Advertisement

Archives of Orthopaedic and Trauma Surgery

, Volume 138, Issue 3, pp 409–418 | Cite as

Posterolateral overhang affects patient quality of life after total knee arthroplasty

  • Mehmet Emin Simsek
  • Mustafa Akkaya
  • Safa Gursoy
  • Cetin Isik
  • Akos Zahar
  • Samih Tarabichi
  • Murat Bozkurt
Knee Arthroplasty
  • 174 Downloads

Abstract

Purpose

To investigate the appropriate mediolateral placement of symmetrical tibial components and the amount of overhang expected from the posterolateral of tibial components implanted to give ideal coverage and the subsequent incidence of residual knee pain and reduction in functional capacity.

Method

A retrospective evaluation was made of 146 consecutive total knee arthroplasties. The posterolateral overhang, rotational alignment and coverage of the tibial component were measured on a post-operative CT scan and the effect of posterolateral overhang on clinical outcomes was analysed 3 years after surgery.

Results

Complaints of local pain in the posterolateral corner were determined in 76 (52.1%) patients. At the Posterolateral corner, overhang was determined in 111 (76%) patients, in the cortical border in 11 (7.6%) patients and underhang in 24 (16.4%) patients. In 71 (48.6%) patients, pain was determined together with oversize and in the evaluation of the overhang of the tibial component in the posterolateral region and the rotation status, there was determined to be overhang in 75 (96.2%) patients where the tibial component was placed in ideal rotation, in 25 (100%) where placement was in external rotation and in 11 (25.6%) where placement was in internal rotation. The mean KSS, KSS-F and WOMAC-P scores were 83.9 ± 6.3, 83.3 ± 7.8 and 4.6 ± 2.9, respectively, in those with posterolateral overhang of the tibial component .The mean KSS, KSS-F and WOMAC-P scores were 86.6 ± 8.4, 89.5 ± 7.8 and 2.8 ± 2.1, respectively, in those with no overhang and the difference was determined to be statistically significant. The amount of overhang was determined as mean 3.6 ± 2.0 mm in those with posterolateral pain and 0.02 ± 3.4 mm in those without pain and the difference was statistically significant.

Conclusions

This study demonstrated that overhang in the posterolateral region is surprisingly high and negatively affects the clinical results following TKA, thereby presenting a danger to the success of TKA. The risk of posterolateral oversizing can increase with placement of the tibial component in external rotation.

Keywords

Knee arthroplasty Posterolateral overhang Tibial baseplate Knee pain 

Notes

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Funding

There is no funding source.

Ethical approval

This article does not contain any studies with human participants or animals performed by any of the authors.

Informed consent

Informed consent was obtained from all individual participants included in the study.

