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Accuracy of anatomical references used for rotational alignment of tibial component in total knee arthroplasty

  • Knee
  • Published:
Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Purpose

This study aimed to research which was the most reliable of the four techniques based on local anatomic markers used to determine tibial component rotation in total knee arthroplasty, and whether the markers varied in knees with varus deformity.

Methods

The study included 33 knees with a normal anatomic axis and 32 knees with a varus deformity and osteoarthritis. On the MR images, the femoral transepicondylar axis (TEA) was determined and transposed to the standard tibial resection level. At this level, four axes were drawn on the axial sections: tibial posterior condylar line (PC), tibial plateau anterior line (AC), a vertical line (AA) drawn to Akagi’s line, and the maximal mediolateral distance (MMLD). The relationships of these lines and the transposed TEA were compared between two groups.

Results

In all the knees, the mean values of the PC, AA, and MMLD axes compared to TEA reference were 5.5° ± 5.7 (mean ± SD), 7° ± 3.2, and 6.7° ± 8.1 internal rotation, respectively, and the AC axis was 8.9° ± 6.7 external rotation. In the AC, AA, and MMLD axes, the change occured because of varus deformity was statistically meaningful. For all the observers, the axis with the least SD and the most accuracy was the AA axis.

Conclusions

Of the four axes used to determine tibial component rotation, only the PC axis is not affected by varus deformity, and the least affected axis according to the observers was the AA axis, and thus the AA and PC axes can be used for guidance in determining the rotation of the tibial component.

Level of evidence

Prognostic studies—investigating natural history and evaluating the effect of a patient characteristic: High-quality prospective cohort study with >80% follow-up, and all patients enrolled at same time point in disease, Level I.

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References

  1. Aglietti P, Sensi L, Cuomo P, Ciardullo A (2008) Rotational position of femoral and tibial components in TKA using the femoral transepicondylar axis. Clin Orthop Relat Res 466:2751–2755

    Article  PubMed  Google Scholar 

  2. Akagi M, Oh M, Nonaka T, Tsujimoto H, Asano T, Hamanishi C (2004) An anteroposterior axis of the tibia for total knee arthroplasty. Clin Orthop Relat Res 420:213–219

    Article  PubMed  Google Scholar 

  3. Akagi M, Mori S, Nishimura S, Nishimura A, Asano T, Hamanishi C (2005) Variability of extraarticular tibial rotation references for total knee arthroplasty. Clin Orthop Relat Res 436:172–176

    Article  PubMed  Google Scholar 

  4. Anouchi YS, Whiteside LA, Kaiser AD, Milliano MT (1993) The effects of axial rotational alignment of the femoral component on knee stability and patellar tracking in total knee arthroplasty demonstrated on autopsy specimens. Clin Orthop Relat Res 287:170–177

    PubMed  Google Scholar 

  5. Berger RA, Rubash HE, Seel MJ, Thompson WH, Crossett LS (1993) Determining the rotational alignment of the femoral component in total knee arthroplasty using the epicondylar axis. Clin Orthop Relat Res 286:40–47

    PubMed  Google Scholar 

  6. Berger RA, Crossett LS, Jacobs JJ, Rubash HE (1998) Malrotation causing patellofemoral complications after total knee arthroplasty. Clin Orthop Relat Res 356:144–153

    Article  PubMed  Google Scholar 

  7. Chowdhury EA, Porter ML (2005) A study of the effect of tibial tray rotation on a specific mobile bearing total knee arthroplasty. J Arthroplasty 20:793–797

    Article  PubMed  Google Scholar 

  8. Churchill DL, Incavo SJ, Johnson CC, Beynnon BD (1998) The transepicondylar axis approximates the optimal flexion axis of the knee. Clin Orthop Relat Res 356:111–118

    Article  PubMed  Google Scholar 

  9. Czurda T, Fennema P, Baumgartner M, Ritschl P (2010) The association between component malalignment and post-operative pain following navigation-assisted total knee arthroplasty: results of a cohort/nested case-control study. Knee Surg Sports Traumatol Arthrosc 18:863–869

    Article  PubMed  Google Scholar 

  10. Dalury DF (2001) Observations of the proximal tibia in total knee arthroplasty. Clin Orthop Relat Res 389:150–155

    Article  PubMed  Google Scholar 

  11. Fukagawa S, Matsuda S, Mitsuyasu H, Miura H, Okazaki K, Tashiro Y, Iwamoto Y (2011) Anterior border of the tibia as a landmark for extramedullary alignment guide in total knee arthroplasty for varus knees. J Orthop Res 29:919–924

    Article  PubMed  Google Scholar 

  12. Graw BP, Harris AH, Tripuraneni KR, Giori NJ (2010) Rotational references for total knee arthroplasty tibial components change with level of resection. Clin Orthop Relat Res 468:2734–2738

    Article  PubMed  Google Scholar 

  13. Incavo SJ, Coughlin KM, Pappas C, Beynnon BD (2003) Anatomic rotational relationships of the proximal tibia, distal femur, and patella: implications for rotational alignment in total knee arthroplasty. J Arthroplasty 18:643–648

