Top

Knee Surgery, Sports Traumatology, Arthroscopy

Published in:

Open Access 01-12-2014 | Knee

Anatomic tibial component design can increase tibial coverage and rotational alignment accuracy: a comparison of six contemporary designs

Authors: Yifei Dai, Giles R. Scuderi, Jeffrey E. Bischoff, Kim Bertin, Samih Tarabichi, Ashok Rajgopal

Published in: Knee Surgery, Sports Traumatology, Arthroscopy | Issue 12/2014

Abstract

Purpose

The aim of this study was to comprehensively evaluate contemporary tibial component designs against global tibial anatomy. We hypothesized that anatomically designed tibial components offer increased morphological fit to the resected proximal tibia with increased alignment accuracy compared to symmetric and asymmetric designs.

Methods

Using a multi-ethnic bone dataset, six contemporary tibial component designs were investigated, including anatomic, asymmetric, and symmetric design types. Investigations included (1) measurement of component conformity to the resected tibia using a comprehensive set of size and shape metrics; (2) assessment of component coverage on the resected tibia while ensuring clinically acceptable levels of rotation and overhang; and (3) evaluation of the incidence and severity of component downsizing due to adherence to rotational alignment and overhang requirements, and the associated compromise in tibial coverage. Differences in coverage were statistically compared across designs and ethnicities, as well as between placements with or without enforcement of proper rotational alignment.

Results

Compared to non-anatomic designs investigated, the anatomic design exhibited better conformity to resected tibial morphology in size and shape, higher tibial coverage (92 % compared to 85–87 %), more cortical support (posteromedial region), lower incidence of downsizing (3 % compared to 39–60 %), and less compromise of tibial coverage (0.5 % compared to 4–6 %) when enforcing proper rotational alignment.

Conclusions

The anatomic design demonstrated meaningful increase in tibial coverage with accurate rotational alignment compared to symmetric and asymmetric designs, suggesting its potential for less intra-operative compromises and improved performance.

Level of evidence

III.

Barrack RL, Schrader T, Bertot AJ, Wolfe MW, Myers L (2001) Component rotation and anterior knee pain after total knee arthroplasty. Clin Orthop Relat Res 392:46–55PubMedCrossRef

Bédard M, Vince KG, Redfern J, Collen SR (2011) Internal rotation of the tibial component is frequent in stiff total knee arthroplasty. Clin Orthop Relat Res 469(8):2346–2355PubMedCentralPubMedCrossRef

Berger RA, Crossett LS, Jacobs JJ, Rubash HE (1998) Malrotation causing patellofemoral complications after total knee arthroplasty. Clin Orthop Relat Res 356:144–153PubMedCrossRef

Bindelglass D, Cohen J, Dorr L (1991) Current principles of design for cemented and cementless knees. Tech Orthop 6:80–85CrossRef

Bischoff JE, Davis B, Seebeck J, Henderson A, Zuhars J, Marion P, Goodlett C (2013) Verification and validation of an open source-based morphology analysis platform to support implant design. J Med Devices 7(4):040903CrossRef

Bonnin MP, Schmidt A, Basiglini L, Bossard N, Dantony E (2013) Mediolateral oversizing influences pain, function, and flexion after TKA. Knee Surg Sports Traumatol Arthrosc 21(10):2314–2324PubMedCentralPubMedCrossRef

Callahan CM, Drake BG, Heck DA, Dittus RS (1994) Patient outcomes following tricompartmental total knee replacement. A meta-analysis. JAMA 271(17):1349–1357PubMedCrossRef

Chau R, Gulati A, Pandit H, Beard DJ, Price AJ, Dodd CA, Gill HS, Murray DW (2009) Tibial component overhang following unicompartmental knee replacement—does it matter? Knee 16:310–313PubMedCrossRef

Cheng FB, Ji XF, Lai Y, Feng JC, Zheng WX, Sun YF, Fu YW, Li YQ (2009) Three dimensional morphometry of the knee to design the total knee arthroplasty for Chinese population. Knee 16(5):341–347PubMedCrossRef

10.

