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Underhang of the tibial component increases tibial bone resorption after total knee arthroplasty

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Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Purpose

One of the causes of aseptic loosening is marked tibial bone resorption (TR) at the tibial bone–component interface after total knee arthroplasty (TKA). It was hypothesized that insufficient coverage of the tibial component and improper cementing technique would cause increased TR after cemented TKA.

Methods

One hundred thirty-four primary TKAs in 107 patients with varus osteoarthritis were included in this study. The relationships between the TRs at 2 years after TKA and the tibial component underhang (TUH), the thickness of the cement mantle around the keel, and clinical parameters were evaluated.

Results

The widths of TRs on anteroposterior radiographs were significantly larger on the medial side than on the lateral side (p = 0.001), whereas the difference between the anterior and posterior sides on lateral radiographs was relatively small. Multiple regression analyses showed that medial TR was positively related to medial TUH (p = 0.006), and lateral TR was positively related to a thicker distal cement mantle (p = 0.027). On the lateral view, stepwise selection indicated that postoperative knee flexion angle was the most significant risk factor (p = 0.005) for anterior TR, and posterior TUH was the strongest predictor (p = 0.001) of posterior TR.

Conclusions

To avert postoperative progressive TR, surgeons should perfectly fit a suitably sized tibial component to the medial edge of the tibia. Also, care should be taken to avoid an excessive cement mantle at the distal portion of the keel during TKA.

Level of evidence

IV.

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Funding

There was no funding for this study.

Author information

Authors and Affiliations

  1. Department of Orthopaedic Surgery, Graduate School of Medicine, Kyoto University, 54 Kawahara-cho, Shogoin, Sakyo-ku, Kyoto, 606-8507, Japan

    ShiZhong Gu, Shinichi Kuriyama, Shinichiro Nakamura, Kohei Nishitani, Hiromu Ito & Shuichi Matsuda

  2. Department of Orthopaedic Surgery, Sports Medicine and Joint Surgery, The First Hospital of China Medical University, Shenyang, Liaoning, China

    ShiZhong Gu

Authors
  1. ShiZhong Gu
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  2. Shinichi Kuriyama
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Corresponding author

Correspondence to Shinichi Kuriyama.

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Conflict of interest

The authors declare no conflicts of interest in association with the present study.

Ethical approval

All procedures were in accordance with the ethical standards of our institutional research committee.

Informed consent

Informed consent was obtained from all study participants.

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Cite this article

Gu, S., Kuriyama, S., Nakamura, S. et al. Underhang of the tibial component increases tibial bone resorption after total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 27, 1270–1279 (2019). https://doi.org/10.1007/s00167-018-5309-4

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  • DOI: https://doi.org/10.1007/s00167-018-5309-4

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