Abstract
Introduction
Despite intensive research, current total knee arthroplasty (TKA) designs do not always provide the correct kinematics for the native joint and thus further optimisation is necessary. Several studies support the importance of malrotation of the tibial components in the failure of TKA. We hypothesise that using the anatomical tibial axis (ATA) to align tibial component rotation on the resected tibial surface may lead to an internal rotation error due to relative anterior shift of the lateral articular surface centre compared to the medial one. The aim of this study was to compare the anatomical tibial axis of the physiological tibial joint surface to the resected one.
Method
Twenty formalin-fixed cadaveric knees were obtained for study. After computed tomography scanning the data of each specimen were entered into a standardised coordinate system and virtual bone cuts were performed with 6, 8 and 10 mm resection depths. The positions of the articular surface centres were determined at each resection depth.
Results
The lateral articular surface centre had moved anteriorly after the resection by a mean 1.475 mm, while the medial one had not changed significantly. Resecting the tibia at a 6-mm cut and using the transverse tibial axis to align the prosthetic tibial plateau will result in a mean 4.0° (95 % confidence interval, 2.5-5.5°) of internal rotation compared to the uncut tibia.
Discussion
The ATA lies in 6 degrees of external rotation compared to the perpendicular to the posterior tibial condylar axis (PTCA). Graw et al. suggest aligning the tibial component in 10 degrees of external rotation to the latter. Thus, if we accept the above suggestion, the ATA is 4 degrees internally rotated compared to the same line on the resected proximal tibia. These prior studies appear to be in accordance with our findings.
Conclusions
We conclude that using the ATA on the resected tibial surface may contribute to an internal rotation error.
Similar content being viewed by others
Abbreviations
- ATA:
-
Anatomical tibial axis
- FFC:
-
Flexion facet centre
- PTCA:
-
Posterior tibial condylar axis
- TKA:
-
Total knee arthroplasty
- TRP:
-
Tibial reference points
References
Ethgen O, Bruyere O, Richy F, Dardennes C, Reginster JY (2004) Health-related quality of life in total hip and total knee arthroplasty. A qualitative and systematic review of the literature. J Bone Joint Surg Am 86-A(5):963–974
van Essen GJ, Chipchase LS, O’Connor D, Krishnan J (1998) Primary total knee replacement: short-term outcomes in an Australian population. J Qual Clin Pract 18(2):135–142
Jacobs CA, Christensen CP, Karthikeyan T (2014) Patient and intraoperative factors influencing satisfaction two to five years after primary total knee arthroplasty. J Arthroplasty 29(8):1576–1579. doi:10.1016/j.arth.2014.03.022
Sesen H, Demirkale I, Karaduman M, Vural CA, Okkaoglu MC, Altay M (2014) Why two-thirds of patients accepted the second session in staged bilateral total knee arthroplasty: a prospective analysis of 111 patients. Knee Surg Sports Traumatol Arthrosc. doi:10.1007/s00167-014-3251-7
Bellemans J, Robijns F, Duerinckx J, Banks S, Vandenneucker H (2005) The influence of tibial slope on maximal flexion after total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 13(3):193–196. doi:10.1007/s00167-004-0557-x
Briard JL, Witoolkollachit P, Lin G (2007) Soft tissue management in total knee replacement. Analysis of ligament balancing. Orthopade 36(7):635–642. doi:10.1007/s00132-007-1109-0
Kurtz S, Ong K, Lau E, Mowat F, Halpern M (2007) Projections of primary and revision hip and knee arthroplasty in the United States from 2005 to 2030. J Bone Joint Surg Am 89(4):780–785. doi:10.2106/JBJS.F.00222
Dalury DF, Pomeroy DL, Gorab RS, Adams MJ (2013) Why are total knee arthroplasties being revised? J Arthroplasty 28(8 Suppl):120–121. doi:10.1016/j.arth.2013.04.051
