Skip to main content
SpringerLink
Log in

High inter- and intraindividual differences in medial and lateral posterior tibial slope are not reproduced accurately by conventional TKA alignment techniques

  • KNEE
  • Published:
Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Purpose

The purpose of this study was to describe the medial and lateral posterior tibial slope (MPTS and LPTS) on 3D-CT in a Caucasian population without osteoarthritis. It was hypothesised that standard TKA alignment techniques would not reproduce the anatomy in a high percentage of native knees.

Methods

CT scans of 301 knees [male:female = 192:109; mean age 30.1 (\(\pm\) 6.1)] were analysed retrospectively. Tibial slope was measured medially and laterally in relation to the mechanical axis of the tibia. The proportion of MPTS and LPTS was calculated, corresponding to the “standard PTS” of 3°–7°. The proportion of knees accurately reproduced with the recommended PTS of 0°–3° for PS and 5°–7° for CR TKA were evaluated.

Results

Interindividual mean values of MPTS and LPTS did not differ significantly (mean (range); MPTS: 7.2° ( – 1.0°–19.0°) vs. LPTS: 7.2° ( − 2.4°–17.8°), n.s.). The mean absolute intraindividual difference was 2.9° (0.0°–10.8°). In 40.5% the intraindividual difference between MPTS and LPTS was > 3°. When the standard slope of 3°–7° medial and lateral was considered, only 15% of the knees were covered. The tibial cut for a PS TKA or a CR TKA changes the combined PTS (MPTS + LPTS) in 99.3% and 95.3% of cases, respectively.

Conclusion

A high interindividual range of MPTS and LPTS as well as considerable intraindividual differences were shown. When implementing the recommended slope values for PS and CR prostheses, changes in native slope must be accepted. Further research is needed to evaluate the impact of altering a patient’s native slope on the clinical outcome.

Level of evidence

IV.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5

Similar content being viewed by others

Abbreviations

ACL:

Anterior cruciate ligament

AP:

Anterior – posterior

CR:

Cruciate retaining

MPTS:

Medial posterior tibial slope

OA:

Osteoarthritis

ROM:

Range of motion

PCL:

Posterior cruciate ligament

PS:

Posterior stabilized

PTS:

Posterior tibial slope

ROM:

Range of motion

LPTS:

Lateral posterior tibial slope

TKA:

Total knee arthroplasty

3D:

Three dimensional

References

  1. Bai B, Baez J, Testa NN, Kummer FJ (2000) Effect of posterior cut angle on tibial component loading. J Arthroplasty 15:916–920

    Article  CAS  Google Scholar 

  2. 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 13:193–196

    Article  CAS  Google Scholar 

  3. Catani F, Leardini A, Ensini A, Cucca G, Bragonzoni L, Toksvig-Larsen S, Giannini S (2004) The stability of the cemented tibial component of total knee arthroplasty posterior cruciate-retaining versus posterior-stabilized design1 1No benefits or funds were received in support of this study. J Arthroplasty 19:775–782

    Article  Google Scholar 

  4. Chambers AW, Wood AR, Kosmopoulos V, Sanchez HB, Wagner RA (2016) Effect of posterior tibial slope on flexion and anterior-posterior tibial translation in posterior cruciate-retaining total knee arthroplasty. J Arthroplasty 31:103–106

    Article  Google Scholar 

  5. Figueroa J, Guarachi JP, Matas J, Arnander M, Orrego M (2016) Is computed tomography an accurate and reliable method for measuring total knee arthroplasty component rotation? Int Orthop 40:709–714

    Article  Google Scholar 

  6. Fucentese SF, Meier P, Jud L, Köchli G-L, Aichmair A, Vlachopoulos L, Fürnstahl P (2020) Accuracy of 3D-planned patient specific instrumentation in high tibial open wedge valgisation osteotomy. J Exp Orthop 7:7. https://doi.org/10.1186/s40634-020-00224-y

    Article  PubMed  PubMed Central  Google Scholar 

  7. Henckel J, Richards R, Lozhkin K, Harris S, y Baena FMR, Barrett ARW, Cobb JP (2006) Very low-dose computed tomography for planning and outcome measurement in knee replacement. J Bone Joint Surg Br 88-B:1513–1518

    Article  Google Scholar 

  8. Hirschmann MT, Moser LB, Amsler F, Behrend H, Leclercq V, Hess S (2019) Phenotyping the knee in young non-osteoarthritic knees shows a wide distribution of femoral and tibial coronal alignment. Knee Surg Sports Traumatol Arthrosc 27:1385–1393

