Tibial Component Alignment After Total Knee Arthroplasty with Intramedullary Instrumentation: A Prospective Analysis

2010 ◽  
Vol 25 (8) ◽  
pp. 1209-1215 ◽  
Author(s):  
Carl T. Talmo ◽  
Andrew J. Cooper ◽  
Tom Wuerz ◽  
Jason E. Lang ◽  
James V. Bono
Keyword(s):  
Total Knee Arthroplasty ◽  
Knee Arthroplasty ◽  
Tibial Component ◽  
Prospective Analysis ◽  
Component Alignment ◽  
Tibial Component Alignment ◽  
Total Knee

Improving tibial component alignment in total knee arthroplasty

2014 ◽  
Vol 23 (12) ◽  
pp. 3563-3570 ◽  
Author(s):  
G. Cinotti ◽  
P. Sessa ◽  
A. D’Arino ◽  
F. R. Ripani ◽  
G. Giannicola
Keyword(s):  
Total Knee Arthroplasty ◽  
Knee Arthroplasty ◽  
Tibial Component ◽  
Component Alignment ◽  
Tibial Component Alignment ◽  
Total Knee

scholarly journals Radiographic evaluation of tibial component alignment in total knee arthroplasty following extramedullary and intramedullary tibial referencing

2017 ◽  
Vol 3 (6) ◽  
pp. 1199
Author(s):  
B. Harikrishnan ◽  
Anjan Prabhakara ◽  
Gururaj R. Joshi
Keyword(s):  
Total Knee Arthroplasty ◽  
Knee Arthroplasty ◽  
Tibial Component ◽  
Radiographic Evaluation ◽  
Component Alignment ◽  
Tibial Component Alignment ◽  
Knee Deformity ◽  
Total Knee ◽  
The Difference

<p class="abstract"><strong>Background:</strong> Long term survivorship of total knee arthroplasty (TKA) is significantly dependant on prostheses alignment. The debate on optimal referencing for femoral component is largely resolved with Intra-medullary jigs reproducing superior alignment. However there is still a contention about whether intramedullary or extramedullary jigs are better for tibial referencing. This study aims to compare the accuracy of tibial component alignment in TKA using intramedullary and extramedullary tibial referencing jigs.</p><p class="abstract"><strong>Methods:</strong> Between December 2012 and September 2014, 66 primary conventional cemented TKAs were performed using Nexgen-LPS Flex (Zimmer) implants in 55 patients, 50-80 y old (mean 65.54 y) with osteoarthritis/rheumatoid arthritis. Intramedullary and extramedullary tibial referencing was used in alternate patients undergoing TKA after excluding patients with BMI <span style="text-decoration: underline;">&gt;</span>35 kg/m<sup>2</sup>, knee deformity <span style="text-decoration: underline;">&gt;</span>15<sup>0</sup>,excessive tibial bowing, previous fractures/surgeries/retained metalwork around knee. Postoperatively, tibial component alignment (TCA) in coronal plane was assessed using AP radiograph of leg. A 3<sup>º</sup> cutoff from neutral mechanical axis (i.e., 90<sup>o</sup>±3<sup>o</sup>) was considered acceptable.<strong></strong></p><p class="abstract"><strong>Results:</strong> The intramedullary group (n=33) had 4 outliers (TCA &gt;93<sup>º</sup> or &lt;87<sup>º</sup>) whereas the extramedullary group (n=33) had 7 outliers (p=0.511). The difference in mean TCA between intramedullary and extramedullary groups was not statistically significant [90.70±2.43 and 90.55±2.17 (p=0.790)]. There were no significant per-operative/post-operative complications in either group.</p><p><strong>Conclusions:</strong> We conclude that both intramedullary and extramedullary tibial referencing guides can be used to achieve desired tibial component alignment (90±3<sup>º</sup>) in TKA. However the surgeon should appreciate the benefits and deficiencies of either types of tibial referencing and use whichever is suited in a particular case. </p>

