Skip to main content
Log in

Proximal tibial resection in varus-deformed tibiae during total knee arthroplasty: an in vitro study using sawbone model

  • Original Paper
  • Published:
International Orthopaedics Aims and scope Submit manuscript

Abstract

Purpose

This study was designed to investigate accuracy of the tibial component in the coronal plane when the lateral condylar eminence was determined as the proximal reference of proximal tibial cutting in varus-deformed knees.

Methods

Varus-deformed tibiae were designed using the entire tibia sawbone models of four categories (varus 0°, 5°, 10° and 15°). Each of ten sawbones was allocated into four in each group. All sawbones were osteotomised with the proximal reference of proximal tibial cutting as the lateral intercondylar eminence. The thickness of the cut tibial medial and lateral condyles were measured. After implantation of the tibial component, anteroposterior (AP) radiographs were obtained. An independent examiner evaluated angles between the perpendicular line to the tibial tray and the shaft/mechanical axes of the tibia.

Results

The mean angular difference between the axis perpendicular to the prosthesis and the mechanical/shaft axes of the tibia were not significant in any group. When the tibial component coronal alignment was measured based on the tibial mechanical axis, no significant difference was observed in any group, but when based on the shaft axis of the tibia, it was significantly different between Group A and Group D.

Conclusions

Accuracy of the tibial component alignment was acceptable in varus-deformed knees when the lateral intercondylar eminence was used as a reference for tibial osteotomy, although any prolonged clinical benefits will require long-term in vivo study.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others

References

  1. Fang DM, Ritter MA, Davis KE (2009) Coronal alignment in total knee arthroplasty: just how important is it? J Arthroplasty 24:39–43

    Article  PubMed  Google Scholar 

  2. Mihalko WM, Boyle J, Clark LD, Krackow KA (2005) The variability of intramedullary alignment of the femoral component during total knee arthroplasty. J Arthroplasty 20:25–28

    Article  PubMed  Google Scholar 

  3. Ritter MA, Davis KE, Meding JB, Pierson JL, Berend ME, Malinzak RA (2011) The effect of alignment and BMI on failure of total knee replacement. J Bone Joint Surg Am 93:1588–1596

    Article  PubMed  Google Scholar 

  4. Ensini A, Catani F, Leardini A, Romagnoli M, Giannini S (2007) Alignments and clinical results in conventional and navigated total knee arthroplasty. Clin Orthop Relat Res 457:156–162

    CAS  PubMed  Google Scholar 

  5. Pitto RP, Graydon AJ, Bradley L, Malak SF, Walker CG, Anderson IA (2006) Accuracy of a computer-assisted navigation system for total knee replacement. J Bone Joint Surg (Br) 88:601–605

    Article  CAS  Google Scholar 

  6. Spencer JM, Chauhan SK, Sloan K, Taylor A, Beaver RJ (2007) Computer navigation versus conventional total knee replacement: no difference in functional results at two years. J Bone Joint Surg (Br) 89:477–480

    Article  CAS  Google Scholar 

  7. Han HSCY, YoonKS LLH, Jo HC, Kan SB (2007) Accuracy of intramedulary versus extramedullary tibial alignment guides : a randomized, prospective study in bilateral total knee arthroplasty. J Korean Knee Soc 19:181–186

    Google Scholar 

  8. Rand JA, Coventry MB (1988) Ten-year evaluation of geometric total knee arthroplasty. Clin Orthop Relat Res 232:168–173

    PubMed  Google Scholar 

  9. Bono JV, Roger DJ, Laskin RS, Peterson MG, Paulsen CA (1995) Tibial intramedullary alignment in total knee arthroplasty. Am J Knee Surg 8:7–11, discussion 11–12

    CAS  PubMed  Google Scholar 

  10. Ishii Y, Ohmori G, Bechtold JE, Gustilo RB (1995) Extramedullary versus intramedullary alignment guides in total knee arthroplasty. Clin Orthop Relat Res 318:167–175

    PubMed  Google Scholar 

  11. Maestro A, Harwin SF, Sandoval MG, Vaquero DH, Murcia A (1998) Influence of intramedullary versus extramedullary alignment guides on final total knee arthroplasty component position: a radiographic analysis. J Arthroplasty 13:552–558

