The accuracy of extramedullary guides for tibial component placement in total knee arthroplasty.
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ABSTRACT:
SUBMITTER: Chiu KY
PROVIDER: S-EPMC2532261 | biostudies-other | 2008 Aug
REPOSITORIES: biostudies-other
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Project description:A 51-year-old woman suffered cardiac arrest requiring emergent intraosseous access that abutted the tibial component of her total knee arthroplasty. She developed a wound at the site and knee pain which was concerning for deep infection. Subsequent imaging was consistent with osteonecrosis developing around the tibial component. The component eventually loosened, requiring a revision surgery. Her deep cultures remained negative throughout. Her findings are most consistent with osteonecrosis and aseptic loosening of her prosthesis. While intraosseous access may be beneficial during resuscitation, it has complications. This is the first reported case of osteonecrosis secondary to intraosseous access leading to prosthetic loosening necessitating a revision surgery.
| S-EPMC9860108 | biostudies-literature
Project description:The rotational axis of the tibial component in total knee arthroplasty described by Insall is generally accepted, but rotational mismatch between the femoral and the tibial components can occur because the alignment of each component is determined separately. We developed a connecting instrument to synchronise the axis of the tibia to the axis of the femur. We compared the rotational axis of the tibial component using our method and medial one third of tibial tuberosity (Insall's reference) in 70 consecutive TKAs. The rotational axis of the tibial component from the femoro-tibial synchronisation was rotated internally 13.8 degrees +/- 5.8 degrees (range, 2 degrees - 24 degrees ) more than the axis of Insall's reference. Eighty three percent of patellae tracked centrally and the patellae tilt measured 2.2 degrees on average. More attention should be given to the rotational congruency between the femoro-tibial components, because the recent prosthetic design has more conforming articular surfaces.
| S-EPMC2269015 | biostudies-other
Project description: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.
| S-EPMC6301685 | biostudies-literature
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.
| S-EPMC7881541 | biostudies-literature
Project description:BackgroundAccurate sizing is critical for the overall success of a total knee arthroplasty (TKA). This study's primary purpose was to investigate the ability to predict the tibial and femoral component size in a single implant system from patient demographics and anthropometric data. A secondary goal was to compare the predicted tibial and femoral component sizes from our statistical model with a previously validated electronic application used to predict the implant size.MethodsA consecutive series of 484 patients undergoing a primary TKA at a single institution was reviewed. Data on height, weight, body mass index, sex, age, and component size were collected. A proportional odds model was developed to predict tibial and femoral component sizes. The relationship between the proportional odds model predictions was also compared with the component sizes determined by the Arthroplasty Size Predictor electronic application.ResultsWeight, height, and sex predicted the implanted component size with an accuracy of 54.0% (n = 247/484) for the tibia and 51.1% (n = 231/484) for the femur. The accuracy improved to 94.4% (n = 457/484) for the tibia and 93.4% (n = 452/484) for the femur within ±1 component size. Our data are highly correlated to the Arthroplasty Size Predictor for the predicted tibial component size (ρ = 0.91, P < .001) and femoral component size (ρ = 0.89, P < .001).ConclusionsOur novel templating model may improve operative efficiency for a single TKA system. Our findings have a high concordance with a widely available electronic application used to predict implant sizes for a variety of TKA systems.
| S-EPMC7606840 | biostudies-literature
Project description:The tibial joint line is offset posteriorly relative to the tibial sagittal anatomic axis. This can have consequences when using stemmed implants during total knee arthroplasty. We retrospectively analyzed native knee lateral radiographs in 100 patients. The distance between the sagittal anatomic axis and the center of a simulated tibial resection was calculated as a percentage of overall tibial width. Analysis of 5 manufacturers' baseplates showed that the tibial stem attached on average 10% anterior to the midline. We measured the impingement point of a 12-mm-diameter stem starting from this position. The tibial joint surface was offset posteriorly from the anatomic axis in all patients by an average of 23.5% of the tibial width (range: 13.1%-33.2%). A 12-mm tibial stem would impinge within 40 mm in 2% (2/100) of patients and within 60 mm in 19% (19/100). There was a weak but statistically significant correlation between proximal tibial offset and distance to impingement. During total knee arthroplasty, the center of the cut tibia is offset posteriorly from the sagittal anatomic axis. In patients with high offset, tibial stem extensions can impinge against the posterior tibia, causing baseplate malpositioning, diminished cement mantle, or fracture.
