Comprehensive assessment of tibial plateau morphology in total knee arthroplasty: Influence of shape and size on anthropometric variability

AbstractThis 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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Use of Osteochondral and Meniscal Allografts from Bone Cuts of Total Knee Arthroplasty for the Treatment of Tibial Plateau Malunions: A Case Series of Four Patients Showing Early Results

Indian Journal of Orthopaedics ◽

10.1007/s43465-020-00347-5 ◽

2021 ◽

Author(s):

Tarun Goyal ◽

Souvik Paul ◽

Arghya Kundu Choudhury ◽

V. Abdusamad

Keyword(s):

Total Knee Arthroplasty ◽

Knee Arthroplasty ◽

Tibial Plateau ◽

Case Series ◽

Early Results ◽

Total Knee

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An imaging measurement study of normal knee parameters in southeast China

Current Medical Imaging Formerly Current Medical Imaging Reviews ◽

10.2174/1573405617666210827131228 ◽

2021 ◽

Vol 17 ◽

Author(s):

Huitong Liu ◽

Bingqiang Xu ◽

Eryou Feng ◽

Shizhang Liu ◽

Wei Zhang ◽

...

Keyword(s):

Total Knee Arthroplasty ◽

Knee Arthroplasty ◽

Tibial Plateau ◽

Femoral Condyle ◽

Age Groups ◽

Young Group ◽

Normal Female ◽

Valgus Angle ◽

Significant Difference ◽

Total Knee

Background: Imaging measurement of distal femur and proximal tibia has been the hot point in the research of total knee arthroplasty and prosthesis development, which is an important treatment for patients with advanced knee joint disease. This study retrospectively investigated the digital imaging measurement of normal knee parameters in southeast China and evaluated their clinical value. Methods: From February 2010 to May 2014, and in accordance with the inclusion criteria, a total of 677 knees (334 female knees and 343 male knees) were categorized into 3 age groups. Clinical and digital imaging data, including the distal femoral condyle diameter (FCD), tibial plateau diameter (TPD), the distance between the medial tibial plateau and fibular head (DPF), tibiofemoral valgus angle, distal femoral valgus angle, proximal tibia (PT) varus angle and the angle from femoral condyle to tibial perpendicular (FT), were measured by using AutoCAD 10.0 software. All measured variables were statistically analyzed by SPSS statistical software (version 18.0). Results: Data are presented as the mean ± standard deviation. The normal female and male femoral condyle diameter was (7.69 ± 0.46) cm and (8.68 ± 0.55) cm, while the normal female and male tibial plateau diameter was (7.66 ± 0.46) cm and (8.60 ± 0.55) cm, respectively. The normal female and male DPF was (0.76 ± 0.36) cm and (0.79 ± 0.36) cm. For females and males, the tibiofemoral valgus angle and distal femoral valgus angle were (3.89 ± 2.20) ° and (3.29 ± 2.12) °, (9.03 ± 2.18) ° and (8.25 ± 2.20) °. As the two methods to measure tibial plateau varus angle, PT angle of normal female and male was (4.29 ± 1.86) ° and (4.84 ± 2.23) °, while the normal female and male FT angle was (5.34 ± 1.95) ° and (5.52 ± 2.07) °. Based on the data obtained, we found significant differences between the two genders in terms of the femoral condyle diameter and tibial plateau diameter in all age groups (P < 0.01). The DPF parameter showed an obvious difference between the young group and the middle-aged group (P < 0.05), and no significant difference was observed between the sides and genders (P > 0.05). The distal femoral valgus angle showed statistical differences between genders in the left side of the young group and middle-aged group (P < 0.05), while angle PT and FT showed no significant difference (P > 0.05). Conclusion: A large number of knee measurements was obtained, and a local knee database was developed in this study. Imaging measurement prior to total knee arthroplasty is clinically important for increasing the accuracy and long-term efficacy of total knee arthroplasty. These data can also provide useful information for knee surgery and sports medicine as well as prosthesis development.

