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Short distance from the keel to the posterior tibial cortex is associated with fracture after cementless Oxford UKA in Asian patients

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Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Purpose

Tibial plateau fractures are serious complications of Oxford mobile-bearing unicompartmental knee arthroplasty (OUKA). This study examined where the fracture lines arises and evaluated the keel–cortex distances (KCDs) using three-dimensional computed tomography (3D-CT) and the effects of technical error (assessed by tibial component positions) and proximal tibial morphology on the KCDs.

Methods

This retrospective study included 217 OUKAs with cementless tibial components. Fifteen patients had tibial fractures after surgery. Anterior and posterior KCDs and fracture line origins were assessed using 3D-CT postoperatively. Proximal tibial morphology was assessed using the medial eminence line (MEL), which runs parallel to the tibial axis and passes through the tip of the medial intercondylar eminence of the tibia on long-leg anteroposterior radiograph. Knees had overhanging medial tibial condyle if the MEL passed medially to the medial tibial cortex. KCDs were compared between patients with/without fractures. Tibial component positions were evaluated, considering effects of tibial morphologies and component positions on fracture prevalence and KCDs.

Results

Fracture lines were found between the keel and posterior cortex in 12/15 patients. Posterior KCDs were significantly shorter in patients with fractures than in patients without (2.7 ± 1.6 mm vs 5.2 ± 1.7 mm, P < 0.001). Patients with medial overhanging condyles were more likely to have fracture (10/51 vs 5/166, P < 0.001) and had significantly shorter posterior KCD than those without (3.6 ± 1.5 mm vs 5.5 ± 1.8 mm, P < 0.001). Patients with tibial component that was set too medial, low, and valgus had higher rates of fracture than those without (7/39 vs 8/178, P = 0.008). Medial (r = 0.30, P < 0.001), low (r = -0.33, P < 0.001), and valgus implantations (r = 0.35, P < 0.001) of tibial components were related to shorter posterior KCDs.

Conclusion

Short posterior KCD after OUKA is a risk factor for postoperative tibial fracture. Patients with either malposition of the tibial component (too medial, low, and valgus) and/or a medial overhanging condyle exhibit a shorter distance of posterior KCD and higher rate of fracture.

Level of evidence: Level III.

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Acknowledgements

The authors would like to thank Mr. Benjamin Phillis at the Clinical Study Support Center, Wakayama Medical University for proofreading and editing.

Funding

The authors received no specific funding for this work.

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Authors and Affiliations

  1. Department of Orthopaedic Surgery and Joint Surgery Center, Takatsuki General Hospital, 1-3-13, Kosobe-cho, Takatsuki, Osaka, 569-1192, Japan

    Tomoyuki Kamenaga, Takafumi Hiranaka, Takaaki Fujishiro & Koji Okamoto

  2. Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, 7-5-1, Kusunoki-cho, chuo-ku, Kobe, 650-0017, Japan

    Tomoyuki Kamenaga, Naoki Nakano, Shinya Hayashi, Ryosuke Kuroda & Tomoyuki Matsumoto

Authors
  1. Tomoyuki Kamenaga
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  2. Takafumi Hiranaka
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  3. Naoki Nakano
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  4. Shinya Hayashi
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  5. Takaaki Fujishiro
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  6. Koji Okamoto
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  7. Ryosuke Kuroda
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  8. Tomoyuki Matsumoto
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Contributions

TK performed data analysis, and wrote the original draft. TF ank KO performed data curation. TH and TM revised the manuscript. NN performed validation analysis, SH　and RK reviewed and edited the manuscript.

Corresponding author

Correspondence to Takafumi Hiranaka.

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The authors declare no conflicts of interest associated with this manuscript.

Ethical approval

This work was approved by the Institutional Review Board in Takatsuki General Hospital.

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A written informed consent was obtained from each patient.

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Kamenaga, T., Hiranaka, T., Nakano, N. et al. Short distance from the keel to the posterior tibial cortex is associated with fracture after cementless Oxford UKA in Asian patients. Knee Surg Sports Traumatol Arthrosc 30, 1220–1230 (2022). https://doi.org/10.1007/s00167-021-06553-4

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  • DOI: https://doi.org/10.1007/s00167-021-06553-4

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