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Optimal rotational positioning of tibial component in total knee arthroplasty: determined by linker surgical technique using a high definition CT

Archives of Orthopaedic and Trauma Surgery volume 140, pages 401–408 (2020)Cite this article

Abstract

Introduction

The rotational alignment of femoral and tibial components is an important determinant of the success of Total Knee Arthroplasty (TKA). The optimal rotational position of the tibial component is still unclear. The purpose of this study was (1) to determine the pre-operative S-TEA (surgical-transepicondylar axis) derived tibialanteroposterior (AP) axis angle and postoperative tibial component axis angle using a “Bird’s eye” high-definition CT image in TKA performed by Linker surgical technique; (2) to determine the femorotibial mismatch angle; and (3) to determine the optimal tibial component rotation in a well-aligned femoral and tibial components.

Materials and methods

55 knees in 49 osteoarthritis patients who underwent primary TKA by Linker surgical technique were evaluated. Preoperative tibial AP axis angle, and the postoperative tibial component axis angle were measured. Rotational mismatch between femoral and tibial components was also measured.

Results

The mean angle of the pre-operative tibial AP axis was 17.8° ± 4.0°, ranging from 4.3° to 25.4°. The mean angle of the post-operative tibial component axis was 16.2° ± 4.9°, ranging from 3.8° to 25.2°. The mean postoperative tibial component axis line was at 14.2% ± 11.9%.

Conclusion

Because of the variability of pre-operative S-TEA derived tibial AP axis angle, the tibial component axis angle was also variable among the knees, but the two angles bore a strong correlation to each other. Based on our results, the optimal axis of the tibial component passes about halfway through the medial edge and medial one-third of the tibial tuberosity.

Level of evidence

Level II.

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Acknowledgements

The authors would like to thank Prof. Yong Chan Ha and Jian Kang for their advice and expert technical assistance with the statistical analysis.

Funding

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

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Affiliations

  1. Department of Orthopaedic Surgery, Murup Hospital, 2-52, 3 Ga Jungang-dong, Masanhappo-gu, Changwon-si, Gyeongnam, 631-423, South Korea

    Woon-Hwa Jung, Dong Hyun Kim, Suryamanikanta Balabadra, Utkrisht Mandot & Dinesh Kumar

  2. Department of Orthopaedic Surgery, Seo Jai Gon Linker Hospital, 436, Baekjegobun-ro, Songpa-gu, Seoul, South Korea

    Jai-Gon Seo

Authors
  1. Woon-Hwa Jung
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  2. Jai-Gon Seo
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  3. Dong Hyun Kim
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  4. Suryamanikanta Balabadra
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  5. Utkrisht Mandot
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  6. Dinesh Kumar
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Contributions

Design of study: WHJ and JGS. Analysis of data: DHK, SB, UM, DK. Writing of manuscript: SB and UM. Supervision of study: WHJ and JGS. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Woon-Hwa Jung.

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The authors declare that they have no conflict of interest.

Ethical approval

Institutional Review Board approval was obtained. All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

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

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Jung, WH., Seo, JG., Kim, D.H. et al. Optimal rotational positioning of tibial component in total knee arthroplasty: determined by linker surgical technique using a high definition CT. Arch Orthop Trauma Surg 140, 401–408 (2020). https://doi.org/10.1007/s00402-020-03340-7

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  • DOI: https://doi.org/10.1007/s00402-020-03340-7

Keywords

  • Preoperative S-TEA derived tibial AP axis angle
  • “Bird’s eye” high-definition CT image
  • Tibial component rotation
  • Mismatch angle
  • Total knee arthroplasty