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Finite-element analysis of the proximal tibial sclerotic bone and different alignment in total knee arthroplasty

BMC Musculoskeletal Disorders ◽

10.1186/s12891-019-3008-z ◽

2019 ◽

Vol 20 (1) ◽

Cited By ~ 2

Author(s):

Ye-Ran Li ◽

Yu-Hang Gao ◽

Chen Yang ◽

Lu Ding ◽

Xuebo Zhang ◽

...

Keyword(s):

Finite Element ◽

Total Knee Arthroplasty ◽

Knee Arthroplasty ◽

Tibial Plateau ◽

Three Dimensional ◽

Genu Varum ◽

Sclerotic Bone ◽

Dimensional Measurements ◽

Tibial Cut ◽

Total Knee

Abstract Background Despite potential for improving patient outcomes, studies using three-dimensional measurements to quantify proximal tibial sclerotic bone and its effects on prosthesis stability after total knee arthroplasty (TKA) are lacking. Therefore, this study aimed to determine: (1) the distribution range of tibial sclerotic bone in patients with severe genu varum using three-dimensional measurements, (2) the effect of the proximal tibial sclerotic bone thickness on prosthesis stability according to finite-element modelling of TKA with kinematic alignment (KA), mechanical alignment (MA), and 3° valgus alignment, and (3) the effect of short extension stem augment utilization on prosthesis stability. Methods The sclerotic bone in the medial tibial plateau of 116 patients with severe genu varum was measured and classified according to its position and thickness. Based on these cases, finite-element models were established to simulate 3 different tibial cut alignments with 4 different thicknesses of the sclerotic bone to measure the stress distribution of the tibia and tibial prosthesis, the relative micromotion beneath the stem, and the influence of the short extension stem on stability. Results The distribution range of proximal tibial sclerotic bone was at the anteromedial tibial plateau. The models were divided into four types according to the thickness of the sclerotic bone: 15 mm, 10 mm, 5 mm, and 0 mm. The relative micromotion under maximum stress was smallest after MA with no sclerotic bone (3241 μm) and largest after KA with 15 mm sclerotic bone (4467 μm). Relative micromotion was largest with KA and smallest with MA in sclerotic models with the same thickness. Relative micromotion increased as thickness of the sclerotic bone increased with KA and MA (R = 0.937, P = 0.03 and R = 0.756, P = 0.07, respectively). Relative micromotion decreased with short extension stem augment in the KA model when there was proximal tibial sclerotic bone. Conclusions The influence of proximal tibial sclerotic bone on prosthesis’s stability is significant, especially with KA tibial cut. Tibial component’s short extension stem augment can improve stability.

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Tibial plateau fractures are associated with a long-lasting increased risk of total knee arthroplasty a matched cohort study of 7,950 tibial plateau fractures

Osteoarthritis and Cartilage ◽

10.1016/j.joca.2018.12.020 ◽

2019 ◽

Vol 27 (5) ◽

pp. 805-809 ◽

Cited By ~ 11

Author(s):

R. Elsoe ◽

M.B. Johansen ◽

P. Larsen

Keyword(s):

Total Knee Arthroplasty ◽

Cohort Study ◽

Knee Arthroplasty ◽

Tibial Plateau ◽

Tibial Plateau Fractures ◽

Matched Cohort ◽

Matched Cohort Study ◽

Increased Risk ◽

Total Knee

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Total knee arthroplasty following internal fixation of a tibial plateau fracture

Injury Extra ◽

10.1016/j.injury.2004.12.065 ◽

2005 ◽

Vol 36 (8) ◽

pp. 352-354 ◽

Cited By ~ 1

Author(s):

M. Rowsell ◽

D. Gale

Keyword(s):

Total Knee Arthroplasty ◽

Internal Fixation ◽

Knee Arthroplasty ◽

Tibial Plateau ◽

Tibial Plateau Fracture ◽

Plateau Fracture ◽

Total Knee

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Experience of Total Knee Arthroplasty to Tibial Plateau Defect Case.

