Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

At a glance: The STEP trials

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.
ADVANCED SEARCH
Log in
Top
Knee Surgery, Sports Traumatology, Arthroscopy
Published in: Knee Surgery, Sports Traumatology, Arthroscopy 11/2018

01-11-2018 | Knee

Preoperative tibial mechanical axis orientation and articular surface design influence on the coronal joint line orientation relative to the ground during gait after total knee arthroplasties

Authors: Koji Murakami, Satoshi Hamai, Ken Okazaki, Satoru Ikebe, Hidehiko Higaki, Takeshi Shimoto, Yasuharu Nakashima

Published in: Knee Surgery, Sports Traumatology, Arthroscopy | Issue 11/2018

Login to get access

Abstract

Purpose

Neutral lower limb alignment does not necessarily produce a horizontal joint line after total knee arthroplasty (TKA). The orientation of the pre- and postoperative tibial mechanical axes (TMAs-G), tibial component, and joint line relative to the ground were evaluated.

Methods

The study group included 46 knees, 23 posterior-stabilized (PS) and 23 bicruciate-stabilized (BCS) TKAs. Using whole-leg standing radiographs, the static orientation of the pre- and postoperative TMAs-G and the tibial component as well as the postoperative alignment were measured. Applying image-matching techniques, the dynamic coronal orientation of the tibial component and joint line over the stance phase of gait were analysed. The correlation between static and dynamic orientation of the tibial component and differences in the joint line between the PS and BCS TKAs were evaluated.

Results

In standing, the postoperative TMA-G (0.8° ± 2.8°) and tibial component (1.5° ± 2.4°) were laterally tilted with a strong correlation. The preoperative lateral tilt of the TMA-G (7.9° ± 5.1°) was a significant predictor of the postoperative TMA-G. The lateral tilt of the tibial component increased to 5.1° ± 2.4° on dynamic analysis, and was moderately correlated to static orientation. The dynamic orientation of the joint line was smaller for the BCS (1.8° ± 2.4°) compared to the PS (5.5° ± 2.7°) TKA.

Conclusion

Even with a mechanically well-aligned TKA, a lateral tilt of the tibial component was identified due to the lateral tilt of the postoperative TMA-G and the stance phase of gait. The BCS can better accommodate the residual lateral tilt of the joint line due to the 3° medial inclination of the joint surfaces of the implant. This study increases the awareness of surgeons regarding the possibility of the coronal joint line orientation to influence preoperative TMA-G and be accommodated by articular surface design, even in mechanically aligned TKA.

