechanical axis deviations.
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Affiliation(s)
- Peter Z Feczko
- Department of Orthopaedic Surgery, Maastricht University Medical Centre, P.O. Box 5800, 6202 AZ, Maastricht, The Netherlands.
| | - Bart G Pijls
- Department of Orthopaedic Surgery, Maastricht University Medical Centre, P.O. Box 5800, 6202 AZ, Maastricht, The Netherlands
| | - Michael J van Steijn
- Department of Orthopaedic Surgery, Maastricht University Medical Centre, P.O. Box 5800, 6202 AZ, Maastricht, The Netherlands
| | - Lodewijk W van Rhijn
- Department of Orthopaedic Surgery, Maastricht University Medical Centre, P.O. Box 5800, 6202 AZ, Maastricht, The Netherlands
| | - Jacobus J Arts
- Department of Orthopaedic Surgery, Maastricht University Medical Centre, P.O. Box 5800, 6202 AZ, Maastricht, The Netherlands
| | - Peter J Emans
- Department of Orthopaedic Surgery, Maastricht University Medical Centre, P.O. Box 5800, 6202 AZ, Maastricht, The Netherlands
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Heyse TJ, Stiehl JB, Tibesku CO. Measuring tibial component rotation of TKA in MRI: What is reproducible? Knee 2015; 22:604-8. [PMID: 26043879 DOI: 10.1016/j.knee.2015.01.009] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2014] [Revised: 01/11/2015] [Accepted: 01/21/2015] [Indexed: 02/02/2023]
Abstract
PURPOSE Correct rotational alignment of components is crucial for the success of total knee arthroplasty (TKA). Defining landmarks on the tibia that allow for reproducible measurement of component rotation seems to be more challenging than on the femoral side. This study compares the reproducibility of three different measurement techniques. SCOPE A magnetic resonance imaging (MRI) analysis of 55 patients following TKA was conducted. The rotation of the tibial components was determined using three different reference lines: a tangent to the posterior tibial margin, the tibial epicondylar axis, and the tibial tubercle. Data were analyzed for intra- and inter-observer reliability using intra-class correlation coefficients (ICCs), and a variance comparison between measurement techniques via F-test. RESULTS Highest reliability and lowest variances for measurement of tibial component rotation were achieved by relation to the tibial epicondylar axis and posterior tibial margin. The tibial tubercle proved to be less reliable (ICC 0.632 (interobserver) and 0.526 (intraobserver)), and variances were significantly higher in comparison with the other two techniques. CONCLUSION Based on the presented MRI data, measurements of the tibial component rotation are done best using the posterior tibial margin and the tibial epicondylar axis. The tibial tubercle measurement proved to be less reliable for this purpose. We suggest that all three reference lines will be used for assessment of a painful knee following TKA to allow for informed decision making and for choice of best treatment options for the patient.
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Affiliation(s)
- Thomas J Heyse
- Department of Orthopedics and Rheumatology, University Hospital Marburg, Baldingerstrasse, 35037 Marburg, Germany
| | - James B Stiehl
- Department of Surgery, St Mary's Hospital, 1054 Martin Luther King Drive, Centralia, IL 62801, USA
| | - Carsten O Tibesku
- Sporthopaedicum Straubing, Bahnhofplatz 27, 94315 Straubing, Germany.