    Article  Google Scholar 

  9. Hirschmann MT, Moser LB, Amsler F, Behrend H, Leclerq V, Hess S (2019) Functional knee phenotypes: a novel classification for phenotyping the coronal lower limb alignment based on the native alignment in young non-osteoarthritic patients. Knee Surg Sports Traumatol Arthrosc 27:1394–1402

    Article  Google Scholar 

  10. Hoch A, Jud L, Roth T, Vlachopoulos L, Fürnstahl P, Fucentese SF (2020) A real 3D measurement technique for the tibial slope: differentiation between different articular surfaces and comparison to radiographic slope measurement. BMC Musculoskelet Disord 21:635. https://doi.org/10.1186/s12891-020-03657-9

    Article  PubMed  PubMed Central  Google Scholar 

  11. Hochreiter B, Hirschmann MT, Amsler F, Behrend H (2019) Highly variable tibial tubercle–trochlear groove distance (TT–TG) in osteoarthritic knees should be considered when performing TKA. Knee Surg Sports Traumatol Arthrosc 27:1403–1409

    Article  Google Scholar 

  12. Jud L, Vlachopoulos L, Beeler S, Tondelli T, Fürnstahl P, Fucentese SF (2020) Accuracy of three dimensional-planned patient-specific instrumentation in femoral and tibial rotational osteotomy for patellofemoral instability. Int Orthop. https://doi.org/10.1007/s00264-020-04496-y

    Article  PubMed  Google Scholar 

  13. Kang K-T, Koh Y-G, Son J, Kwon O-R, Lee J-S, Kwon SK (2017) Biomechanical effects of posterior condylar offset and posterior tibial slope on quadriceps force and joint contact forces in posterior-stabilized total knee arthroplasty. Biomed Res Int 2017:1–12

    Google Scholar 

  14. Kang K-T, Kwon SK, Son J, Kwon O-R, Lee J-S, Koh Y-G (2018) The increase in posterior tibial slope provides a positive biomechanical effect in posterior-stabilized total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 26:3188–3195

    Article  Google Scholar 

  15. Kuwano T, Urabe K, Miura H, Nagamine R, Matsuda S, Satomura M, Sasaki T, Sakai S, Honda H, Iwamoto Y (2005) Importance of the lateral anatomic tibial slope as a guide to the tibial cut in total knee arthroplasty in Japanese patients. J Orthop Sci 10:42–47

    Article  Google Scholar 

  16. Lustig S, Scholes CJ, Leo SPM, Coolican M, Parker DA (2013) Influence of soft tissues on the proximal bony tibial slope measured with two-dimensional MRI. Knee Surg Sports Traumatol Arthrosc 21:372–379

    Article  Google Scholar 

  17. Malviya A, Lingard EA, Weir DJ, Deehan DJ (2009) Predicting range of movement after knee replacement: the importance of posterior condylar offset and tibial slope. Knee Surg Sports Traumatol Arthrosc 17:491–498

    Article  Google Scholar 

  18. Meier M, Janssen D, Koeck FX, Thienpont E, Beckmann J, Best R (2020) Variations in medial and lateral slope and medial proximal tibial angle. Knee Surg Sports Traumatol Arthrosc. https://doi.org/10.1007/s00167-020-06052-y

    Article  PubMed  Google Scholar 

  19. Meier M, Zingde S, Best R, Schroeder L, Beckmann J, Steinert AF (2020) High variability of proximal tibial asymmetry and slope: a CT data analysis of 15,807 osteoarthritic knees before TKA. Knee Surg Sports Traumatol Arthrosc 28:1105–1112

    Article  Google Scholar 

  20. Meric G, Gracitelli GC, Aram L, Swank M, Bugbee WD (2015) Tibial slope is highly variable in patients undergoing primary total knee arthroplasty: analysis of 13,546 computed tomography scans. J Arthroplasty 30:1228–1232

    Article  Google Scholar 

  21. Mizu-uchi H, Colwell CW, Matsuda S, Flores-Hernandez C, Iwamoto Y, D’Lima DD (2011) Effect of total knee arthroplasty implant position on flexion angle before implant-bone impingement. J Arthroplasty 26:721–727

    Article  Google Scholar 

  22. Naendrup J-H, Drouven SF, Shaikh HS, Jaecker V, Offerhaus C, Shafizadeh ST, Pfeiffer TR (2020) High variability of tibial slope measurement methods in daily clinical practice: comparisons between measurements on lateral radiograph, magnetic resonance imaging, and computed tomography. Knee. https://doi.org/10.1016/j.knee.2020.01.013

    Article  PubMed  Google Scholar 

  23. Nunley RM, Nam D, Johnson SR, Barnes CL (2014) Extreme variability in posterior slope of the proximal tibia: measurements on 2395 CT scans of patients undergoing UKA? J Arthroplasty 29:1677–1680

