The Posterolateral Corner-Locked Technique Is Applicable in a Chinese Population Regarding the Tibial Component Rotation Alignment in Total Knee Arthroplasty

2019 ◽  
Vol 33 (05) ◽  
pp. 466-473
Author(s):  
Chao-Hua Fang ◽  
Cheng-Kung Cheng ◽  
Tie-Bing Qu ◽  
Jun-Hui Zhang ◽  
Bo Zhang ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Knee Arthroplasty ◽  
Tibial Component ◽  
Chinese Population ◽  
Posterolateral Corner ◽  
Tibial Tubercle ◽  
Tibial Osteotomy ◽  
Tibial Tray ◽  
Total Knee ◽  
Asymmetrical Design

AbstractRotational malalignment between the femoral and tibial components in total knee arthroplasty (TKA) can affect clinical outcomes, but there is no consensus on how to best determine tibia tray orientation. The posterolateral corner-locked (PLCL) technique may be a new method. This study aims to assess the applicability of this technique in a Chinese population. Forty normal Chinese volunteers were recruited and underwent computed tomography (CT) of the lower limbs. Knee model reconstructions and simulated standard tibial osteotomy were conducted digitally. The transepicondylar axis (TEA), the Akagi line, and the line connecting the medial third of the tibial tubercle with the midpoint of the posterior cruciate ligament (PCL) were projected to the tibial cross-section and marked. The PLCL technique was applied using either symmetrical or asymmetrical tibial tray templates, and the anteroposterior (AP) axis of the tibial tray was marked. The angles between the TEA and these lines were calculated, and the statistical differences were analyzed. The angle between the TEA and the Akagi line and between the TEA and the line connecting the medial third of the tibial tubercle with the midpoint of the PCL were 96.90 ± 5.57 and 107.31 ± 5.95 degrees, respectively. The angles between the TEA and the AP axis of the symmetrical and the asymmetrical design tibial trays were 94.01 ± 4.21 and 96.65 ± 4.70 degrees, respectively. Except for the Akagi line and AP axis of the asymmetrical tibial tray, statistical differences were found between all lines (p < 0.05). The PLCL technique is principally suitable for Chinese patients requiring TKA when using the tibial component referred to in this study, although it may result in slight external rotation.

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.

scholarly journals Rotational Alignment Landmarks in Primary Total Knee Arthroplasty

2014 ◽  
Vol 4 (1) ◽  
pp. 8-12
Author(s):  
Andrea Baldini ◽  
Pier Francesco Indelli ◽  
PT Luca Manfredini ◽  
Massimiliano Marcucci
Keyword(s):  
Total Knee Arthroplasty ◽  
Knee Arthroplasty ◽  
Tibial Component ◽  
Primary Total Knee Arthroplasty ◽  
Surface Curvature ◽  
Rotational Alignment ◽  
Tibial Tubercle ◽  
Anterior Tibial ◽  
Total Knee ◽  
Primary Total Knee

ABSTRACT 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). Indelli PF, Baldini A, Manfredini L, Marcucci M. Rotational Alignment Landmarks in Primary Total Knee Arthroplasty. The Duke Orthop J 2014;4(1):8-12.

scholarly journals The type of approach (medial versus lateral) influences TKA component rotation in total knee arthroplasty - a clinical study using 3D-CT

2018 ◽  
Vol 6 (4_suppl2) ◽  
pp. 2325967118S0001
Author(s):  
Filippo-Franco Schiapparelli ◽  
Felix Amsler ◽  
Michael Hirschmann
Keyword(s):  
Total Knee Arthroplasty ◽  
Knee Arthroplasty ◽  
Tibial Component ◽  
Tibial Tubercle ◽  
Component Position ◽  
Tibial Tubercle Osteotomy ◽  
Subvastus Approach ◽  
Leg Axis ◽  
Component Rotation ◽  
Total Knee

The purpose of this study was to investigate if the type of approach (medial parapatellar approach (MPA) versus lateral parapatellar subvastus approach with tibial tubercle osteotomy (LPA)) influences the rotation of femoral and/or tibial component and leg axis in total knee arthroplasty (TKA). This study included 200 consecutive patients in whom TKA was performed using either a parapatellar medial (n=162, MPA) or parapatellar lateral subvastus approach with tibial tubercle osteotomy (n=38, LPA). All patients underwent clinical follow-up, standardised radiographs and computed radiography (CT). TKA components’ position and the whole leg axis were assessed on 3D reconstructed CT scans (sagittal, coronal and rotational). Mean values of TKA component position and the whole leg alignment of both groups were compared using a T-test. The tibial component was graded as internally rotated (< 3° of external rotation (ER)), neutral rotation (equal or between 3° and 6° of ER) and and externally rotated (>6° ER). The femoral component was graded as internally rotated (< 3° of internal rotation (IR)), neutral rotation (equal or between -3° IR and 3° of ER) and externally rotated (>3° ER). There was no significant difference in terms of whole leg axis after TKA between both groups (MPA: 0.2° valgus ± 3.4; LPA: 0.0° valgus ± 3.5). Means of tibial component position were 2.7° ER ± 6.1 (MPA) and 7.6° ER ± 5.4 (LPA). Patients of group LPA presented a significantly less internally rotated (LPA: 18.4%; MPA: 48.8%) and more externally rotated (LPA: 52.6%; MPA: 22.8%) tibial component (p<0.001). No significant differences were seen for the femoral component position, tibial valgus/varus and tibial slope. The type of approach significantly influences the tibial TKA component rotation. It appears that a MPA tends to internally rotate the tibial TKA component and a LPA tends to externally rotate the tibial TKA.

