scholarly journals The influence of posterior tibial slope on the mid-term clinical effect of medial-pivot knee prosthesis

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Weipeng Shi ◽  
Yaping Jiang ◽  
Xuan Zhao ◽  
Haining Zhang ◽  
Yingzhen Wang ◽  
...  
Keyword(s):  
Postoperative Complications ◽  
Knee Joint ◽  
Knee Prosthesis ◽  
Tibial Slope ◽  
Joint Line ◽  
Posterior Tibial Slope ◽  
Posterior Tibial ◽  
Medial Pivot ◽  
Group A ◽  
The Stability

Abstract Objective To evaluate the effect of posterior tibial slope (PTS) on the mid-term clinical outcome following a medial-pivot (MP) prosthesis. Method Two hundred thirty-three patients from The Affiliated Hospital of Qingdao University, who had undergone a total knee arthroplasty (TKA) with MP prosthesis between January 2015 and December 2015, were retrospectively included in this study. They were divided into 3 groups according to postoperative PTS: A ≤ 5°; B 5-7°; and C ≥ 7°. Multiple assessments were made on the patient postoperatively and recorded in the three groups, the measurements of this study included: the range of motion (ROM), knee scoring system (KSS), Western Ontario and McMaster universities osteoarthritis index (WOMAC), posterior condylar offset (PCO), joint line height, and postoperative complications. Results The average post-operative ROM for groups B and C were 108° and 110° respectively; this was significantly higher than that of group A (98°, P < 0.001). The WOMAC scores of patients in group C were significantly lower than those in groups A and B (P < 0.05). However, there were no significant differences in KSS, PCO, and joint line height among the 3 groups (P > 0.05). Only 2 cases of postoperative complications occurred in group C, these were ameliorated after operation. Conclusion With an increase to PTS, the postoperative ROM can be significantly increased for the patient. However, the knee joint function will not be significantly improved, and the stability of knee joint will not be affected when within the limits of appropriate PTS.

scholarly journals The Influence of Posterior Tibial Slope on the Mid-term Clinical Effect of Medial-pivot Knee Prosthesis

2021 ◽  
Author(s):  
Weipeng Shi ◽  
Yaping Jiang ◽  
Xuan Zhao ◽  
Haining Zhang ◽  
Yingzhen Wang ◽  
...  
Keyword(s):  
Postoperative Complications ◽  
Knee Joint ◽  
Knee Prosthesis ◽  
Tibial Slope ◽  
Joint Line ◽  
Posterior Tibial Slope ◽  
Posterior Tibial ◽  
Medial Pivot ◽  
Group A ◽  
The Stability

Abstract Objective: To evaluate the effect of posterior tibial slope (PTS) on the mid-term clinical outcome following a medial-pivot (MP) prosthesis. Method: 233 patients from this hospital, who had undergone a total knee arthroplasty (TKA) with MP prosthesis between January 2015 and December 2015, were retrospectively included in this study. They were divided 3 groups according to postoperative PTS: A ≤ 5°; B 5-7° and C ≥ 7°. Multiple assessments were made on the patient postoperatively and recorded in the three groups, the measurements of this study included: The range of motion (ROM), knee scoring system (KSS), Western Ontario and McMaster universities osteoarthritis index (WOMAC), posterior condylar offset (PCO), joint line height and postoperative complications. Results: The average post-operative ROM for groups B and C were 108°and 110°respectively, this was significantly higher than that of group A (98°, P < 0.001). The WOMAC scores of patients in group C were significantly lower than those in groups A and B (p < 0.05). However, there were no significant differences in KSS, PCO, joint line height among the 3 groups (P>0.05). Only 2 cases of postoperative complications occurred in group C, these were recovered after operation. Conclusion: With an increase to PTS, the postoperative ROM can be significantly increased for the patient, however, the knee joint function will not be significantly improved, and the stability of knee joint will not be affected within the appropriate PTS.

scholarly journals Use of a Suspended and Straightened Knee Joint Position When Fixing Steel Plates Can Prevent the Increase in Postoperative Posterior Tibial Slope After Open‑wedge High Tibial Osteotomy

2021 ◽  
Author(s):  
Wenru Ma ◽  
Zengshuai Han ◽  
Shengnan Sun ◽  
Jinli Chen ◽  
Yi Zhang ◽  
...  
Keyword(s):  
Knee Joint ◽  
Tibial Slope ◽  
Steel Plates ◽  
Posterior Tibial Slope ◽  
Tibial Osteotomy ◽  
Joint Position ◽  
Radiological Assessment ◽  
Posterior Tibial ◽  
Wedge High Tibial Osteotomy

