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Tibia Vara Affects the Aspect Ratio of Tibial Resected Surface in Female Japanese Patients Undergoing TKA

  • Symposium: Special Considerations for TKA in Asian Patients
  • Published:
Clinical Orthopaedics and Related Research®

Abstract

Background

Tibia vara seen in Japanese patients reportedly influences the tibial component alignment when performing TKA. However, it is unclear whether tibia vara affects the component position and size selection.

Questions/purposes

We therefore determined (1) the amount of medial tibial bow, (2) whether the tibia vara influences the aspect ratio of the tibial resected surface in aligning the tibial component with the tibial shaft axis, and (3) whether currently available tibial components fit the shapes of resected proximal tibias in terms of aspect ratio.

Methods

We measured the tibia vara angle (TVA), proximal varus angle (PVA), and the mediolateral and middle AP dimensions of the resected surface using three-dimensional preoperative planning software in 90 knees of 74 female patients with varus osteoarthritis. We determined the correlations of the aspect ratio with TVA or PVA and compared the aspect ratios to those of five prosthesis designs.

Results

The mean TVA and PVA were 0.6° and 2.0°, respectively. The aspect ratio negatively correlated with both TVA and PVA (r = −0.53 and −0.55, respectively). The mean aspect ratio of the resected surface was 1.48 but gradually decreased with increasing AP dimension, whereas four of the five prostheses had a constant aspect ratio.

Conclusions

The aspect ratio of resected tibial surface was inversely correlated to the degree of tibia vara, and currently available prosthesis designs do not fit well to the resected surface in terms of aspect ratio.

Clinical Relevance

The design of a tibial component with a smaller aspect ratio could be developed to obtain better bone coverage in Japanese patients.

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References

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

    Article  PubMed  Google Scholar 

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

    Article  PubMed  Google Scholar 

  3. Cheng FB, Ji XF, Lai Y, Feng JC, Zheng WX, Sun YF, Fu YW, Li YQ. Three dimensional morphometry of the knee to design the total knee arthroplasty for Chinese population. Knee. 2009;16:341–347.

    Article  PubMed  Google Scholar 

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

    Article  PubMed  Google Scholar 

  5. Hicks CA, Noble P, Tullos H. The anatomy of the tibial intramedullary canal. Clin Orthop Relat Res. 1995;321:111–116.

    PubMed  Google Scholar 

  6. Hitt K, Shurman JR 2nd, Greene K, McCarthy J, Moskal J, Hoeman T, Mont MA. Anthropometric measurements of the human knee: correlation to the sizing of current knee arthroplasty systems. J Bone Joint Surg Am. 2003;85(suppl 4):115–122.

    PubMed  Google Scholar 

  7. Hollister AM, Jatana S, Singh AK, Sullivan WW, Lupichuk AG. The axes of rotation of the knee. Clin Orthop Relat Res. 1993;290:259–268.

    PubMed  Google Scholar 

  8. Hovinga KR, Lerner AL. Anatomic variations between Japanese and Caucasian populations in the healthy young adult knee joint. J Orthop Res. 2009;27:1191–1196.

    Article  PubMed  Google Scholar 

  9. Hsu HP, Garg A, Walker PS, Spector M, Ewald FC. Effect of knee component alignment on tibial load distribution with clinical correlation. Clin Orthop Relat Res. 1989;248:135–144.

    PubMed  Google Scholar 

  10. Hsu RW, Himeno S, Coventry MB, Chao EY. Normal axial alignment of the lower extremity and load-bearing distribution at the knee. Clin Orthop Relat Res. 1990;255:215–227.

    PubMed  Google Scholar 

  11. Kellgren JH, Lawrence JS. Radiological assessment of osteo-arthrosis. Ann Rheum Dis. 1957;16:494–502.

    Article  PubMed  CAS  Google Scholar 

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

    Article  PubMed  CAS  Google Scholar 

  13. Kwak DS, Surendran S, Pengatteeri YH, Park SE, Choi KN, Gopinathan P, Han SH, Han CW. Morphometry of the proximal tibia to design the tibial component of total knee arthroplasty for the Korean population. Knee. 2007;14:295–300.

    Article  PubMed  Google Scholar 

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

    Article  PubMed  Google Scholar 

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

    PubMed  CAS  Google Scholar 

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

    Article  PubMed  CAS  Google Scholar 

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

    Article  PubMed  CAS  Google Scholar 

  18. Stiehl JB, Abbott BD. Morphology of the transepicondylar axis and its application in primary and revision total knee arthroplasty. J Arthroplasty. 1995;10:785–789.

    Article  PubMed  CAS  Google Scholar 

  19. Stiehl JB, Cherveny PM. Femoral rotational alignment using the tibial shaft axis in total knee arthroplasty. Clin Orthop Relat Res. 1996;331:47–55.

    Article  PubMed  Google Scholar 

  20. Tang Q, Zhou Y, Yang D, Xu H, Liu Q. The offset of the tibial shaft from the tibial plateau in Chinese people. J Bone Joint Surg Am. 2010;92:1981–1987.

    Article  PubMed  Google Scholar 

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

    PubMed  Google Scholar 

  22. Uehara K, Kadoya Y, Kobayashi A, Ohashi H, Yamano Y. Anthropometry of the proximal tibia to design a total knee prosthesis for the Japanese population. J Arthroplasty. 2002;17:1028–1032.

    Article  PubMed  CAS  Google Scholar 

  23. Vail TP, Lang JE. Surgical techniques and instrumentation in total knee arthroplasty. In: Scott WN, ed. Surgery of the Knee. 4th ed. New York, NY: Churchill-Livingstone; 2006:1455–1521.

    Google Scholar 

  24. Yoo JH, Kang YG, Chang CB, Seong SC, Kim TK. The relationship of the medially-offset stem of the tibial component to the medial tibial cortex in total knee replacements in Korean patients. J Bone Joint Surg Br. 2008;90:31–36.

    PubMed  CAS  Google Scholar 

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Acknowledgments

The authors thank E. Matsuki, laboratory assistant, for her assistance in patient data collection.

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Authors and Affiliations

  1. Department of Orthopaedic Surgery, Kinki University Faculty of Medicine, 377-2 Ohno-Higashi, Osaka-Sayama City, Osaka, 589-8511, Japan

    Shigeshi Mori MD, Masao Akagi MD, PhD, Shigeki Asada MD, Tetsunao Matsushita MD & Kazuhiko Hashimoto MD

Authors
  1. Shigeshi Mori MD
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  2. Masao Akagi MD, PhD
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  3. Shigeki Asada MD
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  4. Tetsunao Matsushita MD
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  5. Kazuhiko Hashimoto MD
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Corresponding author

Correspondence to Masao Akagi MD, PhD.

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Each author certifies that his or her institution approved or waived approval for the human protocol for this investigation, that all investigations were conducted in conformity with ethical principles of research, and that informed consent for participation in the study was obtained.

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Mori, S., Akagi, M., Asada, S. et al. Tibia Vara Affects the Aspect Ratio of Tibial Resected Surface in Female Japanese Patients Undergoing TKA. Clin Orthop Relat Res 471, 1465–1471 (2013). https://doi.org/10.1007/s11999-013-2800-6

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  • DOI: https://doi.org/10.1007/s11999-013-2800-6

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