Which Asymmetric Tibial Component Is Optimally Designed for Calipered Kinematically Aligned Total Knee Arthroplasty?

2021 ◽  
Author(s):  
Alexander J. Nedopil ◽  
Tomas Zamora ◽  
Connor Delman ◽  
Stephen M. Howell ◽  
Maury L. Hull
Keyword(s):  
Total Knee Arthroplasty ◽  
Knee Arthroplasty ◽  
Tibial Component ◽  
External Rotation ◽  
Oxford Knee Score ◽  
Tibial Tubercle ◽  
Tibial Resection ◽  
Flexion Extension ◽  
Patient Reported ◽  
Total Knee

AbstractCalipered kinematically aligned (KA) total knee arthroplasty (TKA) restores the patient's prearthritic joint lines and sets internal-external rotation of the tibial component parallel to the flexion-extension (FE) plane, which is not a mechanical alignment (MA) target. Two asymmetric tibial components designed for MA set the tibial component to either a femoral component (FC) target or a tibial tubercle (TT) target. The study determined the optimal asymmetric tibial component to use with KA as the one with smaller IE deviation from the MA target, greater coverage of tibial resection, and lower incidence of cortical overhang. The study included 40 patients treated with bilateral calipered KA TKA with different asymmetric tibial components in opposite knees. A best-fit of a kinematic tibial template to the tibial resection set the template's slot parallel to the knee's FE plane. Each asymmetric tibial component's anterior-posterior (AP) axis was set parallel to the slot. Computer tomography analysis determined the IE deviation (−internal/+ external) of each tibial component from its MA target, tibial resection coverage by the baseplate and insert, and incidence of cortical overhang. The patient-reported Forgotten Joint Score (FJS) and Oxford Knee Score (OKS) determined outcomes. The mean IE deviation from the MA target was 2 degrees external for the FC-target asymmetric tibial component and −8 degrees internal for the TT-target asymmetric tibial component (p < 0.001). Tibial resection coverage by the baseplate (insert) was 88% (84%) for the FC target and 84% (79%) for the TT target (p < 0.001 for baseplate and insert). The FC target insert covered 3 mm more of the posterolateral resection (p < 0.001). Posteromedial coverage was comparable. The incidence of cortical overhang was 2.5% for each baseplate. There was no difference in FJS and OKS. When performing calipered KA, the more optimal design was the asymmetric tibial component with the FC target because of the smaller deviation from its MA target and the greater coverage of the tibial resection by the baseplate and insert.

Varus alignment of the tibial component up to seven degrees is not associated with poor long-term outcomes in a neutrally aligned total knee arthroplasty

2021 ◽  
Author(s):  
Francisco Antonio Miralles-Muñoz ◽  
Marta Rubio-Morales ◽  
Laiz Bello-Tejada ◽  
Santiago González-Parreño ◽  
Alejandro Lizaur-Utrilla ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Knee Arthroplasty ◽  
Tibial Component ◽  
Varus Alignment ◽  
Long Term Outcomes ◽  
Total Knee

Tibial Cut Accuracy in Mechanically Aligned Total Knee Arthroplasty Using Extensor Hallucis Longus Tendon to Determine Extramedullary Tibial Guide Position

2021 ◽  
Author(s):  
Pablo Besa ◽  
Rafael Vega ◽  
Gerardo Ledermann ◽  
Claudio Calvo ◽  
Manuela Angulo ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Lower Extremity ◽  
Knee Arthroplasty ◽  
Tibial Component ◽  
Anatomical Landmark ◽  
Mechanical Alignment ◽  
Longus Tendon ◽  
Extensor Hallucis Longus ◽  
Tibial Cut ◽  
Total Knee

AbstractThis study aimed to determine the tibial cut (TC) accuracy using extensor hallucis longus (EHL) tendon as an anatomical landmark to position the total knee arthroplasty (TKA) extramedullary tibial guide (EMTG), and its impact on the TKA mechanical alignment (MA). We retrospectively studied 96 TKA, performed by a single surgeon, using a femoral tailored intramedullary guide technique. Seventeen were prior to the use of the EHL and 79 used the EHL tendon to position the EMTG. We analyzed preoperative and postoperative standing total lower extremity radiographs to determine the tibial component angle (TCA) and the correction in MA, comparing pre-EHL use and post-EHL technique incorporation. Mean TCA was 88.89 degrees and postoperative MA was neutral in 81% of patients. Pre- and postoperative MAs were not correlated. As a conclusion of this study, using the EHL provides a safe and easy way to determine the position of EMTG.

Effect of tibial component varus on wear in total knee arthroplasty

The Knee ◽  
2012 ◽  
Vol 19 (5) ◽  
pp. 560-563 ◽  
Author(s):  
Ajay Srivastava ◽  
Gregory Y. Lee ◽  
Nikolai Steklov ◽  
Clifford W. Colwell ◽  
Kace A. Ezzet ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Knee Arthroplasty ◽  
Tibial Component ◽  
Total Knee
Sign in / Sign up

Export Citation Format

Share Document