Cohen ZA, McCarthy DM, Kwak SD, Legrand P, Fogarasi F, Ciaccio EJ, Ateshian GA (1999) Knee cartilage topography, thickness, and contact areas from MRI: in vitro calibration and in vivo measurements. Osteoarthritis Cartilage 7(1):95–109PubMedCrossRef

11.

Dai Y, Bischoff JE (2013) Comprehensive assessment of tibial plateau morphology in total knee arthroplasty: influence of shape and size on anthropometric variability. J Orthop Res 31(10):1643–1652PubMedCrossRef

12.

Dai Y, Seebeck J, Henderson AD, Bischoff JE (2014) Influence of landmark and surgical variability on virtual assessment of total knee arthroplasty. Comput Methods Biomech Biomed Eng 17(10):1157–1164CrossRef

13.

Dennis DA (2004) Evaluation of painful total knee arthroplasty. J Arthroplasty 19(4 Suppl 1):35–40PubMedCrossRef

14.

Fitzpatrick CK, FitzPatrick DP, Auger DD (2008) Size and shape of the resection surface geometry of the osteoarthritic knee in relation to total knee replacement design. Proc Inst Mech Eng H 222(6):923–932PubMedCrossRef

15.

Furnes O, Espehaug B, Lie SA, Vollset SE, Engesæter LB, Havelin LI (2002) Early failures among 7,174 primary total knee replacements: a follow-up study from the Norwegian Arthroplasty Register 1994–2000. Acta Orthop Scand 73(2):117–129PubMedCrossRef

16.

Gioe TJ, Killeen KK, Grimm K, Mehle S, Scheltema K (2004) Why are total knee replacements revised? Analysis of early revision in a community knee implant registry. Clin Orthop Relat Res 428:100–106PubMedCrossRef

17.

Hartel MJ, Loosli Y, Gralla J, Kohl S, Hoppe S, Röder C, Eggli S (2009) The mean anatomical shape of the tibial plateau at the knee arthroplasty resection level: an investigation using MRI. Knee 16(6):452–457PubMedCrossRef

18.

Hartel MJ, Loosli Y, Delfosse D, Diel O, Thali M, Ross S, Kohl S, Eggli S (2014) The influence of tibial morphology on the design of an anatomical tibial base plate for TKA. The Knee 21(2):415–419PubMedCrossRef

19.

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

20.

Incavo SJ, Ronchetti PJ, Howe JG, Tranowski JP (1994) Tibial plateau coverage in total knee arthroplasty. Clin Orthop Relat Res 299:81–85PubMed

21.

Lemaire P, Pioletti DP, Meyer FM, Meuli R, Dörfl J, Leyvraz PF (1997) Tibial component positioning in total knee arthroplasty: bone coverage and extensor apparatus alignment. Knee Surg Sports Traumatol Arthrosc 5:251–257PubMedCrossRef

22.

Mahfouz M, Abdel Fatah EE, Bowers LS, Scuderi G (2012) Three-dimensional morphology of the knee reveals ethnic differences. Clin Orthop Relat Res 470(1):172–185PubMedCentralPubMedCrossRef

23.

Mahoney OM, Kinsey T (2010) Overhang of the femoral component in total knee arthroplasty: risk factors and clinical consequences. J Bone Joint Surg Am 95:1115–1121CrossRef

24.

Malo M, Vince KG (2003) The unstable patella after total knee arthroplasty: etiology, prevention, and management. J Am Acad Orthop Surg 11(5):364–371PubMed

25.

Martin S, Saurez A, Ismaily S, Ashfaq K, Noble P, Incavo SJ (2014) Maximizing tibial coverage is detrimental to proper rotational alignment. Clin Orthop Relat Res 472(1):121–125PubMedCrossRef

26.

Matziolis G, Krocker D, Weiss U, Tohtz S, Perka C (2007) A prospective, randomized study of computer-assisted and conventional total knee arthroplasty. J Bone Joint Surg 89(2):236–243PubMedCrossRef

27.