Abstract Background: Posterior tibial slope (PTS) increases after medial open-wedge high tibial osteotomy (OWHTO) is challenging for patients. This study aims to determine whether use of a suspended and straightened knee joint position during the fixing of steel plates can prevent an increase in the posterior tibial slope after OWHTO.Methods: This study retrospectively analyzed 112 subjects (122 knees) [34 males, 78 females; mean age 59.1±6.6 (range 48–76) years; mean body mass index (BMI) 28.06±3.61 kg/m²] who underwent OWHTO. A total of 78 knees that were suspended and extended by placing a sterile cloth ball under the ipsilateral ankle during the fixing of steel plates comprised the suspended and straightened knee joint position (SSP) group, and 44 knees that were kept naturally straightened without placing a sterile cloth ball under the ipsilateral ankle during the fixing of steel plates comprised the naturally straightened knee joint position (NSP) group. Patients were clinically assessed according to the visual analog pain scale (VAS) and the Western Ontario and McMaster Universities (WOMAC) osteoarthritis index. Radiological assessment was performed according to the changes in the posterior tibial slope between preoperation, 1-day postoperation, and the final follow-up periods. Ultimately, the difference in postoperative PTS changes between the two groups was statistically analyzed. The median follow-up period was 2.2 years (range 1.6–3.7 years).Results: In the final follow-up period, significant improvements were observed in the clinical VAS and WOMAC scores in both groups (P < 0.001), and no difference was found between the two groups. Radiological assessment showed that there was no statistical difference in the preoperative PTS between the two groups. The 1-day post-operative PTS and the most recent follow-up PTS were significantly greater than the preoperative PTS in the NSP group (t=-3.213, -6.406, all P < 0.001), but no significant increase was seen in the SSP group (P >0.05). The increase in PTS in the NSP group was significantly greater than that in the SSP group at the 1-day postoperative (t=2.243, P=0.030) and final follow-up periods (t=6.501, P<0.001).Conclusion: For OWHTO, the use of a suspended and straightened knee joint position rather than a naturally straightened knee joint position during the fixing of steel plates could effectively prevent the increase in postoperative PTS.Level of Evidence: Retrospective Study Level III

scholarly journals Influence of posterior tibial slope on knee flexion in posterior stabilized fixed bearing primary total knee arthroplasty

2020 ◽  
Vol 6 (3) ◽  
pp. 487
Author(s):  
Sandeep Kumar Kanugula ◽  
Mallesh Rathod ◽  
Venugopal S. M. ◽  
Mohan Babu Lebaku
Keyword(s):  
Total Knee Arthroplasty ◽  
Functional Outcome ◽  
Knee Arthroplasty ◽  
Knee Flexion ◽  
Tibial Slope ◽  
Posterior Tibial Slope ◽  
Posterior Tibial ◽  
Group A ◽  
Total Knee ◽  
Pcl Substituting

<p class="abstract"><strong>Background:</strong> The goal of total knee arthroplasty (TKA) is to relieve pain and maintain stable range of motion (ROM) for day to day activities. Among the various factors, posterior tibial slope slope (PTS) may play an important role in achieving good postoperative knee flexion. Our study aims to know the effectiveness of PTS on the ROM of the knee in a posterior cruciate ligament (PCL)-substituting TKA.</p><p class="abstract"><strong>Methods:</strong> A total of 125 unilateral PCL-substituting TKA’s were included in the study. Based on postoperative PTA which was measured on lateral radiograph, patients were divided into 3 groups, Group A (PTS of ≤2) comprise of 24 patients. Group B consists of 91 patients (PTS of 3 to 7). Group C includes 10 patients (PTS of 8 or more). Functional outcome was measured by using knee society score (KSS) and Western Ontario and McMaster Universities osteoarthritis index (WOMAC) which were evaluated preoperatively and at 18months post operatively.<strong></strong></p><p class="abstract"><strong>Results:</strong> Mean postop ROM was 92.91 ± 10.632; 107.24±10.905; 107.49±13.944 in group A, B, C respectively which was significantly related to mean postop PTS (0.74; 5.62; 9.87 in group A, B, C respectively) (P&lt;0.05). Functional outcome was measured by KSS and WOMAC which showed no significant difference pre and postoperatively.</p><p class="abstract"><strong>Conclusions:</strong> The results of our study validate the hypothesis that a positive correlation exists between the postoperative flexion and PTS in the PCL-substituting TKA, an increase in PTS can lead to a greater degree of the knee flexion for every extra degree of PTS.</p><p> </p>

scholarly journals Posterior Tibial Slope Angle Correlates With Peak Sagittal and Frontal Plane Knee Joint Loading During Robotic Simulations of Athletic Tasks