Sharkey PF, Hozack WJ, Rothman RH, Shastri S, Jacoby SM (2002) Insall Award paper. Why are total knee arthroplasties failing today? Clin Orthop Relat Res 404:7–13
Hutter EE, Granger JF, Beal MD, Siston RA (2013) Is there a gold standard for TKA tibial component rotational alignment? Clin Orthop Relat Res 471(5):1646–1653. doi:10.1007/s11999-013-2822-0
Petersen W, Rembitzki IV, Bruggemann GP, Ellermann A, Best R, Koppenburg AG, Liebau C (2014) Anterior knee pain after total knee arthroplasty: a narrative review. Int Orthop 38(2):319–328. doi:10.1007/s00264-013-2081-4
Bedard M, Vince KG, Redfern J, Collen SR (2011) Internal rotation of the tibial component is frequent in stiff total knee arthroplasty. Clin Orthop Relat Res 469(8):2346–2355. doi:10.1007/s11999-011-1889-8
Barrack RL, Schrader T, Bertot AJ, Wolfe MW, Myers L (2001) Component rotation and anterior knee pain after total knee arthroplasty. Clin Orthop Relat Res 392:46–55
Lakstein D, Zarrabian M, Kosashvili Y, Safir O, Gross AE, Backstein D (2010) Revision total knee arthroplasty for component malrotation is highly beneficial: a case control study. J Arthroplasty 25(7):1047–1052. doi:10.1016/j.arth.2009.07.004
Luyckx T, Peeters T, Vandenneucker H, Victor J, Bellemans J (2012) Is adapted measured resection superior to gap-balancing in determining femoral component rotation in total knee replacement? J Bone Joint Surg (Br) 94(9):1271–1276. doi:10.1302/0301-620X.94B9.28670
Fehring TK (2000) Rotational malalignment of the femoral component in total knee arthroplasty. Clin Orthop Relat Res 380:72–79
Kinzel V, Ledger M, Shakespeare D (2005) Can the epicondylar axis be defined accurately in total knee arthroplasty? Knee 12(4):293–296. doi:10.1016/j.knee.2004.09.003
Talbot S, Dimitriou P, Radic R, Zordan R, Bartlett J (2014) The sulcus line of the trochlear groove is more accurate than Whiteside’s Line in determining femoral component rotation. Knee Surg Sports Traumatol Arthrosc. doi:10.1007/s00167-014-3137-8
Kobayashi H, Akamatsu Y, Kumagai K, Kusayama Y, Ishigatsubo R, Muramatsu S, Saito T (2014) The surgical epicondylar axis is a consistent reference of the distal femur in the coronal and axial planes. Knee Surg Sports Traumatol Arthrosc. doi:10.1007/s00167-014-2867-y
Incavo SJ, Coughlin KM, Pappas C, Beynnon BD (2003) Anatomic rotational relationships of the proximal tibia, distal femur, and patella: implications for rotational alignment in total knee arthroplasty. J Arthroplasty 18(5):643–648
Brooks P (2009) Seven cuts to the perfect total knee. Orthopedics 32 (9). doi:10.3928/01477447-20090728-27
Dalury DF (2001) Observations of the proximal tibia in total knee arthroplasty. Clin Orthop Relat Res 389:150–155
Siston RA, Goodman SB, Patel JJ, Delp SL, Giori NJ (2006) The high variability of tibial rotational alignment in total knee arthroplasty. Clin Orthop Relat Res 452:65–69. doi:10.1097/01.blo.0000229335.36900.a0
Eckhoff DG, Metzger RG, Vandewalle MV (1995) Malrotation associated with implant alignment technique in total knee arthroplasty. Clin Orthop Relat Res 321:28–31
Huddleston JI, Scott RD, Wimberley DW (2005) Determination of neutral tibial rotational alignment in rotating platform TKA. Clin Orthop Relat Res 440:101–106
Graw BP, Harris AH, Tripuraneni KR, Giori NJ (2010) Rotational references for total knee arthroplasty tibial components change with level of resection. Clin Orthop Relat Res 468(10):2734–2738. doi:10.1007/s11999-010-1330-8
Ikeuchi M, Yamanaka N, Okanoue Y, Ueta E, Tani T (2007) Determining the rotational alignment of the tibial component at total knee replacement: a comparison of two techniques. J Bone Joint Surg (Br) 89(1):45–49. doi:10.1302/0301-620X.89B1.17728
