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Knee Surgery, Sports Traumatology, Arthroscopy

Published in:

01-05-2018 | Knee

Medial parapatellar approach leads to internal rotation of tibial component in total knee arthroplasty

Authors: Filippo-Franco Schiapparelli, Felix Amsler, Michael T. Hirschmann

Published in: Knee Surgery, Sports Traumatology, Arthroscopy | Issue 5/2018

Abstract

Purpose

The purpose of this study was to investigate if the type of approach [medial parapatellar approach (MPA) versus lateral parapatellar approach with tibial tubercle osteotomy (LPA)] influences rotation of femoral and/or tibial component and leg axis in total knee arthroplasty (TKA). It was the hypothesis that MPA leads to an internally rotated tibial TKA component.

Methods

This study included 200 consecutive patients in whom TKA was performed using either a parapatellar medial (n = 162, MPA) or parapatellar lateral approach with tibial tubercle osteotomy (n = 38, LPA). All patients underwent clinical follow-up, standardized radiographs and computed radiography (CT). TKA components’ position and the whole leg axis were assessed on 3D reconstructed CT scans (sagittal, coronal and rotational). Mean values of TKA component position and the whole leg alignment of both groups were compared using a t test. The tibial component was graded as internally rotated (<3° of external rotation (ER)), neutral rotation (equal or between 3° and 6° of ER) and externally rotated (>6° ER). The femoral component was graded as internally rotated [>3° of internal rotation (IR)], neutral rotation (equal or between −3° IR and 3° of ER) and externally rotated (>3° ER).

Results

There was no significant difference in terms of whole leg axis after TKA between both groups (MPA: 0.2° valgus ± 3.4; LPA: 0.0° valgus ± 3.5). Means of tibial component rotation were 2.7° ER ± 6.1 (MPA) and 7.6° ER ± 5.4 (LPA). Patients of group LPA presented a significantly less internally rotated (LPA: 18.4%; MPA: 48.8%) and more externally rotated (LPA: 52.6%; MPA: 22.8%) tibial component (p < 0.001). No significant differences were seen for the femoral component position, tibial valgus/varus and tibial slope.

Conclusion

The type of approach (medial versus lateral) significantly influenced tibial TKA component rotation. It appears that a MPA tends to internally rotate the tibial TKA component and a LPA tends to externally rotate the tibial TKA. The anterior cortex should not be used as landmark for tibial TKA component placement when using the lateral approach with tibial tubercle osteotomy.

Level of Evidence

Retrospective comparative study, Level III.

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Title: Medial parapatellar approach leads to internal rotation of tibial component in total knee arthroplasty
Authors: Filippo-Franco Schiapparelli
Felix Amsler
Michael T. Hirschmann
Publication date: 01-05-2018
Publisher: Springer Berlin Heidelberg
Published in: Knee Surgery, Sports Traumatology, Arthroscopy / Issue 5/2018
Print ISSN: 0942-2056
Electronic ISSN: 1433-7347
DOI: https://doi.org/10.1007/s00167-017-4586-7

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Medial parapatellar approach leads to internal rotation of tibial component in total knee arthroplasty

Abstract

Purpose

Methods

Results

Conclusion

Level of Evidence

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusion

Level of Evidence

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