Orthopedics & Traumatology ◽

10.5035/nishiseisai.48.875 ◽

1999 ◽

Vol 48 (3) ◽

pp. 875-878

Author(s):

Akihiro Kawano ◽

Shigeru Kuwahara ◽

Shoichi Watanabe ◽

Zyunzi Kanai ◽

Hideho Uchida ◽

...

Keyword(s):

Total Knee Arthroplasty ◽

Knee Arthroplasty ◽

Tibial Plateau ◽

Total Knee

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The Bony Resection Accuracy with Patient-Specific Instruments during Total Knee Arthroplasty: A Retrospective Case Series Study

BioMed Research International ◽

10.1155/2021/8674847 ◽

2021 ◽

Vol 2021 ◽

pp. 1-9

Author(s):

Liang Yuan ◽

Bin Yang ◽

Xiaohua Wang ◽

Bin Sun ◽

Ke Zhang ◽

...

Keyword(s):

Total Knee Arthroplasty ◽

Knee Arthroplasty ◽

Tibial Plateau ◽

Femoral Condyle ◽

Medial Femoral Condyle ◽

Lateral Femoral Condyle ◽

Patient Specific ◽

Lateral Tibial Plateau ◽

Bone Resection ◽

Total Knee

Purpose. Bony resection is the primary step during total knee arthroplasty. The accuracy of bony resection was highly addressed because it was deemed to have a good relationship with mechanical line. Patient-specific instruments (PSI) were invented to copy the bony resection references from the preoperative surgical plan during a total knee arthroplasty (TKA); however, the accuracy still remains controversial. This study was aimed at finding out the accuracy of the bony resection during PSI-assisted TKA. Methods. Forty-two PSI-assisted TKAs (based on full-length leg CT images) were analyzed retrospectively. Resected bones of every patient were given a CT scan, and three-dimensional radiographs were reconstructed. The thickness of each bony resection was measured with the three-dimensional radiographs and recorded. The saw blade thickness (1.27 mm) was added to the measurements, and the results represented intraoperative bone resection thickness. A comparison between intraoperative bone resection thickness and preoperatively planned thickness was conducted. The differences were calculated, and the outliers were defined as >3 mm. Results. The distal femoral condyle had the most accurate bone cuts with the smallest difference (median, 1.0 mm at the distal medial femoral condyle and 0.8 mm at the distal lateral femoral condyle) and the least outliers (none at the distal medial femoral condyle and 1 (2.4%) at the distal lateral femoral condyle). The tibial plateau came in second (median difference, 0.8 mm at the medial tibial plateau and 1.4 mm at the lateral tibial plateau; outliers, none at the medial tibial plateau and 1 (2.6%) at the lateral tibial plateau). Regardless of whether the threshold was set to >2 mm (14 (17.9%) at the tibial plateau vs. 12 (14.6%) at the distal femoral condyle, p > 0.05 ) or >3 mm (1 (1.3%) at the tibial plateau vs. 1 (1.2%) at the distal femoral condyle, p > 0.05 ), the accuracy of tibial plateau osteotomy was similar to that of the distal femoral condyle. Osteotomy accuracy at the posterior femoral condyle and the anterior femoral condyle were the worst. Outliers were up to 6 (15.0%) at the posterior medial femoral condyle, 5 (12.2%) at the posterior lateral femoral condyle, and 6 (15.8%) at the anterior femoral condyle. The percentages of overcut and undercut tended to 50% in most parts except the lateral tibial plateau. At the lateral tibial plateau, the undercut percentage was twice that of the overcut. Conclusion. The tibial plateau and the distal femoral condyle share a similar accuracy of osteotomy with PSI. PSI have a generally good accuracy during the femur and tibia bone resection in TKA. PSI could be a kind of user-friendly tool which can simplify TKA with good accuracy. Level of Evidence. This is a Level IV case series with no comparison group.

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