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

Nam, Ji-Hoon; Koh, Yong‐Gon; Kim, Paul Shinil; Kim, Gihun; Kwak, Yoon Hae; Kang, Kyoung‐Tak

doi:10.1038/s41598-020-70851-z

Cited by 8 publications

(10 citation statements)

References 28 publications

(65 reference statements)

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“… 17 The PCA is often used in other orthopaedic subspecialties (eg, to assess rotation in patients with tibial torsion or to assess the component position for patients undergoing total knee arthroplasty). 28 , 34 Utilizing the PCA as a reference, we calculated an angle (mean, 102.6° ± 8.3°) to define the hinge axis position as a reproducible reference point for the ideal hinge axis position in MOWHTO when no PTS correction is required.…”

Section: Discussionmentioning

confidence: 99%

Extreme Hinge Axis Positions Are Necessary to Achieve Posterior Tibial Slope Reduction With Small Coronal-Plane Corrections in Medial Opening Wedge High Tibial Osteotomy

Eliasberg

Kunze

Swartwout

et al. 2022

Orthopaedic Journal of Sports Medicine

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Background: Both coronal- and sagittal-plane knee malalignment can increase the risk of ligamentous injuries and the progression of degenerative joint disease. High tibial osteotomy can achieve multiplanar correction, but determining the precise hinge axis position for osteotomy is technically challenging. Purpose: To create computed tomography (CT)–based patient-specific models to identify the ideal hinge axis position angle and the amount of maximum opening in medial opening wedge high tibial osteotomy (MOWHTO) required to achieve the desired multiplanar correction. Study Design: Descriptive laboratory study. Methods: A total of 10 patients with lower extremity CT scans were included. Baseline measurements including the mechanical tibiofemoral angle (mTFA) and the posterior tibial slope (PTS) were calculated. Virtual osteotomy was performed to achieve (1) a specified degree of PTS correction and (2) a planned degree of mTFA correction. The mean hinge axis position angle for MOWHTO to maintain an anatomic PTS (no slope correction) was 102.6° ± 8.3° relative to the posterior condylar axis (PCA). Using this as the baseline correction, the resultant hinge axis position and maximum opening were then calculated for each subsequent osteotomy procedure. Results: For 5.0° of mTFA correction, the hinge axis position was decreased by 6.8°, and the maximum opening was increased by 0.49 mm for every 1° of PTS correction. For 10.0° of mTFA correction, the hinge axis position was decreased by 5.2°, and the maximum opening was increased by 0.37 mm for every 1° of PTS correction. There was a significant difference in the trend-line slopes for hinge axis position versus PTS correction ( P = .013) and a significant difference in the trend-line intercepts for maximum opening versus PTS correction ( P < .0001). Conclusion: The mean hinge axis position for slope-neutral osteotomy was 102.6° ± 8.3° relative to the PCA. For smaller corrections in the coronal plane, more extreme hinge axis positions were necessary to achieve higher magnitudes of PTS reduction. Clinical Relevance: Extreme hinge axis positions are technically challenging and can lead to unstable osteotomy. Patient-specific instrumentation may allow for precise correction to be more readily achieved.

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Section: Discussionmentioning

confidence: 99%

Extreme Hinge Axis Positions Are Necessary to Achieve Posterior Tibial Slope Reduction With Small Coronal-Plane Corrections in Medial Opening Wedge High Tibial Osteotomy

Eliasberg

Kunze

Swartwout

et al. 2022

Orthopaedic Journal of Sports Medicine

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“…The consequences of tibial component internal rotation have been debated and discussed in other papers (Liu et al, 2020;Nam et al, 2020;Planckaert et al, 2018), and even though the literature data imply different resection angles that determine internal rotation of the tibial component, the particularity of our study lies in the fact that our analysis used the finite element method, which allowed us to determine the minimum value threshold that determines micro changes of the tibia, cement and polyethylene without causing symptoms.…”

Section: Discussionmentioning

confidence: 98%

Finite element analysis of the tibial component alignment in a transverse plane in total knee arthroplasty

Popescu¹,

Cristea²,

Oleksik³

et al. 2021

JAB

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The research aims to analyze the tibial component rotation using the finite element method by resecting the tibia in a transverse plane at an angle between 1.5° (external rotation) and -1.5° (internal rotation). We used a three-dimensional scanner to obtain the tibia's geometrical model of a cadaveric specimen. We then exported the surfaces of the tibial geometrical model through the Computer-Aided Three-dimensional Interactive Application (CATIA), which is a Computer-Aided Design (CAD) program. The CAD program threedimensionally shaped the tibial component, polyethylene, and cement. Our analysis determined that the maximum equivalent stress is obtained in the case of proximal tibial resection at -1.5° angle in a transverse plane (internal rotation) with a value of 12.75 MPa, which is also obtained for the polyethylene (7.693 MPa) and cement (6.6 MPa). The results have shown that detrimental effects begin to occur at -1.5°. We propose the use of this finite element method to simulate the positioning of the tibial component at different tibial resection angles to appreciate the optimal rotation.

