Effects of tibial baseplate shape on rotational alignment in total knee arthroplasty: three-dimensional surgical simulation using osteoarthritis knees

Ma, Yu; Mizu-uchi, Hideki; Okazaki, Ken; Ushio, Tetsuro; Murakami, Koji; Hamai, Satoshi; Akasaki, Yukio; Nakashima, Yasuharu

doi:10.1007/s00402-017-2828-2

Cited by 16 publications

(24 citation statements)

References 36 publications

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“…What is more, the percentage position of all implant AP axis over the patellar tendon was 26.95% on average, which is close to the intersection point of the Insall line. Ma et al 19 also found a similar position with a different anatomical prosthesis, which strongly supported our findings. The percentage position analyzed in our study was different from the baseplate orientation that it could help direct the mediolateral translation when a specific rotational alignment has already been set in clinical practice.…”

Section: Discussionsupporting

confidence: 91%

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Approximating the maximum tibial coverage in total knee arthroplasty does not necessarily result in implant malrotation

Shao

Wang

et al. 2020

Sci Rep

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Traditionally, the practice of the tibial component placement in total knee arthroplasty has focused on achieving maximum coverage without malrotation. However, the concept of maximizing coverage has not been well defined or researched and yet biased results are often produced. This study aimed to evaluate the effect of a prioritizing maximum coverage positioning strategy on the rotational alignment by using a strict computer algorithm. Computed tomographic scans of 103 tibial specimens were used to reconstruct three-dimensional tibia models. A virtual surgery was performed to generate the resection plane with a posterior slope of 7° on the proximal tibia. Symmetrical and anatomical tibial components were placed and analyzed with an automated program designed for approximating the maximum coverage based on the coherent point drift algorithm. We found that the average tibial coverage achieved across all specimens and implants was 85.62 ± 3.65%, ranging from 83.64 ± 4.10% to 86.69 ± 3.07%. When placed for maximal tibial coverage, the mean degree of rotation related to the Insall line was − 0.73° ± 4.53° for all subjects, 23% of the tibial components were malrotated. The average percentage position of the baseplate anteroposterior axis over the patellar tendon was 26.95 ± 14.71% from the medial edge. These results suggest that with specific design and proper placement of the component, approximating the maximum tibial coverage in total knee arthroplasty does not necessarily result in implant malrotation. the current tibial baseplates have shown good performance on the coverage when aligned parallel to the Insall line with the anteroposterior axis positioned between the medial 1/3 and medial 1/6 of the patella tendon. Insufficient implant coverage and bone support at the osteotomy level could increase the amount of bleeding into the articular cavity of the knee in the immediate postoperative period, which may also increase osteolysis from wear by debris in the long term follow-up, finally resulting in subsidence and instability 1,2. Meanwhile, proper tibial rotation is another key factor that is crucial to the kinematic alignment and long-term survivorship of the prosthesis 3-5. Ideally, a satisfying total knee arthroplasty (TKA) ought to maximize tibial coverage without causing tibial malrotation. Several studies have evaluated both tibial coverage and rotational alignment with virtual matching by using preoperative imageological data 6-13. These studies mainly focused on the comparison between anatomic and symmetric designs which had always been a controversial issue. However, the various definitions of the malrotation and coverage maximizing methods applied in these studies make it hard to draw a firm conclusion on the compromise between coverage and ideal rotation while the latter has an inherent priority 8,14. Theoretically, maximizing coverage usually requires a larger size of the tibial baseplate, which under normal circumstances

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Section: Discussionsupporting

confidence: 91%

“…A coordinate system was modified by referencing the method of Kuwano 18 and Ma 19 . In this modified coordinate system, each of the 3D tibia specimens was repositioned with a standard translation and rotation procedure before the virtual osteotomy.…”

Section: Methodsmentioning

confidence: 99%

Approximating the maximum tibial coverage in total knee arthroplasty does not necessarily result in implant malrotation

Shao

Wang

et al. 2020

Sci Rep

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“…A coordinate system was modified through referencing the studies by Kuwano et al 13 and Ma et al 6 First, we established the longitudinal axis (Z-axis) of the tibial shaft which was defined as the anatomical axis (connecting upper and lower one-third of tibial shaft center) of the tibial shaft on the bone model. Then, we located the center of the PCL attachment which was recognized clearly in the posterior condylar notch of the tibia and the one-third medial side of the tibial tubercle.…”