    Article  PubMed  Google Scholar 

  14. Insall JN (1993) Surgical techniques and instrumentation in total knee arthroplasty. In: Insall JN, Windsor RE, Scott WN, Kelly M, Aglietti P (eds) Surgery of the knee, 2nd edn. Churchill-Livingstone, New York, pp 739–804

    Google Scholar 

  15. Jung YB, Lee HJ, Jung HJ, Song KS, Lee JS, Yang JJ (2009) Comparison of the radiological results between fluoroscopy-assisted and navigation-guided total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 17:286–292

    Article  PubMed  Google Scholar 

  16. Lützner J, Krummenauer F, Günther KP, Kirschner S (2010) Rotational alignment of the tibial component in total knee arthroplasty is beter at the medial third of tibial tuberosity than at the medial border. BMC Musculoskelet Disord 11:57

    Article  PubMed  Google Scholar 

  17. Matsui Y, Kadoya Y, Uehara K, Kobayashi A, Takaoka K (2005) Rotational deformity in varus osteoarthritis of the knee: analysis with computed tomography. Clin Orthop Relat Res 433:147–151

    Article  PubMed  Google Scholar 

  18. Merkow RL, Soudry M, Insall JN (1985) Patellar dislocation following total knee replacement. J Bone Joint Surg Am 67:1321–1327

    PubMed  CAS  Google Scholar 

  19. Miller MC, Berger RA, Petrella AJ, Karmas A, Rubash HE (2001) Optimizing femoral component rotation in total knee arthroplasty. Clin Orthop Relat Res 392:38–45

    Article  PubMed  Google Scholar 

  20. Moreland JR (1988) Mechanisms of failure in total knee arthroplasty. Clin Orthop Relat Res 226:49–64

    PubMed  Google Scholar 

  21. Nagamine R, Whiteside LA, White SE, McCarthy DS (1994) Patellar tracking after total knee arthroplasty. The effect of tibial tray malrotation and articular surface configuration. Clin Orthop Relat Res 304:262–271

    PubMed  Google Scholar 

  22. Page SR, Deakin AH, Payne AP, Picard F (2011) Reliability of frames of reference used for tibial component rotation in total knee arthroplasty. Comput Aided Surg 16:86–92

    Article  PubMed  Google Scholar 

  23. Rossi R, Bruzzone M, Bonasia DE, Marmotti A, Castoldi F (2010) Evaluation of tibial rotational alignment in total knee arthroplasty: a cadaver study. Knee Surg Sports Traumatol Arthrosc 18:889–893

    Article  PubMed  Google Scholar 

  24. Singerman R, Pagan HD, Peyser AB, Goldberg VM (1997) Effect of femoral component rotation and patellar design on patellar forces. Clin Orthop Relat Res 334:345–353

    Article  PubMed  Google Scholar 

  25. Siston RA, Goodman SB, Patel JJ, Delp SL, Giori NJ (2006) The high variability of tibial rotational alignment in total knee arthroplasty. Clin Orthop Relat Res 452:65–69

    Article  PubMed  Google Scholar 

  26. Sun T, Lu H, Hong N, Wu J, Feng C (2009) Bony landmarks and rotational alignment in total knee arthroplasty for Chinese osteoarthritic knees with varus or valgus deformities. J Arthroplasty 24:427–431

    Article  PubMed  Google Scholar 

  27. Whiteside LA, Arima J (1995) The anteroposterior axis for femoral rotational alignment in valgus total knee arthroplasty. Clin Orthop Relat Res 321:168–172

    PubMed  Google Scholar 

  28. Yoshioka Y, Siu DW, Scudamore RA, Cooke TD (1989) Tibial anatomy and functional axes. J Orthop Res 7:132–137

    Article  PubMed  CAS  Google Scholar 

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Authors and Affiliations

  1. Department of Orthopaedics and Traumatology, Bursa Şevket Yılmaz Research and Training Hospital, 16330, Yıldırım, Bursa, Turkey

    Namık Şahin, Alpaslan Öztürk, Yüksel Özkan & Bülent Avcu

  2. Department of Orthopaedics and Traumatology, Faculty of Medicine, Uludag University, 16059, Görükle, Bursa, Turkey

    Teoman Atıcı

  3. Department of Biostatistics, Faculty of Medicine, Uludag University, 16059, Görükle, Bursa, Turkey

    Güven Özkaya

Authors
  1. Namık Şahin
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  2. Teoman Atıcı
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  3. Alpaslan Öztürk
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  4. Güven Özkaya
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  5. Yüksel Özkan
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  6. Bülent Avcu
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Correspondence to Namık Şahin.

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Şahin, N., Atıcı, T., Öztürk, A. et al. Accuracy of anatomical references used for rotational alignment of tibial component in total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 20, 565–570 (2012). https://doi.org/10.1007/s00167-011-1606-x

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  • DOI: https://doi.org/10.1007/s00167-011-1606-x

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