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“…Lu [ 19 ] found the mismatch angles between the Akagi line and the SEA were 0.8° ± 5.0° and 3.0° ± 4.5° in the non-osteoarthritis knees of the male and female, respectively. The angular differences between the male and female have also been shown to exist in the varus knees [ 23 ]. However, the influence of gender differences on the locations of the patellar tendon attachment site as the anatomical landmark has not been investigated.…”

Section: Discussionmentioning

confidence: 99%

“…Installing femoral and tibial component in accordance with SEA is consistent with biomechanical characteristics [ 12 , 22 ]. On the tibial side, due to the inability of the surgeons to locate the SEA directly on the proximal tibial osteotomy surface, the researchers have attempted to establish optimal tibial rotational axes using appropriate intra- or extra-articular anatomical landmarks, such as the medial boundary of the tibial tuberosity [ 16 , 20 ], the medial third boundary of the tibial tuberosity [ 20 , 23 ], the anterior cortex of the tibia [ 16 ], the anterior tibial crest [ 19 , 21 ] and the tibial posterior condylar [ 23 , 25 , 26 ]. However, there is still a lack of consensus on tibial rotational alignment due to the low confidence and high individual variability of reference axes [ 13 , 27 ].…”

Section: Introductionmentioning

confidence: 99%

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Gender differences affect the location of the patellar tendon attachment site for tibial rotational alignment in total knee arthroplasty

Zhang

Zhou

et al. 2022

J Orthop Surg Res

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Purpose This study was carried out to investigate the accuracy of referring different locations of the patellar tendon attachment site and the geometrical center of the osteotomy surface for tibial rotational alignment and observe the influences of gender differences on the results. Methods Computed tomography scans of 135 osteoarthritis patients (82 females and 53 males) with varus deformity was obtained to reconstruct three-dimensional (3D) models preoperatively. The medial boundary, medial one-sixth, and medial one-third of the patellar tendon attachment site were marked on the tibia. These points were projected on the tibial osteotomy plane and connected to the geometrical center (GC) of the osteotomy plane or the middle of the posterior cruciate ligament (PCL) to construct six tibial rotational axes (Akagi line, MBPT, MSPT1, MSPT2, MTPT1 and MTPT2). The mismatch angle between the vertical line of the SEA projected on the proximal tibial osteotomy surface and six different reference axes was measured. In additional, the effect of gender differences on rotational alignment for tibial component were assessed. Results Relative to the SEA, rotational mismatch angles were − 1.8° ± 5.1° (Akagi line), − 2.5° ± 5.3° (MBPT), 2.8° ± 5.3° (MSPT1), 4.5° ± 5.4° (MSPT2), 7.3° ± 5.4° (MTPT1), and 11.6° ± 5.8° (MTPT2) for different tibial rotational axes in all patients. All measurements differed significantly between the male and female. The tibial rotational axes with the least mean absolute deviation for the female or male were Akagi line or MSPT, respectively. There was no significant difference in whether the GC of the osteotomy surface or the midpoint of PCL termination was chosen as the posterior anatomical landmark when the medial boundary or medial one-sixth point of the patellar tendon attachment site was selected as the anterior anatomical landmark. Conclusion When referring patellar tendon attachment site as anterior anatomical landmarks for tibial rotational alignment, the influence of gender difference on the accuracy needs to be taken into account. The geometric center of the tibial osteotomy plane can be used as a substitute for the middle of the PCL termination when reference the medial boundary or medial one-sixth of the patellar tendon attachment site.

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

Cited by 8 publications

References 28 publications

Extreme Hinge Axis Positions Are Necessary to Achieve Posterior Tibial Slope Reduction With Small Coronal-Plane Corrections in Medial Opening Wedge High Tibial Osteotomy

Extreme Hinge Axis Positions Are Necessary to Achieve Posterior Tibial Slope Reduction With Small Coronal-Plane Corrections in Medial Opening Wedge High Tibial Osteotomy

Finite element analysis of the tibial component alignment in a transverse plane in total knee arthroplasty

Gender differences affect the location of the patellar tendon attachment site for tibial rotational alignment in total knee arthroplasty

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