Is the Anterior Tibial Tuberosity a Reliable Rotational Landmark for the Tibial Component in Total Knee Arthroplasy?

Bonnin, Michel; Saffarini, Mo; Mercier, Pierre-Etienne; Laurent, Jean-Raphaël; Carrillon, Yannick

doi:10.1016/j.arth.2010.03.015

Cited by 77 publications

(81 citation statements)

References 39 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…These studies of distal femoral and proximal tibial rotational landmarks and subsequent femorotibial alignment have almost exclusively been based on CT imaging and patient cohorts with arthritis and/or deformity [2,4,12,13,15,26]. The operative management of patients with osteoarthritis should be aimed at restoring knee alignment and kinematics to the premorbid state.…”

Section: Introductionmentioning

confidence: 99%

Normal Femorotibial Rotational Alignment and Implications for Total Knee Arthroplasty: an MRI Analysis

et al. 2016

View full text Add to dashboard Cite

Background: Rotational alignment of prosthetic components in total knee arthroplasty (TKA) is important to successful outcomes. Component malrotation is a known cause of revision and understanding normal rotational alignment may help recreate normal joint kinematics. To date, no large MRI study assessing femorotibial rotational alignment in nonarthritic knees has been undertaken. Questions/ Purposes: Is Insall's tibial axis a reliable rotational landmark against common femoral rotational axes in the nonarthritic patient population? Methods: We reviewed 544 knee MRI scans performed for suspected soft tissue pathology and identified Insall's tibial rotational axis as well as the femoral clinical trans-epicondylar axis (TEAc), femoral surgical trans-epicondylar axis (TEAs), posterior condylar articular axis (PCA), and a modified Eckhoff's cylindrical axis. The perpendiculars of these axes were superimposed on Insall's tibial axis, and the angular differences were measured. Results: Insall's axis was internally rotated to the TEAc by 1.4°, externally rotated to Eckhoff's cylindrical axis by 1.8°, externally rotated to the TEAs by 2.7°, and externally rotated to the PCA by 3.5°. The mean deviation from 0°(optimal alignment for each femoral axis) was significantly greater for the PCA relative to all other femoral axis. Conclusion: Insall's axis is a reliable landmark for rotational positioning of the tibial component and may optimize femorotibial kinematics in fixed-bearing TKA.

show abstract

Section: Introductionmentioning

confidence: 99%

Normal Femorotibial Rotational Alignment and Implications for Total Knee Arthroplasty: an MRI Analysis

et al. 2016

View full text Add to dashboard Cite

show abstract

“…To properly rotate the tray with current designs, especially symmetric designs, tibial coverage may need to be decreased. Bonnin et al [7] noted that correct positioning of the tibial component requires that two criteria be fulfilled simultaneously; first, implant rotation ensuring optimal knee kinematics and second, optimized prosthetic coverage ensuring uniform load transfer. The concern that too little coverage causes an increase in stress of the tibia-implant interface has not been shown to decrease the success of implants, unless coverage was less than 75% [3,11,16,18].…”

Section: Discussionmentioning

confidence: 99%

“…Malrotated components can cause pain and/or compromised motion because of patellar maltracking and flexion-extension gap mismatch [2,7,23]. Function, patient satisfaction, and implant durability depend, to a large degree, on proper placement of TKA components [4,11,17,22].…”

Section: Introductionmentioning

confidence: 99%

Maximizing Tibial Coverage Is Detrimental to Proper Rotational Alignment

Martin

Saurez

Ismaily

et al. 2014

Clinical Orthopaedics &Amp; Related Research

View full text Add to dashboard Cite

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.

show abstract

“…2). Values for alta-baja, patellar tendon attachment and quadriceps force distribution parameters were randomly generated based on a normal distribution, with variability levels determined based on clinical and cadaveric studies (Bonnin et al, 2011;Dennis et al, 2010;Defrate et al, 2007;Farahmand et al, 2004; Table 1). Variability in external loading profiles (vertical hip, femoral A-P force, tibial I-E and V-V loads) was derived from telemetric TKR patient data (Kutzner et al, 2010).…”

Section: Methodsmentioning

confidence: 99%

The role of patient, surgical, and implant design variation in total knee replacement performance

Fitzpatrick¹,

Clary²,

Rullkoetter³

2012

Journal of Biomechanics

View full text Add to dashboard Cite

Is the Anterior Tibial Tuberosity a Reliable Rotational Landmark for the Tibial Component in Total Knee Arthroplasy?

Cited by 77 publications

References 39 publications

Normal Femorotibial Rotational Alignment and Implications for Total Knee Arthroplasty: an MRI Analysis

Normal Femorotibial Rotational Alignment and Implications for Total Knee Arthroplasty: an MRI Analysis

Maximizing Tibial Coverage Is Detrimental to Proper Rotational Alignment

The role of patient, surgical, and implant design variation in total knee replacement performance

Contact Info

Product

Resources

About