    Article  Google Scholar 

  24. Pangaud C, Laumonerie P, Dagneaux L, LiArno S, Wellings P, Faizan A, Sharma A, Ollivier M (2020) Measurement of the posterior tibial slope depends on ethnicity, sex, and lower limb alignment: a computed tomography analysis of 378 healthy participants. Orthop J Sports Med. https://doi.org/10.1177/2325967119895258

    Article  PubMed  PubMed Central  Google Scholar 

  25. Shi X, Shen B, Kang P, Yang J, Zhou Z, Pei F (2013) The effect of posterior tibial slope on knee flexion in posterior-stabilized total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 21:2696–2703

    Article  Google Scholar 

  26. Sierra RJ, Berry DJ (2008) Surgical technique differences between posterior-substituting and cruciate-retaining total knee arthroplasty. J Arthroplasty 23:20–23

    Article  Google Scholar 

  27. Singh G, Tan JH, Sng BY, Awiszus F, Lohmann CH, Nathan SS (2013) Restoring the anatomical tibial slope and limb axis may maximise post-operative flexion in posterior-stabilised total knee replacements. Bone Joint J 95-B:1354–1358

    Article  CAS  Google Scholar 

  28. Utzschneider S, Goettinger M, Weber P, Horng A, Glaser C, Jansson V, Müller PE (2011) Development and validation of a new method for the radiologic measurement of the tibial slope. Knee Surg Sports Traumatol Arthrosc 19:1643–1648

    Article  CAS  Google Scholar 

  29. Wasieliwski RC, Galante JO, Leighty RM, Natarajan RN, Rosenberg AG (1994) Wear patterns on retrieved polyethylene tibial inserts and their relationship to technical considerations during total knee arthroplasty. Clin Orthop Relat Res 299:31–43

    Google Scholar 

  30. Wittenberg S, Sentuerk U, Renner L, Weynandt C, Perka CF, Gwinner C (2019) Importance of the tibial slope in knee arthroplasty. Der Orthopade 49:10–17

    Article  Google Scholar 

Download references

Funding

No direct support for this project was received.

Author information

Author notes

  1. Anna-Katharina Calek and Bettina Hochreiter contributed equally to this work.

Authors and Affiliations

  1. Department of Orthopaedic Surgery and Traumatology, Kantonsspital St. Gallen, Rorschacherstrasse 95, CH-9007, St. Gallen, Switzerland

    Anna-Katharina Calek, Bettina Hochreiter & Henrik Behrend

  2. Department of Orthopaedic Surgery and Traumatology, Kantonsspital Baselland (Bruderholz, Liestal, Laufen), CH-4101, Bruderholz, Switzerland

    Silvan Hess & Michael Tobias Hirschmann

  3. University of Basel, Basel, Switzerland

    Michael Tobias Hirschmann

  4. University of Bern, Bern, Switzerland

    Silvan Hess

  5. Amsler Consulting, Basel, Switzerland

    Felix Amsler

  6. Symbios, Yverdon les Bains, Switzerland

    Vincent Leclerq

Authors
  1. Anna-Katharina Calek
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Bettina Hochreiter
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Silvan Hess
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Felix Amsler
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Vincent Leclerq
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Michael Tobias Hirschmann
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Henrik Behrend
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

AKC and BH were involved in the conceptualization and design of the study. AKC, BH, and FA were involved in analysis and interpretation of the data. AKC and BH were drafting the manuscript. SH, HB, and MTH were involved in manuscript revision. All authors edited, read, and approved the final manuscript.

Corresponding author

Correspondence to Anna-Katharina Calek.

Ethics declarations

Conflict of interest

MTH and FA are paid by DepuySynthes, Lima, S&N, Symbios. MTH is a board member of ESSKA, EKA and DKG, and a member of the editorial team of KSSTA, AP SMART, World J Orthopaedics. All the other authors declare that they have no competing interests.

Ethics approval and consent to participate

Approval was obtained from the local ethical committee (Ethikkommission Nordwest- und Zentralschweiz, ID 2018-00223). All procedures performed were in accordance with the ethical standards of the institutional and/or the national research committees and with the 1964 Declaration of Helsinki and its later amendments or with comparable ethical standards.

Informed consent

Informed consent was obtained from all participants of the study.

Consent for publication

Not applicable.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Calek, AK., Hochreiter, B., Hess, S. et al. High inter- and intraindividual differences in medial and lateral posterior tibial slope are not reproduced accurately by conventional TKA alignment techniques. Knee Surg Sports Traumatol Arthrosc 30, 882–889 (2022). https://doi.org/10.1007/s00167-021-06477-z

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00167-021-06477-z

Keywords

Search

Navigation