Medial Overhang of the Tibial Component Is Associated With Higher Risk of Inferior Knee Injury and Osteoarthritis Outcome Score Pain After Knee Replacement

Nielsen, Christian Skovgaard; Nebergall, Audrey; Huddleston, James I.; Kallemose, Thomas; Malchau, Henrik; Troelsen, Anders

doi:10.1016/j.arth.2017.12.027

Cited by 32 publications

(31 citation statements)

References 31 publications

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“…However, when time is accounted for with a survival analysis, there was no association. An overhang of the tibial component may protect the TAA from an early tibial component failure due to aseptic loosening, as has been demonstrated in total knee arthroplasty, 1,37 but more research is warranted.…”

Section: Discussionmentioning

confidence: 98%

Total Ankle Arthroplasty Survival and Risk Factors for Failure

Escudero

Barahona

et al. 2019

Foot Ankle Int.

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Background: Total ankle arthroplasty (TAA) is an increasingly selected treatment for end-stage ankle arthritis; however, failure and revision of the tibial and talar components remains an issue. Although multiple risk factors have been shown to contribute to early component revision, no study has looked at combining such risk factors into a predictive model that could potentially decrease revision rates and improve implant survival. This study aimed to develop a predictive model for TAA failure based on patient characteristics, patient-reported outcomes (PROs), and immediate postoperative radiographs. Methods: A retrospective review of a single-site ankle arthritis database was conducted. All patients with current-generation ankle replacements including the Hintegra and Infinity prostheses implanted between 2004 and 2015 and with complete postoperative radiographs taken between 6 and 12 weeks postoperatively were included. Eight coronal and sagittal radiographic parameters were assessed and performed twice by 2 independent orthopedic surgeons on included TAAs. These radiographic parameters were then analyzed in association with patient demographics and PRO. Advanced statistical methods including survival analysis were used to construct a predictive model for TAA survival. A total of 107 patients were included and analyzed with a median clinical follow-up of 49 months (minimum 24 months). Results: A predictive model was created, with 4 parameters identified as being statistically associated with TAA metal-component revision: diabetes mellitus, poor baseline Ankle Osteoarthritis Scale (AOS) score, excessively dorsiflexed talar component, and an anteriorly/posteriorly translated talus relative to the tibial axis. The presence of 3 parameters predicted TAA survival of 0.60 whereas presence of all 4 parameters predicted survival of only 0.13 in the period studied. Conclusion: Our predictive model is based on a combination of patient factors, PROs, and radiographic TAA alignment. We believe it can be used by surgeons to predict failure in their TAA patients, thereby optimizing postoperative outcomes by improving patient selection and modifiable outcome-specific parameters. Level of Evidence: Level III, retrospective cohort study using prospectively collected data.

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Section: Discussionmentioning

confidence: 98%

Total Ankle Arthroplasty Survival and Risk Factors for Failure

Escudero

Barahona

et al. 2019

Foot Ankle Int.

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“…The overhang was absolutely forbidden in some studies. 5,15,20,21 In a study by Simsek et al investigating the effects of overhang from the tibial cortical margin on clinical scores, it was reported that the posteromedial underhang and posterolateral overhang significantly decreased the Knee Society score. In addition, comparison of the cases with and without overhang beyond the posterolateral edge showed that the patients with pain in the posterolateral zone of the knee joint had a mean overhang of 3.6 AE 2.0 mm and those without pain had a mean overhang of 0.02 AE 3.4 mm, wherein there was a negative correlation between overhang and clinical scores.…”