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Valkering KP, Breugem SJ, van den Bekerom MPJ, Tuinebreijer WE, van Geenen RCI. Effect of rotational alignment on outcome of total knee arthroplasty. Acta Orthop 2015; 86:432-9. [PMID: 25708694 PMCID: PMC4513597 DOI: 10.3109/17453674.2015.1022438] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
BACKGROUND AND PURPOSE Poor outcomes have been linked to errors in rotational alignment of total knee arthroplasty components. The aims of this study were to determine the correlation between rotational alignment and outcome, to review the success of revision for malrotated total knee arthroplasty, and to determine whether evidence-based guidelines for malrotated total knee arthroplasty can be proposed. PATIENTS AND METHODS We conducted a systematic review including all studies reporting on both rotational alignment and functional outcome. Comparable studies were used in a correlation analysis and results of revision were analyzed separately. RESULTS 846 studies were identified, 25 of which met the inclusion criteria. From this selection, 11 studies could be included in the correlation analysis. A medium positive correlation (ρ = 0.44, 95% CI: 0.27-0.59) and a large positive correlation (ρ = 0.68, 95% CI: 0.64-0.73) were found between external rotation of the tibial component and the femoral component, respectively, and the Knee Society score. Revision for malrotation gave positive results in all 6 studies in this field. INTERPRETATION Medium and large positive correlations were found between tibial and femoral component rotational alignment on the one hand and better functional outcome on the other. Revision of malrotated total knee arthroplasty may be successful. However, a clear cutoff point for revision for malrotated total knee arthroplasty components could not be identified.
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Affiliation(s)
- Kars P Valkering
- Departments of Orthopaedic Surgery,Amphia Hospital, Breda, the Netherlands
| | | | | | - Willem E Tuinebreijer
- Departments of Department of General Surgery, Red Cross Hospital, Beverwijk, the Netherlands
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Knee alignment in the transverse plane during weight-bearing activity and its implication for the tibial rotational alignment in total knee arthroplasty. Clin Biomech (Bristol, Avon) 2015; 30:565-71. [PMID: 25936578 DOI: 10.1016/j.clinbiomech.2015.04.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2014] [Revised: 04/04/2015] [Accepted: 04/08/2015] [Indexed: 02/07/2023]
Abstract
BACKGROUND The alignment of the knee in the transverse plane is important to the biomechanical functions of the lower limb, and is also associated with the outcomes of the total knee arthroplasty. This study aimed to evaluate the dynamic tibiofemoral alignment in the transverse plane during a weight-bearing activity. METHODS Knee kinematics of weight-bearing flexion from 0° to 120° was obtained in 16 healthy subjects utilizing biplanar radiography and 3D-2D registration techniques. The anteroposterior axes of the femur at multiple flexion angles in the range of knee motion were used to calculate the anteroposterior axis of motion using the least square method. The latter was compared to six surface-derived anatomical axes in the proximal tibia which were most commonly reported in the literature. The relationship between the anteroposterior axis of motion and the tibial tubercle was also quantified. FINDINGS The anteroposterior axis of motion did not coincide with any of the six anatomical axes tested. Their orientations varied from 10.3° of external rotation to 9.9° of internal rotation in relation to the former. The anteroposterior axis of motion tended to intersect the tibial tubercle between the medial border and the medial 1/3 point. INTERPRETATION Instead of any of the tested anatomical axes, the transverse knee alignment during functional movements is associated with the medial 1/3 portion of the tibial tubercle. This region may be helpful for the rotational alignment of the tibial components in total knee arthroplasty.
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18
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Clarke HD. Tibial component rotation: The inveterate problem. Knee 2014; 21:879-80. [PMID: 25245604 DOI: 10.1016/j.knee.2014.08.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2013] [Revised: 05/07/2014] [Accepted: 05/22/2014] [Indexed: 02/02/2023]
Affiliation(s)
- Henry D Clarke
- Department of Orthopedic Surgery Mayo Clinic Phoenix, AZ, USA
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19
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Clarke HD. Tibial component rotation: The inveterate problem. Knee 2014:S0968-0160(14)00151-3. [PMID: 25199713 DOI: 10.1016/j.knee.2014.07.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
The Publisher regrets that this article is an accidental duplication of an article that has already been published, http://dx.doi.org/10.1016/j.knee.2014.08.010. The duplicate article has therefore been withdrawn. The full Elsevier Policy on Article Withdrawal can be found at http://www.elsevier.com/locate/withdrawalpolicy.