References

  1. 1.
    Diduch DR et al (1997) Total knee replacement in young, active patients. Long-term follow-up and functional outcome. J B Jt Surg Am 79(4):575–82CrossRefGoogle Scholar
  2. 2.
    Akagi M et al (1999) Effect of rotational alignment on patellar tracking in total knee arthroplasty. Clin Orthop Relat Res 366:155–63CrossRefGoogle Scholar
  3. 3.
    Anderson JG et al (1996) Functional outcome and patient satisfaction in total knee patients over the age of 75. J Arthroplast 11(7):831–40CrossRefGoogle Scholar
  4. 4.
    Bonnin M et al (2000) Revision in non-infected total knee arthroplasty: an analysis of 69 consecutive cases. Rev Chir Orthop Repar Appar Mot 86(7):694–706Google Scholar
  5. 5.
    Dennis DA (2004) Evaluation of painful total knee arthroplasty. J Arthroplast 19(4 Suppl 1):35–40CrossRefGoogle Scholar
  6. 6.
    Elson DW, Brenkel IJ (2006) Predicting pain after total knee arthroplasty. J Arthroplast 21(7):1047–1053CrossRefGoogle Scholar
  7. 7.
    Bourne RB et al (2010) Patient satisfaction after total knee arthroplasty: who is satisfied and who is not? Clin Orthop Relat Res 468(1):57–63CrossRefPubMedGoogle Scholar
  8. 8.
    Matziolis G et al (2012) Increased flexion position of the femoral component reduces the flexion gap in total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 20(6):1092–1096CrossRefPubMedGoogle Scholar
  9. 9.
    Insall JN, Dorr LD, Scott RD, Scott WN (1989) Rationale of the Knee Society clinical rating system. Clin Orthop Relat Res 248:13–14Google Scholar
  10. 10.
    Bilbao A et al (2011) Validation of a proposed WOMAC short form for patients with hip osteoarthritis. Health Qual Life Outcome 9(1):75CrossRefGoogle Scholar
  11. 11.
    Berger RA et al (1993) Determining the rotational alignment of the femoral component in total knee arthroplasty using the epicondylar axis. Clin Orthop Relat Res 286:40–7Google Scholar
  12. 12.
    Berger RA et al (1998) Malrotation causing patellofemoral complications after total knee arthroplasty. Clin Orthop Relat Res 356:144–53.CrossRefGoogle Scholar
  13. 13.
    Lemaire P et al (1997) Tibial component positioning in total knee arthroplasty: bone coverage and extensor apparatus alignment. Knee Surg Sports Traumatol Arthrosc 5(4):251–257CrossRefPubMedGoogle Scholar
  14. 14.
    Bonnin MP et al (2011) Is the anterior tibial tuberosity a reliable rotational landmark for the tibial component in total knee arthroplasty? J Arthroplast 26(2):260–267 (e1–2) CrossRefGoogle Scholar
  15. 15.
    Yang B et al (2012) Sex, age, and annual incidence of primary total knee arthroplasty: a university affiliated hospital survey of 3118 Chinese patients. Chin Med J (Engl) 125(22):3952–3955Google Scholar
  16. 16.
    Booth RE Jr (2006) Sex and the total knee: gender-sensitive designs. Orthopedics 29(9):836–838PubMedGoogle Scholar
  17. 17.
    Baldini A et al (2013) Rotational alignment of the tibial component in total knee arthroplasty: the anterior tibial cortex is a reliable landmark. Joints 1(4):155–60CrossRefPubMedGoogle Scholar
  18. 18.
    Incavo SJ et al (1994) Tibial plateau coverage in total knee arthroplasty. Clin Orthop Relat Res 299:81–5Google Scholar
  19. 19.
    Kwak DS et al (2007) Morphometry of the proximal tibia to design the tibial component of total knee arthroplasty for the Korean population. Knee 14(4):295–300CrossRefPubMedGoogle Scholar
  20. 20.
    Bonnin MP et al (2013) Mediolateral oversizing influences pain, function, and flexion after TKA. Knee Surg Sports Traumatol Arthrosc 21(10):2314–2324CrossRefPubMedPubMedCentralGoogle Scholar
  21. 21.
    Chau R et al (2009) Tibial component overhang following unicompartmental knee replacement—does it matter? Knee 16(5):310–313CrossRefPubMedGoogle Scholar
  22. 22.
    Martin S, Saurez A, Ismaily S, Ashfaq K, Noble P, Incavo SJ (2014) Maximizing tibial coverage is detrimental to proper rotational alignment. Clin Orthop Relat Res 472(1):121–125CrossRefPubMedGoogle Scholar
  23. 23.
    Peersman G et al (2016) Malrotation deformities of the lower extremity and implications on total knee arthroplasty: a narrative review. Arch Orthop Trauma Surg 136(11):1491–1498CrossRefPubMedGoogle Scholar
  24. 24.
    Thienpont E et al (2017) Bone morphotypes of the varus and valgus knee. Arch Orthop Trauma Surg 137(3):393–400CrossRefPubMedGoogle Scholar
  25. 25.
    Foruria X, Schmidt-Braekling T et al (2017) Does the tibia component design affect the need for offset stems in revision total knee arthroplasty? Arch Orthop Trauma Surg 137(6):853–860CrossRefPubMedGoogle Scholar
  26. 26.
    Hitt K et al (2003) Anthropometric measurements of the human knee: correlation to the sizing of current knee arthroplasty systems. J B Jt Surg Am 85-A(Suppl4):115–22CrossRefGoogle Scholar
  27. 27.
    Dai Y, Bischoff JE (2013) Comprehensive assessment of tibial plateau morphology in total knee arthroplasty: influence of shape and size on anthropometric variability. J Orthop Res 31(10):1643–1652CrossRefPubMedGoogle Scholar
  28. 28.
    Mahoney OM, Kinsey T (2010) Overhang of the femoral component in total knee arthroplasty: risk factors and clinical consequences. J B Jt Surg Am 92(5):1115–1121CrossRefGoogle Scholar
  29. 29.
    Heyse TJ, Tibesku CO (2015) Improved tibial component rotation in TKA using patient-specific instrumentation. Arch Orthop Trauma Surg 135(5):697–701CrossRefPubMedGoogle Scholar
  30. 30.
    Bonnin MP et al (2017) Popliteus impingement after TKA may occur with well-sized prostheses. Knee Surg Sports Traumatol Arthrosc 25(6):1720–1730CrossRefPubMedGoogle Scholar
  31. 31.
    Barnes CL, Scott RD (1995) Popliteus tendon dysfunction following total knee arthroplasty. J Arthroplast 10(4):543–545CrossRefGoogle Scholar
  32. 32.
    Kazakin A, Nandi S, Bono J (2014) Diagnosis and treatment of intraoperative popliteus tendon impingement. J Knee Surg 27(6):485–488CrossRefPubMedGoogle Scholar
  33. 33.
    Luyckx L et al (2010) Iliotibial band traction syndrome in guided motion TKA. A new clinical entity after TKA. Acta Orthop Belg 76(4):507–12PubMedGoogle Scholar
  34. 34.
    Hirakawa MKM, Tomari K, Higuma Y, Ikeda S, Noguchi T, Tsumura H (2013) Posterolateral overhang of the femoral component in total knee arthroplasty. B Jt J 95-B(SUPP 15):197Google Scholar
  35. 35.
    Harwin SF, Greene KA, Hitt K (2007) Early experience with a new total knee implant: maximizing range of motion and function with gender-specific sizing. Surg Technol Int 16:199–205PubMedGoogle Scholar
  36. 36.
    Shah DS, Ghyar R, Ravi B, Shetty V (2013) 3D morphological study of the Indian arthritic knee: comparison with other ethnic groups and conformity of current TKA implant. Open J Rheumatol Autoimmun Dis 3:263–269CrossRefGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2017

Authors and Affiliations

  • Mehmet Emin Simsek
    • 1
  • Mustafa Akkaya
    • 1
  • Safa Gursoy
    • 1
  • Cetin Isik
    • 2
  • Akos Zahar
    • 3
  • Samih Tarabichi
    • 4
  • Murat Bozkurt
    • 2
  1. 1.Department of Orthopedics and Traumatology, Ankara Yenimahalle Training and Research HospitalYildirim Beyazit UniversityAnkaraTurkey
  2. 2.Department of Orthopedics and Traumatology, Ankara Atatürk Training and Research HospitalYildirim Beyazit UniversityAnkaraTurkey
  3. 3.Department of Orthopedics and TraumatologyHelios Endo ClinicHamburgGermany
  4. 4.Department of Orthopedics and TraumatologyBurjeel HospitalDubaiUnited Arab Emirates

Personalised recommendations