Section: Three-dimensional (3d) Bone Model On a Modified Coordinate Systemmentioning

confidence: 99%

“…Recent studies showed conflicting results on general tibial coverage rates with symmetrical and anatomical designs due to variations in ethnic groups, alignment strategies, and sizing philosophies. [3][4][5][6][7] These studies focused on basic dimensions of the proximal tibia and relationship between maximizing coverage and malrotation. The medial onethird of the tibial tubercle alignment established by Insall and the medial edge of patella tendon alignment introduced by Akagi were used in most of these studies which reflects the wide acceptance of these two references in the orthopaedist community.…”

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confidence: 99%

Effect of Tibial Component Alignment and Posterior Slope on Tibial Coverage in a Chinese Population: A Three-dimensional Anthropometric Study

et al. 2018

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The standard for rotational alignment and posterior slope of the tibial component in total knee arthroplasty remains controversial. This study aimed to evaluate the effect of tibial component alignment and posterior slope on tibial coverage. Computer tomographic scans of 101 tibial specimens were used to reconstruct three-dimensional tibia models. A virtual surgery was performed to generate a resection plane with different posterior slopes on the proximal tibia. Symmetrical and anatomical tibial components were placed aligning to the medial one-third of tibial tubercle (Insall) and the medial edge of patella tendon (Akagi), respectively. Differences in coverage and mismatch were evaluated and statistically compared across alignments, slope angles, and genders. The tibial coverage increased from 83.21 to 85.96% for Akagi's alignments and from 85.19 to 87.22% for Insall alignments along with the increasing of posterior slope from 0 to 7 degrees. Regardless of the prosthesis design, there was a significant difference between two rotational alignments as the Insall alignment was significantly higher in tibial coverage. With a slope of 7 degrees, more overhang along with less underhang anteromedially were found in males compared with females. The current anatomical tibial design has a tendency of overhang in the anteromedial zone which does not exist in the symmetrical design. The current tibial baseplate design has better tibial coverage when aligning to the medial third of tibial tuberosity with slopes of 5 and 7 degrees. Gender difference should be taken into account and given priority for prosthesis design.

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“…Virtual surgery has an advantage on the precise evaluation of AP alignment 19 . By aligning the mechanical axis of femur and tibia and by adjusting the internal-external rotation in the intended direction, malrotation of the femorotibial joint can be corrected 18 .…”

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confidence: 99%

Evaluation of tibial rotational axis in total knee arthroplasty using magnetic resonance imaging

Nam

Koh

Kim³

et al. 2020

Sci Rep

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Surgeon-dependent factors such as optimal implant alignment of the tibial component are thought to play a significant role in the outcome following primary total knee arthroplasty (TKA). In addition, tibial component malrotation is associated with pain, stiffness, and altered patellofemoral kinematics in TKA. However, measuring tibial component rotation after TKA is difficult. Therefore, the purpose of this study was to find a reliable method for positioning the tibial component in TKA. To investigate the morphology of the tibial plateau, 977 patients' knees (829 females and 148 males) were evaluated using MRI. The relationships between the femoral transepicondylar axis (TEA), Akagi line, posterior tibial margin (PTM), medial third of the tibial tubercle (MTT), and anatomical tibial axis (ATS) were investigated in this study. In addition, gender difference in tibial rotational alignment were evaluated. Relative to the TEA, the MTT and ATS were externally rotated by 0.5° ± 4.4° and 0.5° ± 5.4°, respectively, while Akagi line and PTM were internally rotated by 3.7° ± 4.5° and 9.9° ± 6.1°, respectively. Gender differences were found in MTT, Akagi line and ATS (P < 0.05). Our result showed that the rotational alignment led to notable variance between femoral and tibial components using fixed bone landmarks. The MTT and ATS axes showed the closest perpendicular aspect with projected TEA. And the MTT and Akagi axes showed the reduced variance. In addition, PTM is not a reliable landmark for rotation of the tibial component. Based on the results of this study, surgeons may choose the proper anteroposterior axis of the tibial component in order to reduce rotational mismatch and improve clinical outcomes.

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Effects of tibial baseplate shape on rotational alignment in total knee arthroplasty: three-dimensional surgical simulation using osteoarthritis knees

Cited by 16 publications

References 36 publications

Approximating the maximum tibial coverage in total knee arthroplasty does not necessarily result in implant malrotation

Approximating the maximum tibial coverage in total knee arthroplasty does not necessarily result in implant malrotation

Effect of Tibial Component Alignment and Posterior Slope on Tibial Coverage in a Chinese Population: A Three-dimensional Anthropometric Study

Evaluation of tibial rotational axis in total knee arthroplasty using magnetic resonance imaging

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