Section: Discussionmentioning

confidence: 99%

Low-Degree Tibial Slope Angle Prevents Component Overhang by Enlarging the Lateral Plateau Surface Area in Total Knee Arthroplasty

et al. 2020

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This study aimed to investigate whether overhang or underhang around the tibial component that occurs during the placement of tibial baseplates was affected by different slope angles of the tibial plateau and determine the changes in the lateral and medial plateau diameters while changing the slope angle in total knee arthroplasty. Three-dimensional tibia models were reconstructed using the computed tomography scans of 120 tibial dry bones. Tibial plateau slope cuts were performed with 9, 7, 5, 3, and 0 degrees of slope angles 2-mm below the subchondral bone in the deepest point of the medial plateau. Total, lateral, and medial tibial plateau areas and overhang/underhang rates were measured at each cut level. Digital implantations of the asymmetric and symmetric tibial baseplates were made on the tibial plateau with each slope angles. Following the implantations, the slope angle that prevents overhang or underhang at the bone border and the slope angle that has more surface area was identified. A significant increase was noted in the total tibial surface area, lateral plateau surface area, and lateral anteroposterior distance, whereas the slope cut angles were changed from 9 to 0 degrees in both gender groups. It was found that the amount of posteromedial underhang and posterolateral overhang increased in both the asymmetric and symmetric tibial baseplates when the slope angle was changed from 0 to 9 degrees. Although the mediolateral diameter did not change after the proximal tibia cuts at different slope angles, the surface area and anteroposterior diameter of the lateral plateau could change, leading to increased lateral plateau area. Although prosthesis designs are highly compatible with the tibial surface area, it should be noted that the component overhangs, especially beyond the posterolateral edge, it can be prevented by changing the slope cut angle in males and females.

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“…As regards size, however, it is known that oversizing of the tibial tray is very common (up to 32% in some series) and leads to a poorer clinical outcome, less postoperative mobility and persistence of pain [15]. This poorer outcome is maintained over time until at least five years after surgery [5], [16]. Oversizing at femoral level also causes clinical changes [17].…”

Section: Discussionmentioning

confidence: 99%

“…Incongruity between the sizes of prosthetic components and bone structure has been considered a potential cause of pain and limitation of postoperative mobility. Anteroposterior oversizing of the tibial tray [3], [4] or presence of a medial overhang, seen in 20% of cases in some series [5], is associated with pain, decreased mobility, and loss of function after implantation [6].…”

Section: Introductionmentioning

confidence: 99%

Agreement in component size between preoperative measurement, navigation and final implant in total knee replacement

Hernández-Vaquero

Noriega-Fernandez

Roncero-Gonzalez

et al. 2019

Journal of Orthopaedic Translation

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Summary Background One of the possible causes of dissatisfaction reported by many patients after total knee replacement (TKR) is the lack of agreement between component size and bone structure. To avoid this complication and facilitate the procedure, preoperative planning with digitized templates is recommended. Surgical navigation indicates the best position and the most adequate size of arthroplasty and may therefore replace preoperative radiographic measurement. The objective of the study was to check agreement between the sizes of TKR components measured before surgery with digitized templates, the size recommended by the navigation and sizes actually implanted. Methods In 103 patients scheduled for TKR, preoperative full-limb radiography was performed to measure the mechanical and anatomical axes of the limb, femur and tibia. The most adequate size of the femoral and tibial components was planned by superimposing digitized templates. The size recommended in navigation and the size of the finally implanted components were also recorded. Results A high level of agreement was found between the sizes of femoral and tibial components measured by X-rays and in navigation (0.750 and 0.772, respectively) (intraclass correlation and Cronbach's alpha). Agreement between the sizes recommended by X-rays and navigation and those finally implanted was 0.886 for the femur and 0.891 for the tibia. Agreement levels were not different in cases with prior deformities of limb axis. Conclusions The high level of agreement found in component sizes between radiographic measurement with digitized templates and navigation suggests that preoperative X-ray measurement is not needed when navigation is used for placement of implants during TKR. The translational potential of this article Computer-assisted surgery may avoid preoperative measurement with templates in TKR.

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Medial Overhang of the Tibial Component Is Associated With Higher Risk of Inferior Knee Injury and Osteoarthritis Outcome Score Pain After Knee Replacement

Cited by 32 publications

References 31 publications

Total Ankle Arthroplasty Survival and Risk Factors for Failure

Total Ankle Arthroplasty Survival and Risk Factors for Failure

Low-Degree Tibial Slope Angle Prevents Component Overhang by Enlarging the Lateral Plateau Surface Area in Total Knee Arthroplasty

Agreement in component size between preoperative measurement, navigation and final implant in total knee replacement

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