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.

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 Finite element analysis of the tibial component alignment in a transverse plane in total knee arthroplasty

2021 ◽  
Author(s):  
Roman Popescu ◽  
Stefan Cristea ◽  
Valentin Oleksik ◽  
Adrian Marius Pascu ◽  
Emil George Haritinian
Keyword(s):  
Finite Element Analysis ◽  
Finite Element ◽  
Total Knee Arthroplasty ◽  
Knee Arthroplasty ◽  
Tibial Component ◽  
Transverse Plane ◽  
Component Alignment ◽  
Element Analysis ◽  
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

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

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>

Using fibula as a reference can be beneficial for the tibial component alignment after total knee arthroplasty, a retrospective study

2014 ◽  
Vol 23 (7) ◽  
pp. 2068-2073 ◽  
Author(s):  
Mehmet Erdem ◽  
Deniz Gulabi ◽  
Gultekin Sitki Cecen ◽  
Cem Coskun Avci ◽  
Murat Asci ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Retrospective Study ◽  
Knee Arthroplasty ◽  
Tibial Component ◽  
Component Alignment ◽  
Tibial Component Alignment ◽  
Total Knee
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