Pedobarographic Analysis in Total Knee Arthroplasty

2017 ◽  
Vol 30 (09) ◽  
pp. 951-959 ◽  
Author(s):  
Onur Kocadal ◽  
Budak Akman ◽  
Uğur Şayli ◽  
Faik Altıntaş ◽  
Melih Güven
Keyword(s):  
Total Knee Arthroplasty ◽  
Gait Analysis ◽  
Knee Arthroplasty ◽  
Tibial Component ◽  
Component Alignment ◽  
Abnormal Gait ◽  
Prosthetic Alignment ◽  
Tibial Component Alignment ◽  
Total Knee ◽  
Component Malposition

AbstractPedobarographic gait analysis is a useful tool for the determination of loading distributions and alterations on the lower extremity and their reflection on the foot sole after many orthopaedic surgical applications. To date, there have been no studies evaluating the relationship between component alignment and changes of pedobarographic gait analysis in total knee arthroplasty (TKA). We aimed to investigate the effects of TKA and prosthetic alignment on the distribution of pedobarographic parameters. Quantitative gait patterns of 47 patients were prospectively evaluated by using pedobarography 1 week before surgery and at the seventh month, on average, postoperatively. Component positions were assessed, and all applications were divided into three groups according to tibial component position as varus, neutral, and valgus. Pedobarographic results were compared between pre- and postoperative values for all applications and compared among the groups. Mean postoperative tibiofemoral angle was 5.4 degrees in valgus, and preoperative knee scores were markedly improved postoperatively. The range of tibial component alignment changed between 1 and 4 degrees in the varus and valgus groups. Plantar loading parameters (force and pressure) were significantly decreased in all operated knees, especially in forefoot and midfoot. In varus tibial components, plantar loading values decreased in midfoot and hindfoot. However, in the neutral and valgus groups, similar alterations of plantar loadings were obtained, which included decreasing in forefoot and midfoot with significant increase in hindfoot. Plantar loading distribution changed statistically significantly after TKA despite good clinical and radiographic results. Tibial component alignment was also responsible for plantar loading distribution. Tibial components in varus position create different foot loading characteristics compared with neutral and valgus aligned components. Pedobarographic evaluation in TKA allows clinicians to obtain a proper understanding of abnormal gait caused by component malposition.

scholarly journals Rotational alignment of the tibial component in total knee arthroplasty: the anterior tibial cortex is a reliable landmark

Joints ◽  
2013 ◽  
Vol 01 (04) ◽  
pp. 155-160 ◽  
Author(s):  
Andrea Baldini ◽  
Pier Indelli ◽  
Lapo De Luca ◽  
Pierpaolo Mariani ◽  
Massimiliano Marcucci
Keyword(s):  
Total Knee Arthroplasty ◽  
Knee Arthroplasty ◽  
Tibial Component ◽  
Intraclass Correlation ◽  
Surface Curvature ◽  
Tibial Tubercle ◽  
Component Alignment ◽  
Anterior Tibial ◽  
Total Knee ◽  
Tibial Cortex

Purpose: to compare the anterior tibial surface curvature, the Akagi’s line and the medial third of the tibial tubercle in order to assess which is the most reliable landmark for correct tibial component rotational positioning in total knee arthroplasty. Methods: three independent investigators reviewed 124 knee MRI scans. The most suitable tibial baseplate tracing for the Nexgen Total Knee System (Zimmer, Warsaw, USA) was superimposed on the scan matching the anterior tibial cortex with the anterior aspect of the baseplate. The rotation of the tibial baseplate tracing was calculated with respect to the transepicondylar axis (TEA), the medial third of the tibial tubercle line, Akagi’s line and the femoral posterior condylar axis (PCA). Customized software was created and used for analysis of the MRI datasets.The reliability of each measurement was then calculated by using the intraclass correlation coefficient for interobserver agreement. Results: observer agreement on the position of the Akagi’s line was within 3° in 64% of the cases and within 5°in 85% of the cases. Agreement on the position of the medial third of the tibial tubercle was within 3°in 29% of the cases and within 5°in 70% of the cases. Agreement on the localization of the anterior tibial surface curvature was within 3°in 89% of the cases and within 5°in 99% of the cases. Component alignment along the anterior cortex guaranteed full matching ± 3° with the epicondylar axis in 75% of the knees. Conclusions: the anterior tibial surface curvature was found to be a more reliable and more easily identifiable landmark for correct tibial component alignment than either Akagi’s line or the medial third of the tibialtubercle. Level of evidence: level III, retrospective cohort study.

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