    Article  CAS  PubMed  Google Scholar 

  12. Reed MR, Bliss W, Sher JL, Emmerson KP, Jones SM, Partington PF (2002) Extramedullary or intramedullary tibial alignment guides: a randomised, prospective trial of radiological alignment. J Bone Joint Surg (Br) 84:858–860

    Article  CAS  Google Scholar 

  13. Teter KE, Bregman D, Colwell CW Jr (1995) Accuracy of intramedullary versus extramedullary tibial alignment cutting systems in total knee arthroplasty. Clin Orthop Relat Res 321:106–110

    PubMed  Google Scholar 

  14. Yang SH, Liu TK (1998) Intramedullary versus extramedullary tibial alignment guides in total knee arthroplasty. J Formos Med Assoc 97:564–568

    CAS  PubMed  Google Scholar 

  15. Oswald MH, Jakob RP, Schneider E, Hoogewoud HM (1993) Radiological analysis of normal axial alignment of femur and tibia in view of total knee arthroplasty. J Arthroplasty 8:419–426

    Article  CAS  PubMed  Google Scholar 

  16. Ko PS, Tio MK, Ban CM, Mak YK, Ip FK, Lam JJ (2001) Radiologic analysis of the tibial intramedullary canal in Chinese varus knees: implications in total knee arthroplasty. J Arthroplasty 16:212–215

    Article  CAS  PubMed  Google Scholar 

  17. Moreland JR, Bassett LW, Hanker GJ (1987) Radiographic analysis of the axial alignment of the lower extremity. J Bone Joint Surg Am 69:745–749

    CAS  PubMed  Google Scholar 

  18. Nagamine R, Miura H, Bravo CV, Urabe K, Matsuda S, Miyanishi K, Hirata G, Iwamoto Y (2000) Anatomic variations should be considered in total knee arthroplasty. J Orthop Sci 5:232–237

    Article  CAS  PubMed  Google Scholar 

  19. Matsuda S, Mizu-uchi H, Miura H, Nagamine R, Urabe K, Iwamoto Y (2003) Tibial shaft axis does not always serve as a correct coronal landmark in total knee arthroplasty for varus knees. J Arthroplasty 18:56–62

    Article  PubMed  Google Scholar 

  20. Chiu KY, Yau WP, Ng TP, Tang WM (2008) The accuracy of extramedullary guides for tibial component placement in total knee arthroplasty. Int Orthop 32:467–471

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  21. 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 

  22. Tsukeoka T, Lee TH, Tsuneizumi Y, Suzuki M (2014) The tibial crest as a practical useful landmark in total knee arthroplasty. Knee 21:283–289

    Article  PubMed  Google Scholar 

  23. Haaker RG, Stockheim M, Kamp M, Proff G, Breitenfelder J, Ottersbach A (2005) Computer-assisted navigation increases precision of component placement in total knee arthroplasty. Clin Orthop Relat Res 433:152–159

    Article  PubMed  Google Scholar 

  24. Nabeyama R, Matsuda S, Miura H, Mawatari T, Kawano T, Iwamoto Y (2004) The accuracy of image-guided knee replacement based on computed tomography. J Bone Joint Surg (Br) 86:366–371

    Article  CAS  Google Scholar 

  25. Sparmann M, Wolke B, Czupalla H, Banzer D, Zink A (2003) Positioning of total knee arthroplasty with and without navigation support. A prospective, randomised study. J Bone Joint Surg (Br) 85:830–835

    CAS  Google Scholar 

  26. Bellemans J, Vandenneucker H, Vanlauwe J (2007) Robot-assisted total knee arthroplasty. Clin Orthop Relat Res 464:111–116

    PubMed  Google Scholar 

  27. Bae DK, Song SJ (2011) Computer assisted navigation in knee arthroplasty. Clin Orthop Surg 3:259–267

    Article  PubMed Central  PubMed  Google Scholar 

  28. Jeffcote B, Shakespeare D (2003) Varus/valgus alignment of the tibial component in total knee arthroplasty. Knee 10:243–247

    Article  PubMed  Google Scholar 

Download references

Conflict of interest

None.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Kye-Young Han.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Kim, SM., Kim, KW., Cha, SM. et al. Proximal tibial resection in varus-deformed tibiae during total knee arthroplasty: an in vitro study using sawbone model. International Orthopaedics (SICOT) 39, 429–434 (2015). https://doi.org/10.1007/s00264-014-2485-9

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00264-014-2485-9

Keywords

Navigation