Improving Tibial Component Coronal Alignment During Total Knee Arthroplasty with the Use of a Double‐Check Technique

Abstract

ObjectiveTo compare the efficacy of the restoration of tibial component coronal alignment with a double‐check technique and the conventional surgical technique during total knee arthroplasty (TKA) in knee osteoarthritis patients, and to investigate the distribution of the medial proximal tibial angle (MPTA) after TKA.MethodsA retrospective review was performed of 151 patients (179 knees) with knee osteoarthritis undergoing primary TKA in Beijing Chaoyang Hospital, Capital Medical University from February 2013 to January 2015 to evaluate the differences in MPTA in patients undergoing the conventional TKA and those undergoing a modified TKA with a double‐check technique after the surgery. All patients were evaluated by MPTA, range of motion (ROM), Knee Society Clinical Rating System (KSS) clinical scores, and KSS functional scores. An MPTA deviation of 3° or greater was considered malalignment.ResultsA total of 130 TKA procedures in 119 patients were included in the study: 64 knees treated with conventional TKA and 66 knees treated with the double‐check technique TKA. The mean postoperative MPTA was 88.6° ± 2.2° in the conventional TKA group and 89.1° ± 1.5° in the double‐check TKA group. The mean postoperative MPTA between the two groups was not significantly different. In the conventional TKA group, 79.7% (51 knees) had a postoperative MPTA deviation within 3° and 20.3% (13 knees) had a MPTA deviation greater than 3°. In the double‐check TKA group, 93.9% (62 knees) had a postoperative MPTA deviation within 3°and 6.1% (4 knees) had a MPTA deviation greater than 3°. The postoperative MPTA deviation within 3° showed a statistically significant difference between the two groups. In the double‐check TKA group, a 21.2% (14 knees) tibial malalignment was detected after the first check and a 9.1% (6 knees) tibial malalignment was detected after the second check. The mean postoperative ROM was 118.1° ± 9.2° in the conventional TKA group and 115.7° ± 10.1° in the double‐check TKA group. The mean postoperative KSS clinical score was 89.3 ± 3.5 in the conventional TKA group and 89.0 ± 3.7 in the double‐check TKA group. The mean postoperative KSS functional score was 84.8 ± 10.0 in the conventional TKA group and 84.9 ± 9.0 in the double‐check TKA group. The mean postoperative ROM, KSS clinical scores, and KSS functional scores between the two groups were not statistically significantly different.ConclusionMalalignment of the tibial component can occur after conventional TKA, and the double‐check technique is an effective method to improve tibial component coronal alignment.

Comparison of Kinematic Alignment and Mechanical Alignment in Total Knee Arthroplasty: A Meta‐analysis of Randomized Controlled Clinical Trials

“…Traditional mechanical alignment (MA) has been used in TKA for more than 30 years, and it is still common worldwide. It is generally believed that a hip–knee–ankle (HKA) angle within less than 3° of the neutral mechanical axis is essential for postoperative limb recovery after TKA 9, 10 . With the development of knee biomechanics, however, many people have assumed that MA does not entirely restore normal lower limb alignment, may alter the normal kinematics of knee motion and so contribute to some of the most serious ramifications.…”

A biomechanical comparison between robotic and conventional total knee arthroplasty (TKA) in resection accuracy: a meta‐analysis on cadaveric specimens

“…However, future studies would need to more comprehensively evaluate this phenomenon to validate it. Nevertheless, studies on the clinical value of tibial component coronal alignment suggest that a more accurate proximal tibial resection that yields a better tibial coronal resection error is not associated with higher range of motion, KSS clinical, or KSS functional scores [8].…”