Akagi M, Mori S, Nishimura S, Nishimura A, Asano T, Hamanishi C (2005) Variability of extraarticular tibial rotation references for total knee arthroplasty. Clin Orthop Relat Res 436:172–176
Akagi M, Oh M, Nonaka T, Tsujimoto H, Asano T, Hamanishi C (2004) An anteroposterior axis of the tibia for total knee arthroplasty. Clin Orthop Relat Res 420:213–219
Kaech AMN, Müller-Gerbl M (2002) Implementierung eines standardisierten Koordinatensystems für dreidimensionale CT-Darstellungen des Kniegelenks mit VGStudio max. Dissertation, University of Basel, Basel, pp 1–33
Nowakowski AM, Muller-Gerbl M, Valderrabano V (2012) Assessment of knee implant alignment using coordinate measurement on three-dimensional computed tomography reconstructions. Surg Innov 19(4):375–384. doi:10.1177/1553350611429689
Grood ES, Suntay WJ (1983) A joint coordinate system for the clinical description of three-dimensional motions: application to the knee. J Biomech Eng 105(2):136–144
McPherson A, Karrholm J, Pinskerova V, Sosna A, Martelli S (2005) Imaging knee position using MRI, RSA/CT and 3D digitisation. J Biomech 38(2):263–268. doi:10.1016/j.jbiomech.2004.02.007
Cobb JP, Dixon H, Dandachli W, Iranpour F (2008) The anatomical tibial axis: reliable rotational orientation in knee replacement. J Bone Joint Surg (Br) 90(8):1032–1038. doi:10.1302/0301-620X.90B8.19905
Cheng FB, Ji XF, Lai Y, Feng JC, Zheng WX, Sun YF, Fu YW, Li YQ (2009) Three dimensional morphometry of the knee to design the total knee arthroplasty for Chinese population. Knee 16(5):341–347. doi:10.1016/j.knee.2008.12.019
Baier C, Fitz W, Craiovan B, Keshmiri A, Winkler S, Springorum R, Grifka J, Beckmann J (2014) Improved kinematics of total knee replacement following partially navigated modified gap-balancing technique. Int Orthop 38(2):243–249. doi:10.1007/s00264-013-2140-x
Mayr HO, Reinhold M, Hube R, von Roth P, Bernstein A, Suedkamp N, Stoehr A (2014) Rotational laxity and collateral ligament laxity following total knee arthroplasty with rotating platform. Int Orthop 38(7):1379–1386. doi:10.1007/s00264-014-2308-z
Zhao Z, Wang W, Wang S, Jiang L, Zhang S, Zhao Y (2015) Femoral rotation influences dynamic alignment of the lower extremity in total knee arthroplasty. Int Orthop 39(1):55–60. doi:10.1007/s00264-014-2484-x
Kim YH, Park JW, Kim JS, Park SD (2014) The relationship between the survival of total knee arthroplasty and postoperative coronal, sagittal and rotational alignment of knee prosthesis. Int Orthop 38(2):379–385. doi:10.1007/s00264-013-2097-9
Iorio R, Mazza D, Drogo P, Bolle G, Conteduca F, Redler A, Valeo L, Conteduca J, Ferretti A (2015) Clinical and radiographic outcomes of an accelerometer-based system for the tibial resection in total knee arthroplasty. Int Orthop 39(3):461–466. doi:10.1007/s00264-014-2541-5
Maderbacher G, Schaumburger J, Keshmiri A, Barthel M, Springorum HR, Craiovan B, Grifka J, Baier C (2015) Pinless navigation in total knee arthroplasty: Navigation reduced by the maximum? Int Orthop 39(3):455–460. doi:10.1007/s00264-014-2529-1
Crockarell JR Jr, Hicks JM, Schroeder RJ, Guyton JL, Harkess JW, Lavelle DG (2010) Total knee arthroplasty with asymmetric femoral condyles and tibial tray. J Arthroplasty 25(1):108–113. doi:10.1016/j.arth.2008.11.002
Conflict of interest
The authors declare that they have no conflict of interest.
Author information
Authors and Affiliations
Corresponding author
Additional information
Csaba Forster-Horvath and Valerie Kremo contributed equally to this work
Rights and permissions
About this article
Cite this article
Forster-Horvath, C., Kremo, V., Müller-Gerbl, M. et al. Using the anatomical tibial axis for total knee arthroplasty alignment may lead to an internal rotation error. International Orthopaedics (SICOT) 39, 2347–2353 (2015). https://doi.org/10.1007/s00264-015-2858-8
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00264-015-2858-8