2016 ◽  
Vol 44 (7) ◽  
pp. 1762-1770 ◽  
Author(s):  
Nathaniel A. Bates ◽  
Rebecca J. Nesbitt ◽  
Jason T. Shearn ◽  
Gregory D. Myer ◽  
Timothy E. Hewett
Keyword(s):  
Knee Joint ◽  
Slope Angle ◽  
Frontal Plane ◽  
Acl Injury ◽  
Tibial Slope ◽  
Lateral Compartment ◽  
Posterior Tibial Slope ◽  
Posterior Tibial ◽  
Vertical Jumps ◽  
Posterior Tibial Slope Angle

Background: Tibial slope angle is a nonmodifiable risk factor for anterior cruciate ligament (ACL) injury. However, the mechanical role of varying tibial slopes during athletic tasks has yet to be clinically quantified. Purpose: To examine the influence of posterior tibial slope on knee joint loading during controlled, in vitro simulation of the knee joint articulations during athletic tasks. Study Design: Descriptive laboratory study. Methods: A 6 degree of freedom robotic manipulator positionally maneuvered cadaveric knee joints from 12 unique specimens with varying tibial slopes (range, −7.7° to 7.7°) through drop vertical jump and sidestep cutting tasks that were derived from 3-dimensional in vivo motion recordings. Internal knee joint torques and forces were recorded throughout simulation and were linearly correlated with tibial slope. Results: The mean (±SD) posterior tibial slope angle was 2.2° ± 4.3° in the lateral compartment and 2.3° ± 3.3° in the medial compartment. For simulated drop vertical jumps, lateral compartment tibial slope angle expressed moderate, direct correlations with peak internally generated knee adduction ( r = 0.60-0.65), flexion ( r = 0.64-0.66), lateral ( r = 0.57-0.69), and external rotation torques ( r = 0.47-0.72) as well as inverse correlations with peak abduction ( r = −0.42 to −0.61) and internal rotation torques ( r = −0.39 to −0.79). Only frontal plane torques were correlated during sidestep cutting simulations. For simulated drop vertical jumps, medial compartment tibial slope angle expressed moderate, direct correlations with peak internally generated knee flexion torque ( r = 0.64-0.69) and lateral knee force ( r = 0.55-0.74) as well as inverse correlations with peak external torque ( r = −0.34 to −0.67) and medial knee force ( r = −0.58 to −0.59). These moderate correlations were also present during simulated sidestep cutting. Conclusion: The investigation supported the theory that increased posterior tibial slope would lead to greater magnitude knee joint moments, specifically, internally generated knee adduction and flexion torques. Clinical Relevance: The knee torques that positively correlated with increased tibial slope angle in this investigation are associated with heightened risk of ACL injury. Therefore, the present data indicated that a higher posterior tibial slope is correlated to increased knee loads that are associated with heightened risk of ACL injury.

scholarly journals Posterior tibial slope is a modifiable predictor of relatively large extension gaps in total knee arthroplasty for degenerative osteoarthritis

2021 ◽  
Vol 29 (1) ◽  
pp. 230949902110020
Author(s):  
Kyun-Ho Shin ◽  
Sang-Bum Kim ◽  
Ki-Mo Jang ◽  
Chul-Soo Lee ◽  
Seung-Beom Han
Keyword(s):  
Total Knee Arthroplasty ◽  
Knee Arthroplasty ◽  
Tibial Slope ◽  
Joint Line ◽  
Posterior Tibial Slope ◽  
Weighting Method ◽  
Posterior Tibial ◽  
Posterior Condylar ◽  
Total Knee ◽  
Extension Gap

Background: During total knee arthroplasty (TKA) for osteoarthritis, the sagittal gap imbalance (SGI) with a relatively large extension gap is an important surgical challenge. We determined the predictors of SGI with a relatively large extension gap and evaluated the surgical outcomes of knees with SGI. Methods: 551 consecutive cases of primary TKA for osteoarthritis were retrospectively reviewed. The cohort was divided into two groups according to the SGI and statistically matched according to baseline characteristics via the inverse probability of treatment weighting method. Multiple linear and logistic regression analyses were performed to determine the predictors of sagittal gap difference (SGD) and SGI. Intergroup differences in clinical and radiological outcomes were analyzed. Results: Of all the knees included, 8.5% (n = 45) presented with SGI with a relatively large extension gap and required femoral sagittal balancing to manage SGI. The hyperextension angle (HA), preoperative joint line convergence angle (JLCA), and the change in posterior tibial slope (PTS) significantly correlated to SGD and predicted SGI with a relatively large extension gap. SGI group showed significant changes in femoral posterior condylar offset and joint line height compared to those without SGI (1.48 vs −0.45, 1.37 vs −0.51, respectively). Postoperative ROM and knee society knee scores were lower in SGI group. Conclusion: Knees requiring sagittal balancing to manage SGI with a relatively large extension gap is not uncommon in TKA for osteoarthritic knees. The change in PTS is an independent and modifiable predictor of SGI.

