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Is There a Gold Standard for TKA Tibial Component Rotational Alignment?

  • Basic Research
  • Published:
Clinical Orthopaedics and Related Research®

Abstract

Background

Joint function and durability after TKA depends on many factors, but component alignment is particularly important. Although the transepicondylar axis is regarded as the gold standard for rotationally aligning the femoral component, various techniques exist for tibial component rotational alignment. The impact of this variability on joint kinematics and stability is unknown.

Questions/purposes

We determined how rotationally aligning the tibial component to four different axes changes knee stability and passive tibiofemoral kinematics in a knee after TKA.

Methods

Using a custom surgical navigation system and stability device to measure stability and passive tibiofemoral motion, we tested 10 cadaveric knees from five hemicorpses before TKA and then with the tibial component aligned to four axes using a modified tibial tray.

Results

No changes in knee stability or passive kinematics occurred as a result of the four techniques of tibial rotational alignment. TKA produces a ‘looser’ knee over the native condition by increasing mean laxity by 5.2°, decreasing mean maximum stiffness by 4.5 N·m/°, increasing mean anterior femoral translation during passive flexion by 5.4 mm, and increasing mean internal-external tibial rotation during passive flexion by 4.8°. However, no statistically or clinically important differences occurred between the four TKA conditions.

Conclusions

For all tibial rotations, TKA increased laxity, decreased stiffness, and increased tibiofemoral motion during passive flexion but showed little change based on the tibial alignment.

Clinical Relevance

Our observations suggest surgeons who align the tibial component to any of the axes we examined are expected to have results consistent with those who may use a different axis.

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Acknowledgments

We thank Michael Knopp MD, PhD for assistance with the CT images, Zimmer Inc for loans of surgical trays, and Jeff Stanley at Northern Digital, Inc, for technical support with our camera. We also thank the members of The Ohio State University Neuromuscular Biomechanics Laboratory for assistance during testing.

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Authors and Affiliations

  1. Department of Mechanical and Aerospace Engineering, The Ohio State University, E305 Scott Laboratory, 201 W 19th Avenue, Columbus, OH, 43210, USA

    Erin E. Hutter MS & Robert A. Siston PhD

  2. Department of Orthopaedics, The Ohio State University, 543 Taylor Avenue, Suite 1074, Columbus, OH, USA

    Jeffrey F. Granger MD, Matthew D. Beal MD & Robert A. Siston PhD

Authors
  1. Erin E. Hutter MS
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  2. Jeffrey F. Granger MD
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  3. Matthew D. Beal MD
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  4. Robert A. Siston PhD
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Corresponding author

Correspondence to Robert A. Siston PhD.

Additional information

The institution of one or more of the authors has received funding, during the study period, from the Orthopaedic Research and Education Foundation (Rosemont, IL, USA) (RAS), the American Association of Hip and Knee Surgeons (Rosemont, IL, USA) (RAS), and the National Institute of Arthritis and Musculoskeletal and Skin Diseases (Bethesda, MD, USA) (Award Number R01AR056700) (RAS). Each author certifies that he or she, or a member of his or her immediate family, has no commercial associations (eg, consultancies, stock ownership, equity interest, patent/licensing arrangements, etc) that might pose a conflict of interest in connection with the submitted article.

All ICMJE Conflict of Interest Forms for authors and Clinical Orthopaedics and Related Research editors and board members are on file with the publication and can be viewed on request.

Clinical Orthopaedics and Related Research neither advocates nor endorses the use of any treatment, drug, or device. Readers are encouraged to always seek additional information, including FDA approval status, of any drug or device before clinical use.

Each author certifies that his or her institution approved the human protocol for this investigation, that all investigations were conducted in conformity with ethical principles of research.

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Hutter, E.E., Granger, J.F., Beal, M.D. et al. Is There a Gold Standard for TKA Tibial Component Rotational Alignment?. Clin Orthop Relat Res 471, 1646–1653 (2013). https://doi.org/10.1007/s11999-013-2822-0

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