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Martin S, Saurez A, Ismaily S, Ashfaq K, Noble P, Incavo SJ. Maximizing tibial coverage is detrimental to proper rotational alignment. Clin Orthop Relat Res 2014; 472:121-5. [PMID: 23653101 PMCID: PMC3889435 DOI: 10.1007/s11999-013-3047-y] [Citation(s) in RCA: 64] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Traditionally, the placement of the tibial component in total knee arthroplasty (TKA) has focused on maximizing coverage of the tibial surface. However, the degree to which maximal coverage affects correct rotational placement of symmetric and asymmetric tibial components has not been well defined and might represent an implant design issue worthy of further inquiry. QUESTIONS/PURPOSES Using four commercially available tibial components (two symmetric, two asymmetric), we sought to determine (1) the overall amount of malrotation that would occur if components were placed for maximal tibial coverage; and (2) whether the asymmetric designs would result in less malrotation than the symmetric designs when placed for maximal coverage in a computer model using CT reconstructions. METHODS CT reconstructions of 30 tibial specimens were used to generate three-dimensional tibia reconstructions with attention to the tibial anatomic axis, the tibial tubercle, and the resected tibial surface. Using strict criteria, four commercially available tibial designs (two symmetric, two asymmetric) were placed on the resected tibial surface. The resulting component rotation was examined. RESULTS Among all four designs, 70% of all tibial components placed in orientation maximizing fit to resection surface were internally malrotated (average 9°). The asymmetric designs had fewer cases of malrotation (28% and 52% for the two asymmetric designs, 100% and 96% for the two symmetric designs; p < 0.001) and less malrotation on average (2° and 5° for the asymmetric designs, 14° for both symmetric designs; p < 0.001). CONCLUSIONS Maximizing tibial coverage resulted in implant malrotation in a large percentage of cases. Given similar amounts of tibial coverage, correct rotational positioning was more likely to occur with the asymmetric designs. CLINICAL RELEVANCE Malrotation of components is an important cause of failure in TKA. Priority should be given to correct tibial rotational positioning. This study suggested that it is easier to balance rotation and coverage with asymmetric tibial baseplates; clinical research will need to determine whether the observed difference affects patellar tracking, loosening rates, or the likelihood of revisions after TKA.
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Affiliation(s)
- Stacey Martin
- />Methodist Center for Orthopaedic Surgery, 6550 Fannin, Suite 2600, Houston, TX 77030 USA
| | - Alex Saurez
- />Institute of Orthopaedic Research and Education, Houston, TX USA
| | - Sabir Ismaily
- />Institute of Orthopaedic Research and Education, Houston, TX USA
| | - Kashif Ashfaq
- />Methodist Center for Orthopaedic Surgery, 6550 Fannin, Suite 2600, Houston, TX 77030 USA
| | - Philip Noble
- />Institute of Orthopaedic Research and Education, Houston, TX USA
| | - Stephen J. Incavo
- />Methodist Center for Orthopaedic Surgery, 6550 Fannin, Suite 2600, Houston, TX 77030 USA
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Roper GE, Bloemke AD, Roberts CC, Spangehl MJ, Clarke HD. Analysis of tibial component rotation following total knee arthroplasty using 3D high definition computed tomography. J Arthroplasty 2013; 28:106-11. [PMID: 23906867 DOI: 10.1016/j.arth.2013.04.053] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2012] [Revised: 03/11/2013] [Accepted: 04/07/2013] [Indexed: 02/01/2023] Open
Abstract
Malrotation of the tibial component is associated with poor outcomes after total knee arthroplasty, yet the definition and evaluation of this problem remain controversial. Contributing factors to this controversy include inconsistent and cumbersome methods for measuring rotation, based upon transposed measurements from multiple computed tomography images. We developed and tested the reliability of a new, simple method for measuring tibial component rotation based upon a single, three-dimensional high definition, axial computed tomography image. Sixty individual knees after total knee arthroplasty were evaluated. The intra-reliability and inter-reliability both exceeded 0.9 whether the tibial component was made of titanium, cobalt-chrome or all-polyethylene. Based upon these findings we suggest that this technique be used for evaluating tibial component rotation in future studies.
