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Risk factors for tibial implant malpositioning in total knee arthrosplasty—consecutive series of one thousand, four hundred and seventeen cases

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Abstract

Purpose

Total knee arthroplasty (TKA) malalignment may result in pain and limited range of motion. The present study assessed the influence of different surgeon’s and patient’s related factors on the post-operative tibial tray coronal alignment.

Methods

The charts and the x-rays of a continuous prospective series of 1417 TKAs operated upon between 1987 and 2015 were retrospectively reviewed. The long-leg AP views were performed at two months post-op and the tibial mechanical angle of the tibial tray was measured. Three groups were defined: varus (≤87° n = 167), valgus (≥93° n = 55) and well alignment (88° to 92° n = 1195). The influence of several pre-operative and peri-operative factors was investigated: surgeon handedness and experience (junior or senior), previous tibial osteotomies, Ahlbäck stage of osteoarthritits, pre-operative alignment, height and weight, age at surgery, approach (medial, lateral or tibial tubercle osteotomy), generation of implants, tray fixation, size of the tray and stem lenght. Univariate then multivariate analysis were performed to find out any correlation.

Results

Multivariate analysis showed a strong correlation between varus alignment of the tibial tray and pre-operative varus of the lower limb (p = 0.037), increased BMI (p = 0.016) and operated side opposite to the dominant surgeon’s arm (p = 0.006). In a similar way a strong correlation was found between valgus alignment and pre-operative valgus of the limb (p = 0.026).

Conclusion

Poor alignment of the tibial tray after TKA was associated with pre-operative malalignment of the lower limb, increased BMI and an index knee which was opposite to surgeon’s dominant arm.

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Authors and Affiliations

  1. Centre Albert Trillat, Hôpital de la Croix Rousse, 103 grande rue de la Croix Rousse, 69004, Lyon, France

    Romain Gaillard, Sebastien Lustig, Elvire Servien & Philippe Neyret

  2. Casa Di Cura Villa Betania, Via Piccolomini 27, 00165, Rome, Italy

    Simone Cerciello

  3. Marrelli Hospital, via Gioacchino da fiore, 0962, Crotone, Italy

    Simone Cerciello

Authors
  1. Romain Gaillard
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  2. Simone Cerciello
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  3. Sebastien Lustig
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  4. Elvire Servien
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  5. Philippe Neyret
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Corresponding author

Correspondence to Romain Gaillard.

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Conflict of interest

Philippe Neyret has received royalties from Tornier-Wright® and consultation from Smith&Nephew®.

Other authors declare that they have no conflict of interest.

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Gaillard, R., Cerciello, S., Lustig, S. et al. Risk factors for tibial implant malpositioning in total knee arthrosplasty—consecutive series of one thousand, four hundred and seventeen cases. International Orthopaedics (SICOT) 41, 749–756 (2017). https://doi.org/10.1007/s00264-016-3307-z

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  • DOI: https://doi.org/10.1007/s00264-016-3307-z

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