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Low tibial baseplate migration 1 year after unrestricted kinematically aligned total knee arthroplasty using a medial conforming implant design

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Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Purpose

Varus alignment of the tibial baseplate and limb > 3° might adversely affect baseplate fixation after total knee arthroplasty (TKA), especially for unrestricted kinematically aligned (KA) TKA which aligns a majority of baseplates in varus. The purposes of this study were to determine whether baseplate migration at 1 year (1) was significantly less than a stability limit of 0.5 mm, (2) increased over time, and (3) was related to varus alignment of the baseplate and limb after unrestricted KA TKA.

Methods

Thirty-five patients underwent unrestricted KA TKA using a fixed-bearing, cemented, medial conforming tibial insert with posterior cruciate ligament retention. Using model-based radiostereometric analysis, maximum total point motion (MTPM) (i.e., largest displacement on the baseplate) was computed at 6 weeks, 3 months, 6 months, and 1 year postoperatively relative to the day of surgery. Baseplate and limb alignment were measured postoperatively on long-leg CT scanograms.

Results

At 1 year, mean MTPM of 0.35 mm was significantly less than the 0.5 mm stability limit (p = 0.0002). Mean MTPM did not increase from 6 weeks to 1 year (p = 0.3047). Notably, 89% (31/35) of tibial baseplates and 46% (16/35) of limbs were > 3° varus. Baseplate and limb alignment had no relationship to MTPM at 1 year (|r|≤ 0.173, p ≥ 0.3276).

Conclusion

Low and non-progressive tibial baseplate migration 1 year after unrestricted KA TKA with a medial conforming design should allay any concern that unrestricted KA TKA increases risk of baseplate loosening due to varus alignment of the baseplate and limb.

Level of evidence

Level II, therapeutic prospective cohort study.

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Acknowledgements

The authors are grateful to Medacta USA, Inc. for their financial support. The authors would also like to thank the individuals who participated in this study for their contribution to the advancement of education and research and the clinical staff at Adventist Lodi Memorial Hospital for assisting with the imaging.

Funding

Medacta USA, Inc.

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Authors and Affiliations

  1. Department of Biomedical Engineering, University of California, Davis, One Shields Avenue, Davis, CA, 95616, USA

    Abigail E. Niesen, Anna L. Garverick, Stephen M. Howell & Maury L. Hull

  2. Department of Mechanical Engineering, University of California, Davis, One Shields Avenue, Davis, CA, 95616, USA

    Maury L. Hull

  3. Department of Orthopaedic Surgery, University of California Davis Medical Center, 4860 Y Street, Suite 3800, Sacramento, CA, 95817, USA

    Maury L. Hull

Authors
  1. Abigail E. Niesen
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  2. Anna L. Garverick
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Contributions

AEN designed the study; coordinated patient imaging; analyzed the data; created figures and tables; drafted the manuscript; revised the manuscript. ALG analyzed the data; created figures and tables. SMH conceptualized the study; performed surgeries; supervised data collection and interpretation; reviewed and edited the manuscript. MLH conceptualized the study; obtained research funding; supervised the study design, data collection, and data analysis; reviewed and edited the manuscript.

Corresponding author

Correspondence to Maury L. Hull.

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Conflict of interest

SMH is a paid consultant for Medacta Inc. and receives royalties from Medacta Inc. MLH receives research support from Medacta Inc. and is on the editorial board of the Journal of Biomechanics.

Ethical approval.

This was an IRB approved study at a single institution (IRB# 1251807, UC Davis).

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Informed consent was obtained for all patients prior to participation in the study.

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Niesen, A.E., Garverick, A.L., Howell, S.M. et al. Low tibial baseplate migration 1 year after unrestricted kinematically aligned total knee arthroplasty using a medial conforming implant design. Knee Surg Sports Traumatol Arthrosc 31, 1433–1442 (2023). https://doi.org/10.1007/s00167-022-07171-4

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