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A proposed new rotating reference axis for the tibial component after proximal tibial resection in total knee arthroplasty.

ABSTRACT: PURPOSE:During total knee arthroplasty, few rotating reference axes can be reliably used after tibial resection. We speculated that a line that passes through the lateral edge of the posterior cruciate ligament (PCL) at its tibial attachment after resection and the most prominent point of the tibial tubercle [after-tibial resection (ATR) line] will provide a good reference axis. In this study, we aimed to evaluate the association between ATR and Akagi's lines. MATERIALS AND METHODS:In this case-control simulation study, we retrospectively evaluated 38 patients with varus knee and 28 patients with valgus knee. We defined the reference cutting plane as 10 mm distal from the lateral articular surface of the tibia in varus group and as 7 mm distal from the medial articular surface in the valgus group. We measured angles between Akagi's line and the ATR line (ATR line angle) as well as between Akagi's line and 1/3 Akagi's line (1/3 Akagi's line angle), which passes through the midpoint of PCL and the medial third of the patellar tendon. We used paired t-tests to determine the significance of differences between these angles, with p < 0.05 indicating statistical significance. Intra- and interclass correlation coefficients for the reproducibility of 1/3 Akagi's line angle and ATR line angle were analyzed by two surgeons. RESULTS:We found that 1/3 Akagi's line angle was 10.2° ± 1.3° in the varus group and 10.9° ± 1.3° in the valgus group (p = 0.017). The ATR line was positioned externally compared with Akagi's line in all patients. Mean ATR line angles at 0°, 3° and 7° posterior slopes were 6.1° ± 1.9°, 5.8° ± 2.0° and 6.0° ± 1.7° in the varus group and 6.3° ± 2.3°, 6.2° ± 2.3° and 5.4° ± 2.1° in the valgus group, respectively. There were no significant differences in the ATR line angle between the varus and valgus groups. (p = 0.34-0.67) Intra- and interclass correlation coefficients for the reproducibility of 1/3 Akagi's line angle were 0.936 and 0.986 and those for the reproducibility of ATR line angle were 0.811 and 0.839. CONCLUSIONS:The ATR line was positioned between Akagi's line and 1/3 Akagi's line in all patients and was a valid option for evaluating rotational tibial alignment after tibial resection.

SUBMITTER: Ohmori T

PROVIDER: S-EPMC6301685 | biostudies-literature | 2018

REPOSITORIES: biostudies-literature

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A proposed new rotating reference axis for the tibial component after proximal tibial resection in total knee arthroplasty.

Ohmori Takaaki T Kabata Tamon T Kajino Yoshitomo Y Inoue Daisuke D Taga Tadashi T Yamamoto Takashi T Takagi Tomoharu T Yoshitani Junya J Ueno Takuro T Ueoka Ken K Tsuchiya Hiroyuki H

PloS one 20181220 12

<h4>Purpose</h4>During total knee arthroplasty, few rotating reference axes can be reliably used after tibial resection. We speculated that a line that passes through the lateral edge of the posterior cruciate ligament (PCL) at its tibial attachment after resection and the most prominent point of the tibial tubercle [after-tibial resection (ATR) line] will provide a good reference axis. In this study, we aimed to evaluate the association between ATR and Akagi's lines.<h4>Materials and methods</h ...[more]

PMID: 30571784

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Project description:PurposeThe aim of this study is to investigate the prognostic value of tibial component coverage (over-hang and under-hang) and the alignment of total knee arthroplasty (TKA) components 1 week after surgery. We select patient-reported outcome measures (PROMS) (the Knee Society score (KSS score) and the Western Ontario and McMaster Universities Osteoarthritis Index-pain score (WOMAC pain score)) and tibial bone resorption (TBR) 2 years after surgery as the end points.MethodsThe study retrospectively analyzed 109 patients undergoing TKA (fixed-bearing prosthesis with asymmetrical tibial tray) from January 2014 to December 2017 in Huashan Hospital. By using standard long-leg X-rays, anteroposterior (AP) and lateral X-rays of the knee, tibial component coverage (under-hang or over-hang), AP tibial-femoral anatomical angle (AP-TFA), AP femoral angle (AP-FA), AP tibial angle (AP-TA), and lateral tibial angle (L-TA) were measured at 1 week after surgery, while TBR was measured through postoperative 1-week and 2-year AP and lateral radiographs of the knee on three sides (medial side, lateral side on AP radiograph, and anterior side on lateral radiograph). The Pearson correlation analysis, simple linear regression, multiple linear regression, the Student's t test, and one-way ANOVA together with Tukey's post hoc test (or Games-Howell post hoc test) were used in the analyses.ResultsTibial under-hang was more likely to appear in our patients following TKA (42%, medially, 39%, laterally, and 25%, anteriorly). In multivariate linear regression analysis of TBR, tibial under-hang (negative value) 1 week after surgery was positively correlated with TBR 2 years later on the medial (p = 0.003) and lateral (p = 0.026) side. Tibial over-hang (positive value) 1 week after surgery on the medial side was found negatively related with KSS score (p = 0.004) and positively related with WOMAC pain score (p = 0.036) 2 years later in multivariate linear regression analysis of PROMS. Both scores were better in the anatomically sized group than in the mild over-hang group (or severe over-hang) (p < 0.001). However, no significant relationship was found between the alignment of TKA components at 1 week after surgery and the end points (TBR and PROMS) 2 years later.ConclusionUnder-hang of the tibial component on both the medial and lateral sides can increase the risk of TBR 2 years later. Over-hang of tibial component on the medial side decreases the PROMS (KSS score and WOMAC pain score) 2 years later. An appropriate size of tibial component during TKA is extremely important for patient's prognosis, while the alignment of components might not be as important.

Project description:Kinematically aligned total knee arthroplasty strives to correct the arthritic deformity by restoring the native tibial joint line. However, the precision of such surgical correction needs to be quantified in order to reduce recuts of the resection and to design assisting instrumentation. This study describes a method for novel three-dimensional analysis of tibial resection parameters in total knee arthroplasty. Pre-operative versus post-operative differences in the slopes of the varus-valgus and flexion-extension planes and the proximal-distal level between the tibia resection and the arthritic tibial joint line can reliably be measured using the three-dimensional models of the tibia and fibula. This work uses the proposed comparison method to determine the parameters for resecting the tibia in kinematically aligned total knee arthroplasty.Three-dimensional shape registration was performed between arthritic surface models segmented from pre-operative magnetic resonance imaging scans and resected surface models segmented from post-operative computed tomography scans. Mean, standard deviation and 95% confidence intervals were determined for all measurements. RESULTS: Results indicate that kinematically aligned total knee arthroplasty consistently corrects the varus deformity and restores the slope of the flexion-extension plane and the proximal-distal level of the arthritic tibial joint line. The slope of the varus-valgus plane is most precisely associated with the overall arthritic slope after approximately 3° of correction and the posterior slope is biased towards the overall arthritic plateau, though less precisely than the varus correlation.Use of this analysis on a larger population can quantify the effectiveness of the tibial resection for correcting pathologies, potentially reduce imprecisions in the surgical technique, and enable development of instrumentation that reduces the risk of resection recuts. The kinematic alignment technique consistently corrects varus deformities.

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A proposed new rotating reference axis for the tibial component after proximal tibial resection in total knee arthroplasty.

Publications

A proposed new rotating reference axis for the tibial component after proximal tibial resection in total knee arthroplasty.

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