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Antero-posterior axis of the tibia is a better landmark for tibial component rotation in Oxford medial unicompartmental knee arthroplasty

Die anteroposteriore Achse der Tibia ist ein besserer Orientierungspunkt für die Tibiakomponentenrotation bei der medialen unikompartimentellen Oxford-Knieendoprothetik

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Abstract

Background

This retrospective study compares tibial component rotations and radiological and functional outcomes in patients who underwent Oxford medial unicompartmental knee arthroplasty (UKA), using the antero-posterior (AP) tibia axis or anterior superior iliac spine (ASIS) as the landmarks for the direction of the vertical cut.

Methods

A total of 86 patients, who underwent Oxford medial UKA were divided into 2 groups, each consisting of 43 patients, according to the use of AP axis (group I) or ASIS (group II) as landmarks for the rotation of vertical tibial cut and compared for the radiological and functional outcomes. Tibial component rotations (α-angle), involvement of the posterior cruciate ligament (PCL) fossa, and instant bearing position (IBP) were measured on computed tomography (CT) images. Functional outcomes were evaluated using Oxford knee score (OKS) and Knee Society score (KSS).

Result

The median α‑angle was significantly smaller in group I than group II (2.5°, range −4–5.5° vs. −6°, range −13–0.5°, p < 0.001). The rates of PCL fossa involvements were 14 (32.6%) and 17 (39.5%, p = 0.7). The median flexion angle of the femoral component (7° vs. 10.5°) and posterior tibial slope (6° vs. 8°) were significantly lower in group I than group II (p = 0.001). All other radiological parameters, preoperative and final OKS and KSS were statistically similar in both groups.

Conclusion

Taking the AP tibial axis as a landmark for vertical tibial cut rotation provides more neutral tibial component rotation in Oxford medial UKA compared to ASIS; however, this difference may not influence the clinical outcomes.

Zusammenfassung

Hintergrund

Diese retrospektive Studie vergleicht die Rotation der Tibiakomponente sowie die radiologischen und funktionellen Ergebnisse bei Patienten, die eine mediale unikondyläre Knieendoprothese (Oxford-Schlittenprothese) am Kniegelenk erhalten hatten, wobei die anteroposteriore Tibiaachse oder die Spina iliaca anterior superior (SIAS) als Orientierungspunkt für die Richtung des vertikalen Schnitts verwendet wurde.

Methoden

Insgesamt 86 Patienten, die eine mediale unikondyläre Schlittenprothese erhalten hatten, wurden in 2 Gruppen mit jeweils 43 Patienten unterteilt, je nachdem, ob die a.-p.-Achse (Gruppe I) oder die SIAS (Gruppe II) als Orientierungspunkt für die Rotation des vertikalen Tibiaschnitts verwendet wurde, und hinsichtlich der radiologischen und funktionellen Ergebnisse verglichen. Die Rotation der Tibiakomponente (α-Winkel), die Beteiligung der Fossa des hinteren Kreuzbands (HKB) und die sofortige Lagerposition („instant bearing position“ [IBP]) wurden auf CT-Bildern gemessen. Die funktionellen Ergebnisse wurden mit dem Oxford Knie Score (OKS) und dem Knee Society Score (KSS) bewertet.

Ergebnis

Der mediane α‑Winkel war in Gruppe I signifikant kleiner als in Gruppe II (2,5°, Range: −4 bis 5,5° vs. −6°, Range: −13 bis 0,5°; p < 0,001). Die Raten der HKB-Fossa-Beteiligung betrugen 14 (32,6 %) und 17 (39,5 %; p = 0,7). Der mediane Flexionswinkel der femoralen Komponente (7 vs. 10,5) und die posteriore tibiale Neigung (6 vs. 8) waren in Gruppe I signifikant geringer als in Gruppe II (p = 0,001). Alle anderen radiologischen Parameter sowie der präoperative und endgültige OKS und KSS waren in beiden Gruppen statistisch ähnlich.

Schlussfolgerung

Bei der medialen unikondylären Oxford-Schlittenprothese führt die Verwendung der a.-p.-Tibiaachse als Orientierungspunkt für die vertikale Rotation des Tibiaschnitts zu einer neutraleren Rotation der Tibiakomponente im Vergleich zur SIAS; dieser Unterschied hat jedoch möglicherweise keinen Einfluss auf das klinische Outcome.

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Authors and Affiliations

  1. Department of Orthopaedics and Traumatology, Bezmialem Vakıf University, İskender Paşa Mh Adnan Menderes Bulvarı, Adnan Menderes Blv., 34093, Fatih/İstanbul, Turkey

    Orkhan Aliyev MD, Muzaffer Ağır MD, Aghamazahir Aghazada MD, Deniz Kara MD, İbrahim Tuncay MD & Fatih Yıldız MD, FEBOT

  2. Department of Radiology, Bezmialem Vakıf University, Fatih/İstanbul, Turkey

    Dilek Hacer Çeşme MD

  3. Department of Biostatistics and Medical Informatics, Bezmialem Vakıf University, İskender Paşa Mh Adnan Menderes Bulvarı, Adnan Menderes Blv., 34093, Fatih/İstanbul, Turkey

    Ali Toprak PhD

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  1. Orkhan Aliyev MD
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  2. Muzaffer Ağır MD
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  8. Fatih Yıldız MD, FEBOT
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Corresponding author

Correspondence to Fatih Yıldız MD, FEBOT.

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Conflict of interest

O. Aliyev, M. Ağır, A. Aghazada, D.H. Çeşme, D. Kara, A. Toprak, İ. Tuncay, and F. Yıldız declare that they have no competing interests.

Ethical standards.

All studies mentioned were in accordance with the ethical standards indicated in each case.

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Level of evidence

Level III therapeutic

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Aliyev, O., Ağır, M., Aghazada, A. et al. Antero-posterior axis of the tibia is a better landmark for tibial component rotation in Oxford medial unicompartmental knee arthroplasty. Orthopädie 51, 996–1002 (2022). https://doi.org/10.1007/s00132-022-04308-8

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