The Medial Tibial Plateau Can Be Used as a Direct Anatomical Reference for the Posterior Tibial Slope in Medial Unicompartmental Knee Arthroplasty

AbstractThere has been no consensus about how to determine the individual posterior tibial slope (PTS) intraoperatively. The purpose of this study was to investigate whether the tibial plateau could be used as a reference for reproducing individual PTS during medial unicompartmental knee arthroplasty (UKA). Preoperative computed tomography (CT) data from 48 lower limbs for medial UKA were imported into a three-dimensional planning software. Digitally reconstructed radiographs were created from the CT data as the lateral knee plain radiographs and the radiographic PTS angle was measured. Then, the PTS angles on the medial one-quarter and the center of the MTP (¼ and ½ MTP, respectively), and that on the medial tibial eminence (TE) were measured on the sagittal multiplanar reconstruction image. Finally, 20 lateral knee radiographs with an arthroscopic probe placed on the ¼ and the ½ MTP were obtained intraoperatively, and the angle between the axis of the probe and the tangent line of the plateau was measured. The mean radiographic PTS angle was 7.9 ± 3.0 degrees (range: 1.7–13.6 degrees). The mean PTS angles on the ¼ MTP, the ½ MTP, and the TE were 8.1 ± 3.0 degrees (1.2–13.4 degrees), 9.1 ± 3.0 degrees (1.4–14.7 degrees), and 9.9 ± 3.1 degrees (3.1–15.7 degrees), respectively. The PTS angles on the ¼ MTP and the ½ MTP were strongly correlated with the radiographic PTS angle (r =0.87 and 0.80, respectively, p < 0.001). A statistically significant difference was observed between the mean angle of the radiographic PTS and the PTS on the TE (p < 0.01). The mean angle between the axis of the probe and the tangent line of the tibial plateau was −0.4 ± 0.9 degrees (−2.3–1.3 degrees) on the ¼ MTP and −0.1 ± 0.7 degrees (−1.5–1.2 degrees) on the ½ MTP, respectively. An area from the medial one-quarter to the center of the MTP could be used as an anatomical reference for the individual PTS.

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Effect of Posterior Tibial Slope Change on Postoperative Range of Motion and Clinical Outcomes after Posterior Cruciate-Substituting Total Knee Arthroplasty

The Journal of Knee Surgery ◽

10.1055/s-0041-1729967 ◽

2021 ◽

Author(s):

O-Sung Lee ◽

Jangyun Lee ◽

Myung Chul Lee ◽

Hyuk-Soo Han

Keyword(s):

Total Knee Arthroplasty ◽

Range Of Motion ◽

Correlation Coefficient ◽

Knee Arthroplasty ◽

Tibial Slope ◽

Posterior Tibial Slope ◽

Posterior Tibial ◽

Clinical Scores ◽

Total Knee ◽

The Mean

AbstractThe posterior tibial slope (PTS) is usually adjusted by less than 5 degrees, without considering its individual difference, during posterior cruciate-substituting (PS) total knee arthroplasty (TKA). The effect of these individual changes of PTS would be important because clinical results depending on postoperative PTS were reported conflictingly. We investigated the effect of the change in PTS on the postoperative range of motion (ROM) and clinical scores after PS TKA. We retrospectively reviewed 164 knees from 107 patients who underwent PS TKA with a 2-year follow-up. We analyzed the preoperative and postoperative PTS, ROM, visual analog scale pain scale, Western Ontario and McMaster University Index (WOMAC), Hospital for Special Surgery Knee Score, Knee Society Score, and Forgotten Joint Score (FJS). The association of the absolute change in PTS with ROM and clinical scores was analyzed using correlation analysis and multiple regression analysis. As a result, the mean PTS and mean ROM changed from 9.6 ± 3.4 and 120.1 ± 15.4 degrees preoperatively to 2.0 ± 1.3 and 128.4 ± 9.3 degrees postoperatively, and the mean PTS change was 7.6 ± 3.5 degrees. The PTS change had no statistically significant association with the postoperative ROM and clinical scoring systems, although it did have a weak positive correlation with WOMAC function, No 10 (difficulty in rising from sitting) (correlation coefficient = 0.342, p = 0.041), and moderate positive correlation with the FJS, No. 6 (awareness when climbing stairs) (correlation coefficient = 0.470, p = 0.001). The authors concluded that the amount of change in PTS did not affect the postoperative ROM and clinical scores, although proximal tibial resection with a constant target of PTS resulted in individually different changes in the PTS after PS TKA,