Nicoll D, Rowley DI (2010) Internal rotational error of the tibial component is a major cause of pain after total knee replacement. J Bone Joint Surg Br 92-B:1238–1244CrossRef

28.

Rosenberger RE, Hoser C, Quirbach S, Attal R, Hennerbichler A, Fink C (2008) Improved accuracy of component alignment with the implementation of image-free navigation in total knee arthroplasty. Knee Surg Sports Trumatol Arthrosc 16:249–257CrossRef

29.

Sahin N, Atıcı T, Öztürk A, Özkaya G, Özkan Y, Avcu B (2012) Accuracy of anatomical references used for rotational alignment of tibial component in total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 20(3):565–570PubMedCrossRef

30.

Servien E, Saffarini M, Lustig S, Chomel S, Neyret P (2008) Lateral versus medial tibial plateau: morphometric analysis and adaptability with current tibial component design. Knee Surg Sports Traumatol Arthrosc 16(12):1141–1145PubMedCrossRef

31.

Sharkey PF, Hozack WJ, Rothman RH, Shastri S, Jacoby SM (2002) Why are total knee arthroplasties failing today? Clin Orthop Relat Res 404:7–13PubMedCrossRef

32.

Stulberg BN, Dombrowski RM, Froimson M, Easley K (1995) Computed tomography analysis of proximal tibial coverage. Clin Orthop Relat Res 311:148–156PubMed

33.

Surendran S, Kwak DS, Lee UY, Park SE, Gopinathan P, Han SH, Han CW (2007) Anthropometry of the medial tibial condyle to design the tibial component for unicondylar knee arthroplasty for the Korean population. Knee Surg Sports Traumatol Arthrosc 15(4):436–442PubMedCrossRef

34.

Uehara K, Kadoya Y, Kobayashi A, Ohashi H, Yamano Y (2002) Anthropometry of the proximal tibia to design a total knee prosthesis for the Japanese population. J Arthroplasty 17(8):1028–1032PubMedCrossRef

35.

Victor J, Van Doninck D, Labey L, Innocenti B, Parizel PM, Bellemans J (2009) How precise can bony landmarks be determined on a CT scan of the knee? Knee 16(5):358–365PubMedCrossRef

36.

Wernecke GC, Harris IA, Houang MT, Seeto BG, Chen DB, MacDessi SJ (2012) Comparison of tibial bone coverage of 6 knee prostheses: a magnetic resonance imaging study with controlled rotation. J Orthop Surg (Hong Kong) 20(2):143–147

37.

Yue B, Varadarajan KM, Ai S, Tang T, Rubash HE, Li G (2011) Differences of knee anthropometry between Chinese and white men and women. J Arthroplasty 26(1):124–130PubMedCentralPubMedCrossRef

Title: Anatomic tibial component design can increase tibial coverage and rotational alignment accuracy: a comparison of six contemporary designs
Authors: Yifei Dai
Giles R. Scuderi
Jeffrey E. Bischoff
Kim Bertin
Samih Tarabichi
Ashok Rajgopal
Publication date: 01-12-2014
Publisher: Springer Berlin Heidelberg
Published in: Knee Surgery, Sports Traumatology, Arthroscopy / Issue 12/2014
Print ISSN: 0942-2056
Electronic ISSN: 1433-7347
DOI: https://doi.org/10.1007/s00167-014-3282-0

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Anatomic tibial component design can increase tibial coverage and rotational alignment accuracy: a comparison of six contemporary designs

Abstract

Purpose

Methods

Results

Conclusions

Level of evidence

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusions

Level of evidence

Please log in to get access to this content

Other articles of this Issue 12/2014

Total patellectomy in knees without prior arthroplasty: a systematic review

Preoperative morphometric differences in the distal femur are based on skeletal size in Japanese patients undergoing total knee arthroplasty

Kinematic behaviour and soft tissue management in guided motion total knee replacement

Femoral and tibial insert downsizing increases the laxity envelope in TKA

Predicting knee rotation by the projection overlap of the proximal fibula and tibia in long-leg radiographs

Toe-out angle changes after total knee arthroplasty in patients with varus knee osteoarthritis