Level of evidence

IV.
Literature
1.
Akagi M, Mori S, Nishimura S, Nishimura A (2005) Variability of extraarticular tibial rotation references for total knee arthroplasty. Clin Orthop Relat Res 436:172–176CrossRef
2.
Amis AA (2013) Biomechanics of high tibial osteotomy. Knee Surg Sports Traumatol Arthrosc 21:197–205CrossRef
3.
Andriacchi TP, Stanwyck TS, Galante JO (1986) Knee biomechanics and total knee replacement. J Arthroplasty 1:211–219CrossRef
4.
Babis GC, An KN, Chao E, Rand JA, Sim FH (2002) Double level osteotomy of the knee: a method to retain joint-line obliquity: clinical results. J Bone Joint Surg Am 84A:1380–1388CrossRef
5.
Callaghan JJ, O’Rourke MR, Iossi MF, Liu SS, Goetz DD, Vittetoe DA, Sullivan PM, Johnston RC (2005) Cemented rotating-platform total knee replacement: a concise follow-up, at a minimum of fifteen years, of a previous report. J Bone Joint Surg Am 87:1995–1998PubMed
6.
Catani F, Ensini A, Belvedere C, Feliciangeli A, Benedetti MG, Leardini A, Giannini S (2009) In vivo kinematics and kinetics of a bi-cruciate substituting total knee arthroplasty: a combined fluoroscopic and gait analysis study. J Orthop Res 27:1569–1575CrossRef
7.
Chakrabarty G, Vashishtha M, Leeder D (2015) Polyethylene in knee arthroplasty: a review. J Clin Orthop Trauma 6:108–112CrossRef
8.
Deep K, Eachempati KK, Apsingi S (2015) The dynamic nature of alignment and variations in normal knees. Bone Joint J 97-B:498–502CrossRef
9.
Dennis DA, Komistek RD, Kim RH, Sharma A (2010) Gap balancing versus measured resection technique for total knee arthroplasty. Clin Orthop Relat Res 468:102–107CrossRef
10.
Duffy GP, Crowder AR, Trousdale RR, Berry DJ (2007) Cemented total knee arthroplasty using a modern prosthesis in young patients with osteoarthritis. J Arthroplasty 22:67–70CrossRef
11.
Ellerkmann RM, Cundiff GW, Melick CF, Nihira MA, Leffler K, Bent AE (2001) Correlation of symptoms with location and severity of pelvic organ prolapse. Am J Obstet Gynecol 185:1332–1338CrossRef
12.
Gursu S, Sofu H, Verdonk P, Sahin V (2016) Effects of total knee arthroplasty on ankle alignment in patients with varus gonarthrosis: do we sacrifice ankle to the knee? Knee Surg Sports Traumatol Arthrosc 24:2470–2475CrossRef
13.
Hamai S, Miura H, Okazaki K, Shimoto T, Higaki H, Iwamoto Y (2014) No influence of coronal laxity and alignment on lift-off after well-balanced and aligned total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 22:1799–1804CrossRef
14.
Hamai S, Okazaki K, Ikebe S, Murakami K, Higaki H, Nakahara H. Shimoto T, Mizu-uchi H, Akasaki Y, Iwamoto Y (2016) In vivo kinematics of healthy and osteoarthritis knees during stepping using density-based image-matching techniques. J Appl Biomech 32:586–592CrossRef
15.
Hungerford DS, Kenna RV (1983) Preliminary experience with a total knee prosthesis with porous coating used without cement. Clin Orthop Relat Res 176:95–107
16.
Hungerford DS, Krackow KA (1985) Total joint arthroplasty of the knee. Clin Orthop Relat Res 192:23–23
17.
Hutt J, Massé V, Lavigne M, Vendittoli PA (2016) Functional joint line obliquity after kinematic total knee arthroplasty. Int Orthop 40:29–34CrossRef
18.
Ji HM, Han J, Jin DS, Seo H, Won YY (2016) Kinematically aligned TKA can align knee joint line to horizontal. Knee Surg Sports Traumatol Arthrosc 24:2436–2441CrossRef
19.
Kawahara S, Matsuda S, Okazaki K, Tashiro Y, Mitsuyasu H, Nakahara H, Iwamoto Y (2012) Relationship between the tibial anteroposterior axis and the surgical epicondylar axis in varus and valgus knees. Knee Surg Sports Traumatol Arthrosc 20:2077–2081CrossRef
20.
Keeney JA, Eunice S, Pashos G, Wright RW, Clohisy JC (2010) What is the evidence for total knee arthroplasty in young patients? A systematic review of the literature. Clin Orthop Relat Res 469:574–583CrossRef
21.
Kozanek M, Hosseini A, Liu F, Van de Velde SK, Gill TJ, Rubash HE, Li G (2009) Tibiofemoral kinematics and condylar motion during the stance phase of gait. J Biomech 42:1877–1884CrossRef
22.
Kuriyama S, Ishikawa M, Nakamura S, Furu M, Ito H, Matsuda S (2016) No condylar lift-off occurs because of excessive lateral soft tissue laxity in neutrally aligned total knee arthroplasty: a computer simulation study. Knee Surg Sports Traumatol Arthrosc 24:2517–2524CrossRef
23.
Kuroyanagi Y, Mu S, Hamai S, Robb WJ, Banks SA (2012) In vivo knee kinematics during stair and deep flexion activities in patients with bicruciate substituting total knee arthroplasty. J Arthroplasty 27:122–128CrossRef
24.
Lee YS, Lee BK, Lee SH, Park HG, Jun D-S, Moon DH (2013) Effect of foot rotation on the mechanical axis and correlation between knee and whole leg radiographs. Knee Surg Sports Traumatol Arthrosc 21:2542–2547CrossRef
25.
Lindstrand A, Boegard T, Egund N, Thorngren KG (1982) Use of a guide instrument for compartmental knee arthroplasty. Acta Orthop Scand 53:633–639CrossRef
26.
Mahaluxmivala J, Bankes MJ, Nicolai P, Aldam CH, Allen PW (2001) The effect of surgeon experience on component positioning in 673 Press Fit Condylar posterior cruciate-sacrificing total knee arthroplasties. J Arthroplasty 16:635–640CrossRef
27.
Matsuda S, Kawahara S, Okazaki K, Tashiro Y, Iwamoto Y (2013) Postoperative alignment and ROM affect patient satisfaction after TKA. Clin Orthop Relat Res 471:127–133CrossRef