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Affiliation(s)
- Glade E Roper
- Department of Radiology, Mayo Clinic, Phoenix, Arizona
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Abstract
Today's most basic and important total knee replacement design concepts arose out of an earlier era in which 2 distinct approaches emerged, functional and anatomic. Functional approaches simplified knee kinetics, were easier to implant, and gained widespread popularity, in part, from their inventory control. Anatomic approaches were an attempt to recreate normal knee motion with low prosthetic contact stress. Historically, however, they became impractical to produce because of the cost of maintaining a wide variety of anatomic knee implants. New customized designs may return the anatomic design to favor due to several key features that borrow anatomic principles developed in the past, and improved with new ideas.
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Affiliation(s)
- Evan M. Schwechter
- Department of Orthopedic Surgery, Brigham and Women’s Hospital, 75 Francis Street, Boston, MA 02115 USA
| | - Wolfgang Fitz
- Department of Orthopedic Surgery, Brigham and Women’s Hospital, 75 Francis Street, Boston, MA 02115 USA
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Driscoll MD, Isabell GP, Conditt MA, Ismaily SK, Jupiter DC, Noble PC, Lowe WR. Comparison of 2 femoral tunnel locations in anatomic single-bundle anterior cruciate ligament reconstruction: a biomechanical study. Arthroscopy 2012; 28:1481-9. [PMID: 22796141 DOI: 10.1016/j.arthro.2012.03.019] [Citation(s) in RCA: 63] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2011] [Revised: 03/13/2012] [Accepted: 03/14/2012] [Indexed: 02/02/2023]
Abstract
PURPOSE To evaluate knee stability after anterior cruciate ligament (ACL) reconstruction using 2 modern clinically relevant single-bundle constructs. METHODS Two arthroscopic ACL reconstructions were performed on 6 fresh-frozen human cadaveric knees using bone-patellar tendon-bone autografts. The tibial tunnel was centered in the anatomic tibial footprint. The femoral tunnel was reamed through the anteromedial (AM) portal and centered alternately in either the AM portion of the femoral footprint (center-AM) or the center of the femoral footprint (center-center). Two external loading conditions were applied: (1) a 134-N anterior tibial load and (2) a 10-Nm valgus load combined with a 5-Nm internal tibial torque. Resulting kinematics were determined under 4 conditions: (1) ACL intact, (2) ACL deficient, (3) center-AM reconstruction, and (4) center-center reconstruction. RESULTS In response to anterior tibial loading, anterior translation was similar in the ACL-intact knee and the 2 reconstructions at 0° to 60° of flexion but was greater in the reconstructed specimens at 90°. In response to the complex rotatory load, internal tibial rotation (ITR) at 30° of flexion was slightly greater in center-AM knees compared with ACL-intact knees (11.0° ± 0.6° v 10.5° ± 0.6°, P = .03). At other angles tested, ITR in both reconstructions was similar to the ACL-intact knee (P > .05). When we compared the 2 reconstruction alternatives, however, center-center knees exhibited greater resistance to ITR at all angles (P < .05). CONCLUSION Anatomic single-bundle ACL reconstruction performed with the femoral tunnel placed through the AM portal restores translational and rotational knee stability to an extent that closely approximates the ACL-intact condition. When compared with the AM femoral tunnel position, a femoral tunnel positioned in the anatomic center of the femoral origin of the ACL may further improve rotatory stability without sacrificing anterior stability. CLINICAL RELEVANCE This study provides additional biomechanical evidence in support of anatomic single-bundle ACL reconstruction with tunnels positioned in the center of the femoral and tibial footprints.
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