How does the inclination of the tibial component matter? A three-dimensional finite element analysis of medial mobile-bearing unicompartmental arthroplasty

Dai, Xuesong; Fang, Jinghua; Jiang, Lifeng; Xiong, Yan; Zhang, Miaofeng; Zhu, Shibin

doi:10.1016/j.knee.2018.02.004

Cited by 30 publications

(28 citation statements)

References 24 publications

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“…Rivière et al 35 conducted the computer simulation study and revealed that a varus aligned tibial tray in Oxford UKA showed better adaptation than mechanical aligned (perpendicular to the tibial axis) tray. Dai et al 36 reported that a slight varus implantation of the Oxford tibial tray reduced the peak stress on the medial cortex in a 3-D finite element analysis study. In addition, these experimental studies, the acceptable range of tibial component alignment has been considered within < 5° varus to < 5° valgus 37 .…”

Section: Discussionmentioning

confidence: 99%

Tibial shape and size predicts the risk of tibial plateau fracture after cementless unicompartmental knee arthroplasty in Japanese patients

Hiranaka

Yoshikawa

Yoshida

et al. 2020

The Bone & Joint Journal

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Aims Cementless unicompartmental knee arthroplasty (UKA) has advantages over cemented UKA, including improved fixation, but has a higher risk of tibial plateau fracture, particularly in Japanese patients. The aim of this multicentre study was to determine when cementless tibial components could safely be used in Japanese patients based on the size and shape of the tibia. Methods The study involved 212 cementless Oxford UKAs which were undertaken in 174 patients in six hospitals. The medial eminence line (MEL), which is a line parallel to the tibial axis passing through the tip of medial intercondylar eminence, was drawn on preoperative radiographs. Knees were classified as having a very overhanging medial tibial condyle if this line passed medial to the medial tibial cortex. They were also classified as very small if a size A/AA tibial component was used. Results The overall rate of fracture was 8% (17 out of 212 knees). The rate was higher in knees with very overhanging condyles (Odds ratio (OR) 13; p < 0.001) and with very small components (OR 7; p < 0.001). The OR was 21 (p < 0.001) in those with both very overhanging condyles and very small components. In all, 69% of knees (147) had neither very overhanging nor very small components, and the fracture rate in these patients was 1.4% (2 out of 147 knees). Males had a significantly reduced risk of fracture (OR 0.13; p = 0.002), probably because no males required very small components and females were more likely to have very overhanging condyles (OR 3; p = 0.013). 31% of knees (66) were in males and in these the rate of fracture was 1.5% (1 out of 66 knees). Conclusion The rate of tibial plateau fracture in Japanese patients undergoing cementless UKA is high. We recommend that cemented tibial fixation should be used in Japanese patients who require very small components or have very overhanging condyles, as identified from preoperative radiographs. In the remaining 69% of knees cementless fixation can be used. This approach should result in a low rate of fracture. Cite this article: Bone Joint J 2020;102-B(7):861–867.

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Section: Discussionmentioning

confidence: 99%

Tibial shape and size predicts the risk of tibial plateau fracture after cementless unicompartmental knee arthroplasty in Japanese patients

Hiranaka

Yoshikawa

Yoshida

et al. 2020

The Bone & Joint Journal

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“…They consistently demonstrated that neutral alignment in the coronal plane is most optimal in terms of strain on the native tibia. 101 - 103 …”

Section: Resultsmentioning

confidence: 99%

A structured evaluation of the symptomatic medial Oxford unicompartmental knee arthroplasty (UKA)

et al. 2021

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Unicompartmental knee arthroplasty (UKA) has several advantages over total knee arthroplasty; however, in many reports, the risk of revision remains higher after UKA. Many reasons for failure of UKA exist. Successful treatment starts with accurate assessment of the symptomatic UKA as a specific mode of failure requires a specific solution. A structured and comprehensive evaluation aids assessment of the symptomatic UKA. This review provides an overview of the causes for a symptomatic medial UKA, its risk factors, diagnostic modalities that can be used, and briefly discusses treatment options. Cite this article: EFORT Open Rev 2021;6:850-860. DOI: 10.1302/2058-5241.6.200105

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“…In addition, Dai et al concluded that a slight varus inclination of the mobile-bearing tibial component is acceptable as it lowers the peak stress on the medial cortex using a three-dimensional finite element analysis. 22 Zambianchi et al reported that revised UKAs had an average tibial component alignment of 0.2 AE 2.5 degree varus, while unrevised UKAs showed an average tibial component alignment of 3.8 AE 3.7 degree varus. They suggested that a slight varus alignment of the tibial component relative to the tibial longitudinal axis may be preferable over valgus deviations.…”

Section: Discussionmentioning

confidence: 99%

Radiographic Comparison of the Mechanical Axis Including Calcaneus to the Conventional Mechanical Axis in Medial Unicompartmental Knee Arthroplasty

et al. 2019

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Since a hindfoot alignment is not included in the conventional mechanical axis (hip–ankle [HA] line), a mechanical axis including the calcaneus (hip–calcaneus [HC] line) has recently attracted attention as an alternative weight-bearing line. However, there are few reports on unicompartmental knee arthroplasty (UKA) regarding the HC line. Therefore, this study aimed to compare postoperative alignments after UKA between the HA line and the HC line. Postoperatively, HC radiographs were taken in 88 consecutive patients who underwent medial UKA. The hip–knee–ankle (HKA) and hip–knee–calcaneus (HKC) angles were compared in the same patient. Regarding tibial inclination, the conventional tibial component–ankle (TCA) angle was compared with reference to the HC line (tibial component–calcaneus [TCC] angle). The mean postoperative HKA and HKC angles were 2.8 ± 2.7 and 2.0 ± 2.5 degree, respectively. The mean postoperative TCA and TCC angles were 87.7 ± 2.1 and 88.5 ± 2.1 degree, respectively. There were significant differences between the two groups in both lower limb alignment and tibial component angle. The present study indicated that the HKC and the TCC angles significantly decreased the varus alignment by approximately 1 degree compared with the HKA and TCA angles. Neutral in the HA line corresponds to valgus in reference to the HC line, which may result in overcorrection. Surgeons should consider evaluating the HC line in place of the HA line, which may affect preoperative planning and postoperative outcome during UKA. This is a Level II, diagnostic study.

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How does the inclination of the tibial component matter? A three-dimensional finite element analysis of medial mobile-bearing unicompartmental arthroplasty

Cited by 30 publications

References 24 publications

Tibial shape and size predicts the risk of tibial plateau fracture after cementless unicompartmental knee arthroplasty in Japanese patients

Tibial shape and size predicts the risk of tibial plateau fracture after cementless unicompartmental knee arthroplasty in Japanese patients

A structured evaluation of the symptomatic medial Oxford unicompartmental knee arthroplasty (UKA)

Radiographic Comparison of the Mechanical Axis Including Calcaneus to the Conventional Mechanical Axis in Medial Unicompartmental Knee Arthroplasty

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