28.
Matsuda S, Mizu-uchi H, Miura H, Nagamine R, Urabe K, Iwamoto Y (2003) Tibial shaft axis does not always serve as a correct coronal landmark in total knee arthroplasty for varus knees. J Arthroplasty 18:56–62CrossRef
29.
Medel FJ, Martínez-Morlanes MJ, Alonso PJ, Rubín J, Pascual FJ, Puértolas JA (2013) Microstructure, thermooxidation and mechanical behavior of a novel highly linear, vitamin E stabilized, UHMWPE. Mater Sci Eng C Mater Biol Appl 33:182–188CrossRef
30.
Meehan JP, Danielsen B, Kim SH, Jamali AA, White RH (2014) Younger age is associated with a higher risk of early periprosthetic joint infection and aseptic mechanical failure after total knee arthroplasty. J Bone Joint Surg Am 96:529–535CrossRef
31.
Moro-oka T-A, Shiraishi H, Iwamoto Y, Banks SA (2009) Modified gap-balancing technique in total knee arthroplasty: evaluation of the post-operative coronal laxity. Knee Surg Sports Traumatol Arthrosc 18:375–380CrossRef
32.
Nakahara H, Okazaki K, Hamai S, Kawahara S, Higaki H, Mizu-uchi H, Iwamoto Y (2015) Rotational alignment of the tibial component affects the kinematic rotation of a weight-bearing knee after total knee arthroplasty. Knee 22:201–205CrossRef
33.
Nakamura S, Tian Y, Tanaka Y (2017) The effects of kinematically aligned total knee arthroplasty on stress at the medial tibia. Bone Joint Res 6:43–51CrossRef
34.
Nishikawa K, Okazaki K, Matsuda S, Tashiro Y, Kawahara S, Nakahara H, Okamoto S, Shimoto T, Higaki H, Iwamoto Y (2014) Improved design decreases wear in total knee arthroplasty with varus malalignment. Knee Surg Sports Traumatol Arthrosc 22:2635–2640CrossRef
35.
Norton AA, Callaghan JJ, Amendola A, Phisitkul P, Wongsak S, Liu SS, Fruehling-Wall C (2014) Correlation of knee and hindfoot deformities in advanced knee OA: compensatory hindfoot alignment and where it occurs. Clin Orthop Relat Res 473:166–174CrossRef
36.
Okamoto Y, Otsuki S, Jotoku T, Nakajima M, Neo M (2016) Clinical usefulness of hindfoot assessment for total knee arthroplasty: persistent post-operative hindfoot pain and alignment in pre-existing severe knee deformity. Knee Surg Sports Traumatol Arthrosc 19:211–218
37.
Parvizi J, Nunley RM, Berend KR, Lombardi AV, Ruh EL, Clohisy JC, Hamilton WG, Valle Della CJ, Barrack RL (2013) High level of residual symptoms in young patients after total knee arthroplasty. Clin Orthop Relat Res 472:133–137CrossRef
38.
39.
Scuderi GR, Bourne RB, Noble PC, Benjamin JB, Lonner JH, Scott WN (2011) The new knee society knee scoring system. Clin Orthop Relat Res 470:3–19CrossRef
40.
Taniguchi N, Matsuda S, Kawaguchi T, Tabara Y, Ikezoe T, Tsuboyama T, Ichihashi N, Nakayama T, Matsuda F, Ito H (2015) The KSS 2011 reflects symptoms, physical activities, and radiographic grades in a Japanese population. Clin Orthop Relat Res 473:70–75CrossRef
41.
Thienpont E, Cornu O, Bellemans J, Victor J (2015) Current opinions about coronal plane alignment in total knee arthroplasty: A survey article. Acta Orthop Belg 81:471–477PubMed
42.
Vessely MB, Whaley AL, Harmsen WS, Schleck CD, Berry DJ (2006) The Chitranjan Ranawat Award: long-term survivorship and failure modes of 1000 cemented condylar total knee arthroplasties. Clin Orthop Relat Res 452:28–34CrossRef
43.
Victor J, Bellemans J (2006) Physiologic kinematics as a concept for better flexion in TKA. Clin Orthop Relat Res 452:53–58CrossRef
44.
Victor JMK, Bassens D, Bellemans J, Gürsu S, Dhollander AAM, Verdonk PCM (2013) Constitutional varus does not affect joint line orientation in the coronal plane. Clin Orthop Relat Res 472:98–104CrossRef
45.
Victor J, Ghijselings S, Tajdar F, Van Damme G, Deprez P, Arnout N, Van Der Straeten C (2014) Total knee arthroplasty at 15–17 years: does implant design affect outcome? Int Orthop 38:235–241CrossRef
Metadata
Title
Preoperative tibial mechanical axis orientation and articular surface design influence on the coronal joint line orientation relative to the ground during gait after total knee arthroplasties
Authors
Koji Murakami
Satoshi Hamai
Ken Okazaki
Satoru Ikebe
Hidehiko Higaki
Takeshi Shimoto
Yasuharu Nakashima
Publication date
01-11-2018
Publisher
Springer Berlin Heidelberg
Published in
Knee Surgery, Sports Traumatology, Arthroscopy / Issue 11/2018
Print ISSN: 0942-2056
Electronic ISSN: 1433-7347
DOI
https://doi.org/10.1007/s00167-018-4899-1

Other articles of this Issue 11/2018

Knee Surgery, Sports Traumatology, Arthroscopy 11/2018 Go to the issue

Knee

3D patient imaging and retrieval analysis help understand the clinical importance of rotation in knee replacements

Knee

Intra-articular injections of expanded mesenchymal stem cells with and without addition of platelet-rich plasma are safe and effective for knee osteoarthritis

Knee

The WOMAC score can be reliably used to classify patient satisfaction after total knee arthroplasty

Knee

Patient-reported outcome metrics following total knee arthroplasty are influenced differently by patients’ body mass index

Knee

Native rotational knee kinematics are lost in bicruciate-retaining total knee arthroplasty when the tibial component is replaced

Knee

Rotation of intramedullary alignment rods affects distal femoral cutting plane in total knee arthroplasty