The purpose of the present study is to compare newer designs of various symmetric and asymmetric tibial components and measure tibial bone coverage using the rotational safe zone defined by two commonly utilized anatomic rotational landmarks.
Computed tomography scans (CT scans) of one hundred consecutive patients scheduled for total knee arthroplasty were obtained pre-operatively. A virtual proximal tibial cut was performed and two commonly used rotational axes were added for each image: the medio-lateral axis (ML-axis) and the medial 1/3 tibial tubercle axis (med-1/3-axis). Different symmetric and asymmetric implant designs were then superimposed in various rotational positions for best cancellous and cortical coverage. The images were imported to a public domain imaging software, and cancellous and cortical bone coverage was computed for each image, with each implant design in various rotational positions.
One single implant type could not be identified that provided the best cortical and cancellous coverage of the tibia, irrespective of using the med-1/3-axis or the ML-axis for rotational alignment. However, it could be confirmed that the best bone coverage was dependent on the selected rotational landmark. Furthermore, improved bone coverage was observed when tibial implant positions were optimized between the two rotational axes.
Tibial coverage is similar for symmetric and asymmetric designs, but depends on the rotational landmark for which the implant is designed. The surgeon has the option to improve tibial coverage by optimizing placement between the two anatomic rotational alignment landmarks, the medial 1/3 and the ML-axis. Surgeons should be careful assessing intraoperative rotational tibial placement using the described anatomic rotational landmarks to optimize tibial bony coverage without compromising patella tracking.
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Total knee replacement
Tibial plateau center
Medial plateau center
Lateral plateau center
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Posterior cruciate ligament
Posterior tibial axis
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Conflict of interest
The authors declare that they have no competing interests.
There was no outside funding or grants received that assisted in this study.
This study has been performed in accordance with ethical standards concerning investigations in the United States of America.
For this type of article informed consent is not required.
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Meier, M., Webb, J., Collins, J.E. et al. Do modern total knee replacements improve tibial coverage?. Knee Surg Sports Traumatol Arthrosc 26, 3219–3229 (2018). https://doi.org/10.1007/s00167-018-4836-3
- Total knee arthroplasty
- Tibial coverage
- Rotational alignment
- Total knee replacement
- Tibial rotation