Case-related factors affecting cutting errors of the proximal tibia in total knee arthroplasty assessed by computer navigation

  • Tadashi TsukeokaEmail author
  • Yoshikazu Tsuneizumi
  • Kensuke Yoshino
  • Mashiko Suzuki



The aim of this study was to determine factors that contribute to bone cutting errors of conventional instrumentation for tibial resection in total knee arthroplasty (TKA) as assessed by an image-free navigation system. The hypothesis is that preoperative varus alignment is a significant contributory factor to tibial bone cutting errors.


This was a prospective study of a consecutive series of 72 TKAs. The amount of the tibial first-cut errors with reference to the planned cutting plane in both coronal and sagittal planes was measured by an image-free computer navigation system. Multiple regression models were developed with the amount of tibial cutting error in the coronal and sagittal planes as dependent variables and sex, age, disease, height, body mass index, preoperative alignment, patellar height (Insall-Salvati ratio) and preoperative flexion angle as independent variables.


Multiple regression analysis showed that sex (male gender) (R = 0.25 p = 0.047) and preoperative varus alignment (R = 0.42, p = 0.001) were positively associated with varus tibial cutting errors in the coronal plane. In the sagittal plane, none of the independent variables was significant.


When performing TKA in varus deformity, careful confirmation of the bone cutting surface should be performed to avoid varus alignment. The results of this study suggest technical considerations that can help a surgeon achieve more accurate component placement.

Level of evidence



Total knee arthroplasty Cutting error Proximal tibia Computer navigation 



We would like to thank Dr. Yasunori Sato, Chiba University for assisting us in our statistical analysis.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.


No funding was obtained for the work associated with this study.

Ethical approval

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

Informed consent

Informed consent was obtained from all individual participants included in this study.


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Copyright information

© European Society of Sports Traumatology, Knee Surgery, Arthroscopy (ESSKA) 2016

Authors and Affiliations

  • Tadashi Tsukeoka
    • 1
    Email author
  • Yoshikazu Tsuneizumi
    • 1
  • Kensuke Yoshino
    • 1
  • Mashiko Suzuki
    • 2
  1. 1.Department of Orthopaedic SurgeryChiba Rehabilitation CenterChibaJapan
  2. 2.Research Center for Frontier Medical EngineeringChiba UniversityChibaJapan

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