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Rotational alignment of tibial components in mobile-bearing TKA: posterior substituted vs. PCL retaining

Archives of Orthopaedic and Trauma Surgery volume 135, pages 1299–1305 (2015)Cite this article

Abstract

Purpose

The medial border of the tibial tubercle (MBTT) is one of the fixed anatomic landmarks for tibial component setting during total knee arthroplasty (TKA). In mobile-bearing TKA using a tibial cut first technique, the final tibial component rotation can be guided by the position it achieves following several flexion–extension cycles. In this study, tibial component angle (TCA) and tibial rotational angle (TRA) were determined in dependence of retention or resection of the posterior cruciate ligament (PCL).

Methods

The TCA and TRA were examined in 206 patients who underwent primary TKA (PCL retaining: 104 knees, PCL substituting: 102 knees). The tibial component rotation was intraoperatively setting between the parallel to the axis of the most medial aspect of the tibial tubercle as the anterior anatomic landmark and the center of the tibial component as the posterior landmark at the maximum coverage with the osteotomized tibial plateau with its adjustment after several knee flexion–extension exercises. A postoperative quantitative three-dimensional computed tomography technique was used for measurements by a single observer.

Results

The TCA showed a divergence of 0.21° external to the MBTT in the PCL-retaining design and 1.62° internal divergence in the PCL-substituting design. The TRA showed an internal divergence of 0.88° in the PCL-retaining design and an internal divergence of 2.12° in the PCL-substituting design. There were no significant differences between the two designs.

Conclusions

The MBTT might be regarded as a reliable landmark for obtaining an acceptable tibial rotational setting in mobile-bearing TKA despite PCL retention.

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Author information

Affiliations

  1. Ishii Orthopaedic and Rehabilitation Clinic, 1089 Shimo-Oshi, Gyoda, Saitama, 361-0037, Japan

    Yoshinori Ishii, Hideo Noguchi, Junko Sato & Koji Todoroki

  2. Division of Information Science and Biostatistics, Niigata University Graduate School of Medical and Dental Sciences, 1-754 Asahimachi Dori, Niigata, Niigata, 951-8520, Japan

    Shin-Ichi Toyabe

Authors
  1. Yoshinori Ishii
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  2. Hideo Noguchi
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  3. Junko Sato
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  4. Koji Todoroki
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  5. Shin-Ichi Toyabe
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Corresponding author

Correspondence to Yoshinori Ishii.

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No benefit or funds were received in support of the study.

Additional information

The present work was performed at the Ishii Orthopaedic and Rehabilitation Clinic, 1089 Shimo-Oshi, Gyoda, Saitama 361-0037, Japan.

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Ishii, Y., Noguchi, H., Sato, J. et al. Rotational alignment of tibial components in mobile-bearing TKA: posterior substituted vs. PCL retaining. Arch Orthop Trauma Surg 135, 1299–1305 (2015). https://doi.org/10.1007/s00402-015-2275-x

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  • DOI: https://doi.org/10.1007/s00402-015-2275-x

Keywords

  • Knee arthroplasty
  • Rotational alignment
  • Tibial prosthesis
  • Mobile-bearing TKA
  • Tibial tubercle