Influences of Antero-Posterior Tibial Slope on the Prosthetic Knee Contact Stresses

2016 ◽  
Vol 823 ◽  
pp. 137-142
Author(s):  
Dan Calafeteanu ◽  
Dan Tarnita ◽  
Marius Catana ◽  
Daniel Calin ◽  
Daniela Tarniţă
Keyword(s):  
Knee Prosthesis ◽  
Tibial Slope ◽  
Contact Stresses ◽  
Posterior Tibial Slope ◽  
Human Knee ◽  
Prosthetic Knee ◽  
Posterior Tibial ◽  
Human Knee Joint ◽  
Total Knee ◽  
3D Finite Element Method

In this paper, using 3D finite element method and starting from the virtual model of the human knee joint-prosthesis assembly, we investigate the effects of antero-posterior tibial slope on contact stresses in the three components of total knee prosthesis. Using AnsysWorkbench15.07 software, the stress and displacements maps are obtained for knee-prosthesis assemblies and for their components, considering two loading force: 800N and 2400N and two cases of prosthetic knee varus slope: 176o and b) 191o. For each prosthesis-knee assembly and for each considered force, two variants of antero-posterior tibial slope were considered: 00 and 50.

scholarly journals The influence of High tibial osteotomies on the posterior tibial slope - Study of 190 medial open wedge and 89 lateral closed wedge cases

2020 ◽  
Vol 8 (5_suppl4) ◽  
pp. 2325967120S0030
Author(s):  
Ilona Schubert ◽  
Felix Ferner ◽  
Peter Strohm ◽  
Jörg Dickschas
Keyword(s):  
Surgical Technique ◽  
Knee Joint ◽  
Tibial Slope ◽  
Posterior Tibial Slope ◽  
Open Wedge ◽  
Posterior Tibial ◽  
Closed Wedge ◽  
The Common ◽  
The Mean ◽  
The Impact

Aims and Objectives: High tibial osteotomies (HTO) are nowadays an established method to treat unicompartmental, medial gonarthrosis. Common surgical HTO techniques include medial open wedge (MOW) and lateral closed wedge osteotomies (LCW). In addition to the intended change in the frontal plane these surgical techniques take influence on various other biomechanical issues of the knee joint e.g. the posterior tibial slope (PTS). Aim of this study was to rate and evaluate changes of the tibial slope by HTOs dependent on the used surgical technique (MOW versus LCW). Materials and Methods: 414 HTOs, that had been performed in our institution between 2004 and November 2018, were reviewed retrospectively. 135 cases were excluded. The included 279 cases from 247 patients were divided into two groups dependent on the used surgical technique (MOW/LCW). In both groups the values of PTS were defined by measuring the proximal posterior tibia angle (PPTA) on lateral x-rays of the knee from before and 4 to 6 weeks after surgery. The change of PTS was evaluated as delta-PPTA. Microsoft Excel was used for statistical analysis. Results: 279 cases were included: 190 were assigned to the group of MOW and 89 to the group of LCW osteotomies. Considering demographic data the MOW-group showed a gender distribution of 124 men/ 46 women in 93 left and 97 right knees, and the LCW-group of 46 men/43 women in 40 left and 49 right knees. The mean value of age in the MOW group was 47,6 +/- 10 years (15-70 years) and in the LCW-group 40,6+/-13,7 years (15-67 years). Before surgery there was no statistical significant difference in the PPTA-values between both groups (p=0,720): The mean PPTA in the MOW-group measured 79,9°+/-3,2° (68-88°), in the LCW-group 80,6°+/-2,6° (74-88°). The change caused by surgery showed no statistical significance in the MOW-group (delta-PPTA 0,07°+/- 2,9° [-12° bis 11°]). However, in the LCW-Gruppe we observed a significant (p<0,001) decrease of the PTS (delta-PPTA -3,09°+/- 4,5° [-12°bis 5°]). Nevertheless, the analysis of delta-PPTA in the LCW-group over the timeline of the study period showed tendencies of a decline of slope-reduction. Conclusion: As the PTS plays a relevant role in biomechanics of the knee joint a consideration of the impact of changes in PTS by HTOs is indispensable. Our results support the common thesis of a slope-reduction by LCW osteotomies but nevertheless the analysis throughout the study period showed a reduction of the slope-decrease over timeline. The common thesis of a slope-increase by MOW osteotomies was not supported by our results which showed no significant change.

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