Variability of Extraarticular Tibial Rotation References for Total Knee Arthroplasty

Akagi, Masao; Mori, Satoshi; Nishimura, Shunji; Nishimura, Akio; Asano, Tsuyoshi; Hamanishi, Chiaki

doi:10.1097/01.blo.0000160027.52481.32

Cited by 181 publications

(173 citation statements)

References 22 publications

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“…Akagi et al [22] reported that the anteroposterior axis was more reliably identified on CT images than the TMA, whereas other authors found their results for this axis to be more consistent when using particular methods, such as those involving osteometric apparatus (24 AE 9.3 ) [3] or CT-based scanning (28 AE 10.0 ) [23], and these findings are similar to our own results (Table I). However, Eckhoff et al found that, when using the TMA to measure tibial torsion, it showed less variation, ranging from 15 to 30 [24].…”

Section: Discussionsupporting

confidence: 90%

Reliability of frames of reference used for tibial component rotation in total knee arthroplasty

Page

Deakin

Payne

et al. 2011

Computer Aided Surgery

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This study evaluated seven different frames of reference used for tibial component rotation in total knee arthroplasty (TKA) to determine which ones showed good reliability between bone specimens.An optoelectronic system based around a computer-assisted surgical navigation system was used to measure and locate 34 individual anatomical landmarks on 40 tibias. Each particular frame of reference was reconstructed from a group of data points taken from the surface of each bone. The transverse axis was used as the baseline to which the other axes were compared, and the differences in angular rotation between the other six reference frames and the transverse axis were calculated.There was high variability in the tibial rotational alignment associated with all frames of reference. Of the references widely used in current TKA procedures, the tibial tuberosity axis and the anterior condylar axis had lower standard deviations (6.1 and 7.3 , respectively) than the transmalleolar axis and the posterior condylar axis (9.3 for both). In conclusion, we found high variability in the frames of reference used for tibial rotation alignment. However, the anterior condylar axis and transverse axis may warrant further tests with the use of navigation. Combining different frames of reference such as the tibial tuberosity axis, anterior condylar axis and transverse axis may reduce the range of errors found in all of these measurements.

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Section: Discussionsupporting

confidence: 90%

Reliability of frames of reference used for tibial component rotation in total knee arthroplasty

Page

Deakin

Payne

et al. 2011

Computer Aided Surgery

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“…This large variation among specimens agrees with what other researchers have noted regarding tibial rotational alignment. Akagi et al [1] found the angle between the TEA and the transmalleolar axis ranged from 8°to 49.4°. Similarly, Matziolis et al [33] found the angle between the TEA and an axis that aligned to the midpoint point of the tibial tubercle ranged from 0.7°to 43.4°.…”

Section: Discussionmentioning

confidence: 99%

“…Currently, many anatomic landmarks are used to align the tibial component, including the projected femoral TEA [1,2,20,24], medial border of the tibial tubercle [17,18,22,47], medial 1/3 of the tibial tubercle [17,20,47], PCL attachment [1,2,23,47], transverse axis of the tibia [18,20,47], posterior condylar line of the tibia [18,20,23], midsulcus of the tibial spine [17], malleolar axis [1,18], patellar tendon [1,2,23,24], and axis of the second metatarsal [1]. This lack of a gold standard for tibial component alignment, combined with the difficulty in identifying anatomic landmarks during surgery and variations in anatomy between knees, may lead to variations in the surgeons' ability to locate tibial component alignment axes as large as 44°internal rotation to 46°external rotation [47].…”

Section: Introductionmentioning

confidence: 99%

Is There a Gold Standard for TKA Tibial Component Rotational Alignment?

Hutter

Granger

Beal

et al. 2013

Clinical Orthopaedics &Amp; Related Research

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“…Then, the tibial AP axis was drawn as a line connecting the middle of the PCL and the medial border of the patellar tendon at its attachment to the tibial tubercle [1,2]. After setting each reference point for these two axes, the tibia was verticalized along the TSA and frontalized along the tibial AP axis.…”

Section: Methodsmentioning

confidence: 99%

Tibia Vara Affects the Aspect Ratio of Tibial Resected Surface in Female Japanese Patients Undergoing TKA

Mori¹,

Akagi²,

Asada³

et al. 2013

Clinical Orthopaedics &Amp; Related Research

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Background Tibia vara seen in Japanese patients reportedly influences the tibial component alignment when performing TKA. However, it is unclear whether tibia vara affects the component position and size selection. Questions/purposes We therefore determined (1) the amount of medial tibial bow, (2) whether the tibia vara influences the aspect ratio of the tibial resected surface in aligning the tibial component with the tibial shaft axis, and (3) whether currently available tibial components fit the shapes of resected proximal tibias in terms of aspect ratio. Methods We measured the tibia vara angle (TVA), proximal varus angle (PVA), and the mediolateral and middle AP dimensions of the resected surface using threedimensional preoperative planning software in 90 knees of 74 female patients with varus osteoarthritis. We determined the correlations of the aspect ratio with TVA or PVA and compared the aspect ratios to those of five prosthesis designs. Results The mean TVA and PVA were 0.6°and 2.0°, respectively. The aspect ratio negatively correlated with both TVA and PVA (r = À0.53 and À0.55, respectively). The mean aspect ratio of the resected surface was 1.48 but gradually decreased with increasing AP dimension, whereas four of the five prostheses had a constant aspect ratio. Conclusions The aspect ratio of resected tibial surface was inversely correlated to the degree of tibia vara, and currently available prosthesis designs do not fit well to the resected surface in terms of aspect ratio. Clinical Relevance The design of a tibial component with a smaller aspect ratio could be developed to obtain better bone coverage in Japanese patients.

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Variability of Extraarticular Tibial Rotation References for Total Knee Arthroplasty

Cited by 181 publications

References 22 publications

Reliability of frames of reference used for tibial component rotation in total knee arthroplasty

Reliability of frames of reference used for tibial component rotation in total knee arthroplasty

Is There a Gold Standard for TKA Tibial Component Rotational Alignment?

Tibia Vara Affects the Aspect Ratio of Tibial Resected Surface in Female Japanese Patients Undergoing TKA

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