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Biomechanical effect of tibial slope on the stability of medial unicompartmental knee arthroplasty in posterior cruciate ligament-deficient knees

Bone and Joint Research ◽

10.1302/2046-3758.99.bjr-2020-0128.r1 ◽

2020 ◽

Vol 9 (9) ◽

pp. 593-600 ◽

Cited By ~ 1

Author(s):

Jin-Ah Lee ◽

Yong-Gon Koh ◽

Paul Shinil Kim ◽

Ki Won Kang ◽

Yoon Hae Kwak ◽

...

Keyword(s):

Articular Cartilage ◽

Posterior Cruciate Ligament ◽

Contact Stress ◽

Knee Arthroplasty ◽

Unicompartmental Knee Arthroplasty ◽

Cruciate Ligament ◽

Tibial Slope ◽

Posterior Tibial Slope ◽

High Flexion ◽

Posterior Tibial

Aims Unicompartmental knee arthroplasty (UKA) has become a popular method of treating knee localized osteoarthritis (OA). Additionally, the posterior cruciate ligament (PCL) is essential to maintaining the physiological kinematics and functions of the knee joint. Considering these factors, the purpose of this study was to investigate the biomechanical effects on PCL-deficient knees in medial UKA. Methods Computational simulations of five subject-specific models were performed for intact and PCL-deficient UKA with tibial slopes. Anteroposterior (AP) kinematics and contact stresses of the patellofemoral (PF) joint and the articular cartilage were evaluated under the deep-knee-bend condition. Results As compared to intact UKA, there was no significant difference in AP translation in PCL-deficient UKA with a low flexion angle, but AP translation significantly increased in the PCL-deficient UKA with high flexion angles. Additionally, the increased AP translation became decreased as the posterior tibial slope increased. The contact stress in the PF joint and the articular cartilage significantly increased in the PCL-deficient UKA, as compared to the intact UKA. Additionally, the increased posterior tibial slope resulted in a significant decrease in the contact stress on PF joint but significantly increased the contact stresses on the articular cartilage. Conclusion Our results showed that the posterior stability for low flexion activities in PCL-deficient UKA remained unaffected; however, the posterior stability for high flexion activities was affected. This indicates that a functional PCL is required to ensure normal stability in UKA. Additionally, posterior stability and PF joint may reduce the overall risk of progressive OA by increasing the posterior tibial slope. However, the excessive posterior tibial slope must be avoided. Cite this article: Bone Joint Res 2020;9(9):593–600.

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Ángulo de pendiente tibial posterior “Slope” en prótesis total de rodilla. Diferencias entre alineación Intra o Extramedular y su repercusión sobre el rango de movilidad postoperatorio.

Revista Española de Cirugía Osteoarticular ◽

10.37315/sotocav201928054143 ◽

2019 ◽

pp. 143-148

Keyword(s):

Total Knee Arthroplasty ◽

Knee Arthroplasty ◽

Slope Angle ◽

Tibial Slope ◽

Posterior Tibial Slope ◽

Posterior Slope ◽

Posterior Tibial ◽

Total Knee ◽

The Mean ◽

Posterior Slope Angle

Introduction: The aim of this work was to compare the posterior tibial slope of the tibial component after performing a total knee arthroplasty, as an intramedullary or extramedullary guide was used during the surgical technique, as well as comparing the range of mobility obtained according to the Instrumentation used. Material and methods: We conducted a descriptive, retrospective, observational study of a series of 57 patients operated in our Center during 2012 and 2013, with the same model of total knee arthroplasty (Sigma PS® DePuy), divided into two homogeneous groups in terms of age, sex, degree of osteoarthritis evolution, the first with patients operated by extramedullary guidance and the second by intramedullary guidance. A radiographic study was performed, measuring the posterior slope angle in the sagittal plane. The range of mobility achieved after arthroplasty and implant survival was studied. Results: Together, in both groups, measurements of the posterior slope angle were made, which was 4.35º preoperative average. In groups, the mean postoperative posterior fall angle was 4.04 ° in the patients who underwent an EM guide, while those who underwent an IM guide the mean was 1.76 °; the differences being statistically significant. The range of mobility in the ATRs operated by intramedullary guidance was 102.7º on average (range 80-125º), while in the group where the extramedullary guide was used, it was 104.3º (range 80-130º) no these differences being statistically significant. Regarding the survival of the implant, during the study period two cases of patients undergoing surgery for the replacement of prostheses were found, both of which belonged to the “Extramedullary guide” group. Conclusion: The posterior drop angle, for the same PS prosthesis model, was statistically different according to the guide used, being within the 3-7º range in the group where the extramedullary guide was used; but despite these differences, no impact on the range of mobility was observed. Currently, it is recommended to restore the patient's posterior tibial slope, and in cases with a slope greater than 10º use a PS ATR.

