Skip to main content
SpringerLink
Log in

The effect of tibial component alignment on periprosthetic bone remodeling after total knee arthroplasty

  • Original Article
  • Published:
European Orthopaedics and Traumatology

Abstract

Introduction

Total knee arthroplasty (TKA) implantation alters mechanical loading of both femur and tibia and leads to local bone loss which can compromise the prosthesis survival and present problems at revision arthroplasty. The aim of this study is to assess the effect of tibial component alignment on periprosthetic bone remodeling after TKA.

Patients and methods

A prospective study was conducted involving 60 patients (90 knees) who underwent primary cemented posterior stabilized fixed platform TKA. Tibial component alignment was measured in the immediate postoperative X-ray, and patients were divided into three groups: group I with less than 10° of malalignment, group II with 10–15° of varus malalignment, and group III with more than 15°. Dual-energy X-ray absorptiometry (DEXA) was done within 1 week postoperatively and repeated after 12 and 24 months. Three regions of interest (ROIs) were measured: ROI 1 for the lateral tibial plateau, ROI 2 for the medial tibial plateau, and ROI 3 just distal to the tip of the prosthesis.

Results

The results of DEXA showed statistically insignificant difference in bone remodeling between group I and group II and statistically significant difference in group III compared to group I and II, with increased bone loss in ROI 1 in group III and increased bone loss in ROI 2 in groups I and II.

Conclusion

Marked tibial component malalignment more than 15° significantly alters periprosthetic bone remodeling after total knee arthroplasty; however, the effect of this abnormal remodeling on prosthetic survival needs longer follow-up.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others

References

  1. Robertsson O, Knutson K, Lewold S, Lidgren L (2001) The Swedish Knee Arthroplasty Register 1975–1997. Acta Orthop Scand 72:503–513

    Article  CAS  PubMed  Google Scholar 

  2. Math KR, Zaidi SF, Petchprapa C, Harwin SF (2006) Imaging of total knee arthroplasty. Semin Musculoskelet Radiol 10(1):47–63

    Article  PubMed  Google Scholar 

  3. Rorabeck CH, Taylor JW (1999) Periprosthetic fractures of the femur complicating total knee arthroplasty. Orthop Clin North Am 30(2):265–277

    Article  CAS  PubMed  Google Scholar 

  4. Insall JN, Dorr LD, Scott RD, Scott WN (1989) Rationale of the Knee Society clinical rating system. Clin Orthop 248:13–14

    PubMed  Google Scholar 

  5. Austin MS MD, Sharkey PF, Hozack WJ, Rothman RH (2004) Knee failure mechanisms after total knee arthroplasty. Techniq Knee Surg 3(1):55–59, Lippincott Williams & Wilkins, Inc., Philadelphia

    Article  Google Scholar 

  6. Mintzer CM, Robertson DD, Rackemann S, Ewald FC, Scott RD, Spector M (1990) Bone loss in the distal anterior femur after total knee arthroplasty. Clin Orthop Relat Res 260:135–143

    PubMed  Google Scholar 

  7. Robertson DD, Mintzner CM, Weissman BN et al (1994) Distal loss of femoral bone following total knee arthroplasty: measurement with visual and computer-processing of roentgenograms and dual-energy x-ray absorptiometry. J Bone Joint Surg Am 76-A:66–76

    Google Scholar 

  8. Kamath S, Chang W, Shaari E, Bridges A, Campbell A, McGill P (2008) Comparison of peri-prosthetic bone density in cemented and uncemented total knee arthroplasty. Acta Orthop Belg 74(3):354–359

    PubMed  Google Scholar 

  9. Abu-Rajab RB, Watson WS, Walker B, Roberts J, Gallacher SJ, Meek RM (2006) Peri-prosthetic bone mineral density after total knee arthroplasty: cemented versus cementless fixation: doi: 10.1302/0301-620X.88B5.16893. J Bone Joint Surg (Br) 88-B(5):606–613

    Article  Google Scholar 

  10. Hernandez-Vaquero D, Garcia-Sandoval MA, Fernandez-Carreira JM, Gava R (2008) Influence of the tibial stem design on bone density after cemented total knee arthroplasty: a prospective seven year follow-up study. Int Orthop 32:47–51

    Article  PubMed Central  PubMed  Google Scholar 

  11. Soininvaara TA, Harju KA, Miettinen HJ, Kröger HP (2013) Periprosthetic bone mineral density changes after unicondylar knee arthroplasty. Knee 20(2):120–127

    Article  PubMed  Google Scholar 

  12. Soininvaara TA, Miettinen HJ, Jurvelin JS, Suomalainen OT, Alhava EM, Kröger HP (2004) Periprosthetic femoral bone loss after total knee arthroplasty:1-year follow-up study of 69 patients. Knee 11(4):297–302

    Article  PubMed  Google Scholar 

  13. Soininvaara TA, Miettinen HJ, Jurvelin JS et al (2004) Periprosthetic tibial bone mineral density changes after total knee arthroplasty: one-year follow-up study of 69 patients. Acta Orthop Scand 75:600–550

    Article  PubMed  Google Scholar 

  14. Regner LR, Carlsson LV, Karrholm JN et al (1999) Bone mineral and migratory patterns in uncemented total knee arthroplasties: a randomized 5-year follow-up study of 38 knees. Acta Orthop Scand 70:603–608

    Article  CAS  PubMed  Google Scholar 

  15. Petersen MM, Nielsen PT, Lauritzen JB, Lund B (1995) Changes in bone mineral density of the proximal tibia following uncemented total knee arthroplasty. A 3-year follow-up of 25 knees. Acta Orthop Scand 66:513–516

    Article  CAS  PubMed  Google Scholar 

  16. Sharkey PF, Hozack WJ, Rothman RH et al (2002) Why are total knee arthroplasties failing today? Clin Orthop 404:7–13

    Article  PubMed  Google Scholar 

Download references

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Author information

Authors and Affiliations

  1. Ain Shams University, Cairo, Egypt

    Haytham Abdelazim & Aya Yassin

Authors
  1. Haytham Abdelazim
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Aya Yassin
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Haytham Abdelazim.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Abdelazim, H., Yassin, A. The effect of tibial component alignment on periprosthetic bone remodeling after total knee arthroplasty. Eur Orthop Traumatol 6, 433–437 (2015). https://doi.org/10.1007/s12570-015-0328-9

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s12570-015-0328-9

Keywords

Search

Navigation