Rotational alignment of the tibial component in total knee arthroplasty is better at the medial third of tibial tuberosity than at the medial border

Lützner, Jörg; Krummenauer, Frank; Günther, Klaus‐Peter; Kirschner, S.

doi:10.1186/1471-2474-11-57

Cited by 89 publications

(109 citation statements)

References 25 publications

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“…However, multiple recent publications demonstrate that internal tibial component rotation still occurs and is a source of failure in TKA [3,6,17,18]. Correct rotation can be achieved using symmetric or asymmetric components, but the extent of coverage (especially posteromedial) may vary depending on component design.…”

Section: Discussionmentioning

confidence: 99%

“…It has been shown that 15% to 19% of patients undergoing TKA are not completely satisfied with the function of their joint [4,17,19,20]. We believe inadvertent internal rotation of the tibial tray, in an effort to increase tibial bone coverage, may be part of this problem and thus sought to evaluate the influence of component design (symmetric versus asymmetric components) on rotation.…”

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%

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Maximizing Tibial Coverage Is Detrimental to Proper Rotational Alignment

Martin

Saurez

Ismaily

et al. 2014

Clinical Orthopaedics &Amp; Related Research

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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.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

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

show abstract

“…13 While the transepicondylar axis is universally recognized as a primary reference for the femoral rotational alignment. 911 there is no consensus for the tibial rotational alignment.…”

Section: Discussionmentioning

confidence: 99%

“…Many studies related a poor functional outcome to femoral and tibial components rota tional malalignment. 13 Rotational malalignment may lead to patellar maltracking, anterior knee pain, flexion instability and premature wear of the polyethylene inlay. The rotational alignment of the femoral component has been extensively studied and useful reference axes for setting proper femoral rotation have been established, including the posterior con dylar axis, the midtrochlear line (Whiteside's line) and the transepicondylar axis.…”

Section: Introductionmentioning

confidence: 99%

Rotational Alignment Landmarks in Primary Total Knee Arthroplasty

Baldini

Indelli²,

Manfredini³

et al. 2014

The Duke Orthopaedic Journal

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Purpose: We hypothesized that the anterior tibial surface curvature is a more reliable landmark for correct tibial component rotational positioning in TKA respect to the 'Akagi' line and the medial third of the tibial tubercle.Methods: Three independent investigators reviewed 124 knee MRI scans, identifying independently the femoral transepicondylar axis (TEA), the femoral posterior condylar axis (PCA), a line connecting the middle of the posterior cruciate ligament and the medial edge of the patellar tendon attachment (Akagi's line), the medial third of the tibial tubercle and the anterior tibial surface curvature. The most appropriate tibial baseplate tracing for the NexGen Total Knee System (Zimmer, Warsaw, USA) was superimposed matching the anterior tibial cortex with its anterior surface. At this point, the rotation of the tibial plate tracing was calculated in respect to the TEA, the medial third of the tibial tubercle line, the Akagi's line and the PCA. Customized software was created and used for analysis of the MRI datasets. Results:The investigators agreed on the localization of the Akagi's line in 64% of the cases within 3° and in 85% of the cases within 5° (minimum -16°, maximum -7°): this landmark might lead to internal rotation of the tibial component. The observers agreed on the localization of the medial third of the tibial tubercle in 29% of the cases within 3° and, in 70% of the cases, within 5° (minimum -4°, maximum +4°): this landmark might lead to external rotation of the tibial component. The investigators agreed on the localization of the anterior tibial surface curvature in 89% of the cases within 3° and in 99% of the cases within 5° (minimum -1°, maximum +4°): component alignment along the anterior cortex guaranteed full matching ±3° to the epicondylar axis in 75% of the knees. Conclusion:Alignment of the tibial component, when based on the anterior tibial surface, was more reliable and easier identifiable than either the Akagi's line or the medial third of the tibial tubercle. Level of evidence:Level 3 (Retrospective cohort study).

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Computational tibial bone remodeling over a population after total knee arthroplasty: A comparative study

Anijs¹,

Eemers²,

Minoda

et al. 2021

J Biomed Mater Res

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Periprosthetic bone loss is an important factor in tibial implant failure mechanisms in total knee arthroplasty (TKA). The purpose of this study was to validate computational postoperative bone response using longitudinal clinical DEXA densities. Computational remodeling outcome over a population was obtained by incorporating the strain-adaptive remodeling theory in finite element (FE) simulations of 26 different tibiae. Physiological loading conditions were applied, and bone mineral density (BMD) in three different regions of interest (ROIs) was considered over a postoperative time of 15 years. BMD outcome was compared directly to previously reported clinical BMD data of a comparable TKA cohort. Similar trends between computational and clinical bone remodeling over time were observed in the two proximal ROIs, with most rapid bone loss taking place in the initial months after TKA and BMD starting to level in the following years. The extent of absolute proximal BMD change was underestimated in the FE population compared with the clinical subject group, which might be the result of significantly higher initial clinical baseline BMD values.Large differences in remodeling response were found in the distal ROI, in which resorption was measured clinically, but a large BMD increase was predicted by the FE models. Multiple computational limitations, related to the FE mesh, loading conditions, and strain-adaptive algorithm, likely contributed to the extensive local bone formation. Further research incorporating subject-specific comparisons using followup CT scans and more extensive physiological knee loading is recommended to optimize bone remodeling more distal to the tibial baseplate.

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Rotational alignment of the tibial component in total knee arthroplasty is better at the medial third of tibial tuberosity than at the medial border

Cited by 89 publications

References 25 publications

Maximizing Tibial Coverage Is Detrimental to Proper Rotational Alignment

Maximizing Tibial Coverage Is Detrimental to Proper Rotational Alignment

Rotational Alignment Landmarks in Primary Total Knee Arthroplasty

Computational tibial bone remodeling over a population after total knee arthroplasty: A comparative study

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