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The influence of posterior tibial slope changes on joint gap and range of motion in unicompartmental knee arthroplasty

The Knee ◽

10.1016/j.knee.2016.01.003 ◽

2016 ◽

Vol 23 (3) ◽

pp. 517-522 ◽

Cited By ~ 10

Author(s):

Koji Takayama ◽

Tomoyuki Matsumoto ◽

Hirotsugu Muratsu ◽

Kazunari Ishida ◽

Daisuke Araki ◽

...

Keyword(s):

Range Of Motion ◽

Knee Arthroplasty ◽

Unicompartmental Knee Arthroplasty ◽

Tibial Slope ◽

Posterior Tibial Slope ◽

Posterior Tibial ◽

Unicompartmental Knee ◽

Joint Gap

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Finite element analysis of the influence of the posterior tibial slope on mobile-bearing unicompartmental knee arthroplasty

The Knee ◽

10.1016/j.knee.2021.01.004 ◽

2021 ◽

Vol 29 ◽

pp. 116-125

Author(s):

Yong-Gon Koh ◽

Kyoung-Mi Park ◽

KiWon Kang ◽

Paul Shinil Kim ◽

Young Han Lee ◽

...

Keyword(s):

Finite Element Analysis ◽

Finite Element ◽

Knee Arthroplasty ◽

Unicompartmental Knee Arthroplasty ◽

Mobile Bearing ◽

Tibial Slope ◽

Posterior Tibial Slope ◽

Element Analysis ◽

Posterior Tibial ◽

Unicompartmental Knee

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Mid-Term Clinical Outcome and Reconstruction of Posterior Tibial Slope after UKA

The Journal of Knee Surgery ◽

10.1055/s-0038-1651528 ◽

2018 ◽

Vol 32 (05) ◽

pp. 468-474 ◽

Cited By ~ 3

Author(s):

Alois Franz ◽

Christoph Boese ◽

Andrej Matthies ◽

Jörg Leffler ◽

Christian Ries

Keyword(s):

Clinical Outcome ◽

Knee Arthroplasty ◽

Tibial Slope ◽

Clinical Results ◽

Posterior Tibial Slope ◽

Posterior Tibial ◽

Post Surgery ◽

Surgery Patient ◽

The Individual

AbstractUnicompartmental knee arthroplasty (UKA) has gained growing popularity over the last decades. The posterior tibial slope (PTS) has been shown to play a significant role for knee biomechanics and is thought to be crucial for clinical function of the UKA. We evaluated the clinical outcome at mid-term follow-up after UKA. Furthermore, the reconstruction of the individual PTS was analyzed. A total of 91 consecutive patients undergoing medial UKA for osteoarthritis were included. Patients were contacted by telephone for a survival analysis at a minimum of 30 months after surgery. Patient-oriented questionnaires and Knee Osteoarthritis Outcome Score (KOOS) were obtained. A retrospective chart review and radiological analysis of component alignment were performed for all patients before and at 6 weeks after surgery. Of 91 patients (93 knees) undergoing UKA, 69 patients (70 knees) were available for clinical follow-up after a mean of 56.0 (range 31–81) months post-surgery. The clinical results of the examined patients in the present study showed mean subscale scores of the KOOS and Western Ontario and McMaster Universities Osteoarthritis Index between 71 and 91%. Overall 7 of 91 patients were revised during the course of follow-up period and underwent total knee arthroplasty. A Kaplan–Meier analysis showed a survival rate for UKA of 90.5% after 48 months. Calculated implant survival was 75.9 months (95% confidence interval 72.3–79.6) at the mean. The radiographic analysis of pre- and postoperative PTS showed no differences (p = 0.113).UKA for osteoarthritis of the medial knee compartment shows encouraging clinical results at mid-term follow-up. The individual PTS could be reconstructed within acceptable ranges. This is a retrospective therapeutic study with Level IV.

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