| S-EPMC8685910 | biostudies-literature
Project description:This retrospective study was to determine if patient-specific instrumentation (PSI) for total knee arthroplasty (TKA) leads to shortened surgical time through increased operating room efficiency according to different tibial PSI designs. 166 patients underwent primary TKA and were categorized into three groups as follows: PSI without extramedullary (EM) tibial guide (group 1, n = 48), PSI with EM tibial guide (group 2, n = 68), and conventional instrumentation (CI) group (group 3, n = 50). Four factors were compared between groups, namely, operative room time, thickness of bone resection, tibial slope, and rotation of the component. The mean surgical time was significantly shorter in the PSI with EM tibial guide group (group 2, 63.9 ± 13.6 min) compared to the CI group (group 3, 82.8 ± 24.9 min) (P < 0.001). However, there was no significant difference in the PSI without EM tibial guide group (group 1, 75.3 ± 18.8 min). This study suggests that PSI incorporating an EM tibial guide may lead to high operative efficiency in TKA compared to CI. This trial is registered with KCT0002384.
| S-EPMC5559926 | biostudies-other
Project description:During total knee arthroplasty, balancing is necessary for long-term stability and longevity of implants as improper balancing leads to abnormal surface strain. A routine practice among surgeons is to add more posterior slope to the proximal tibia to provide an increase in the flexion gap to balance the knee throughout the entire range of motion, particularly when doing cruciate-retaining knees. The aim of this technique guide is to provide a simple estimate of the posterior slope added or subtracted when cutting the proximal tibia using a standard extramedullary guide. It can also be applied to predict the amount of coronal change instituted using a standard extramedullary drop guide. Using a few basic calculations with a sine equation, a surgeon can accurately predict the amount of change in the slope applied when cutting the proximal tibia. This can be done to control the degree of slope added to the anterior-posterior direction and can be used to predict coronal alignment changes as well. This technique can be applied to any length extramedullary guide and applied across all companies to provide surgeons with an exact degree change in the tibial slope and coronal alignment with simple calculations.
| S-EPMC7987928 | biostudies-literature
Project description:Background There is no consensus on whether unicompartmental arthroplasty (UKA) or high tibial osteotomy (HTO) is superior for unicompartmental arthritis. While there are studies comparing revision and complication rates, none matched a large number of patients undergoing HTO and UKA in the United States and compared these outcomes. We investigated TKA conversion rate and the complications following HTO or UKA. Methods This retrospective study queried the PearlDiver database of all patients undergoing UKA and HTO using CPT codes between January 2011 and January 2020. We compared propensity-matched populations based on age, gender, Charlson comorbidity index, and Elixhauser comorbidity index to compare odds of complications, TKA conversion, and drug use between UKA and HTO groups. Two-independent sample t-test for unequal variances and test of significance were performed. Results We found 32,583 UKA patients and 816 HTO patients. Each matched group had 535 patients. One-year complication showed higher risk of pneumonia, hematoma, infection, and mechanical complications among HTO patients. UKA patients used narcotics on average of 10.3 days compared to 9.1 days among HTO patients (P < .01). UKA conversion rates were 4.1%, 5.4%, 7.7%, and 9.2% at 1-, 2-, 5-, and 10-year intervals, respectively. HTO conversion rates were less than 2% at 1- and 2-year intervals, 3.4% at 5-year, and 4.5% at 10-year intervals. This difference was statistically significant at 5- and 10-year intervals (P < .01). Conclusions Using large matched cohorts, HTO may be converted to TKA later than UKA in short- to mid-term follow-up, and HTO patients used opioids for shorter duration.
| S-EPMC10104836 | biostudies-literature
Project description:AimsA novel enhanced cement fixation (EF) tibial implant with deeper cement pockets and a more roughened bonding surface was released to market for an existing total knee arthroplasty (TKA) system.This randomized controlled trial assessed fixation of the both the EF (ATTUNE S+) and standard (Std; ATTUNE S) using radiostereometric analysis.MethodsOverall, 50 subjects were randomized (21 EF-TKA and 23 Std-TKA in the final analysis), and had follow-up visits at six weeks, and six, 12, and 24 months to assess migration of the tibial component. Low viscosity bone cement with tobramycin was used in a standardized fashion for all subjects. Patient-reported outcome measure data was captured at preoperative and all postoperative visits.ResultsThe patient cohort mean age was 66 years (SD seven years), 59% were female, and the mean BMI was 32 kg/m2 (SD 6 kg/m2). Mean two-year subsidence of the EF-TKA was 0.056 mm (95% confidence interval (CI) 0.025 to 0.086) versus 0.006 mm (95% CI -0.029 to 0.040) for the Std-TKA, and the two-year maximum total point motion (MTPM) was 0.285 mm (95% upper confidence limit (UCL) ≤ 0.363) versus 0.346 mm (95% UCL ≤ 0.432), respectively, for a mean difference of -0.061 mm (95% CI -0.196 to 0.074). Inducible displacement also did not differ between groups. The MTPMs between 12 and 24 months for each group was below the published threshold of 0.2 mm for predicting early aseptic loosening (p < 0.001 and p = 0.001, respectively).ConclusionBoth the enhanced fixation and the standard tibial implant design showed fixation with a predicted low risk of long-term aseptic loosening.
| S-EPMC10792398 | biostudies-literature