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Revision Total Knee Arthroplasty pp 155–167Cite as

Tibial Alignment

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Abstract

Precise component alignment in both the anteroposterior and lateral planes is essential for proper implant function and longevity in total knee arthroplasty (TKA). Inability to achieve proper alignment can generate eccentric implant loading resulting in early aseptic loosening and failure. In addition, correction of the mechanical axis of the lower extremity to within 5–7° of valgus has been shown to improve TKA implant longevity both biomechanically and clinically. To correct deformity in TKA, the angle of the distal femoral and tibial cuts can be achieved through the use of intramedullary or extramedullary alignment systems, computer-assisted surgery (CAS), or patient-specific instrumentation (PSI). Each technique is associated with benefits and drawbacks; thus this chapter attempts to shed light on this discussion. Furthermore, this chapter will discuss several instances in which a pre-existing intramedullary nail was encountered during arthroplasty and describe various technical tricks to still achieve appropriate alignment or remove the nail as needed.

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Author information

Authors and Affiliations

  1. Tufts University School of Medicine, Boston, MA, 02111, USA

    James V. Bono M.D. (Clinical Professor of Orthopaedic Surgery, Vice Chair, Orthopaedics)

  2. New England Baptist Hospital, 125 Parker Hill Ave, Fremont-Smith Building Suite 573, Boston, MA, 02120, USA

    James V. Bono M.D. (Clinical Professor of Orthopaedic Surgery, Vice Chair, Orthopaedics)

  3. Department of Orthopaedic Surgery, New England Baptist Hospital, 125 Parker Hill Ave, Fremont-Smith Building Suite 573, Boston, MA, 02120, USA

    Maxwell K. Langfitt M.D.

  4. Emeritus, Harvard Medical School, Boston, MA, USA

    Richard D. Scott M.D. (Professor of Orthopaedic Surgery, Former Chief, Joint Arthroplasty Service)

  5. New England Baptist and Brigham and Women’s Hospitals, Boston, MA, USA

    Richard D. Scott M.D. (Professor of Orthopaedic Surgery, Former Chief, Joint Arthroplasty Service)

Authors
  1. James V. Bono M.D.
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  2. Maxwell K. Langfitt M.D.
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  3. Richard D. Scott M.D.
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Corresponding author

Correspondence to James V. Bono M.D. .

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Editors and Affiliations

  1. Clinical Professor of Orthopedic Surgery, Tufts University School of Medicine, Boston, Massachusetts, USA

    James V. Bono

  2. Professor of Orthopaedic Surgery, Emeritus, Harvard Medical School, Boston, Massachusetts, USA

    Richard D. Scott

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Bono, J.V., Langfitt, M.K., Scott, R.D. (2018). Tibial Alignment. In: Bono, J., Scott, R. (eds) Revision Total Knee Arthroplasty. Springer, Cham. https://doi.org/10.1007/978-3-319-67344-8_12

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  • DOI: https://doi.org/10.1007/978-3-319-67344-8_12

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  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-67342-4

  • Online ISBN: 978-3-319-67344-8

  • eBook Packages: MedicineMedicine (R0)

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