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

01-11-2018 | Knee

Medial joint line elevation of the tibia measured during surgery has a significant correlation with the limb alignment changes following medial unicompartmental knee arthroplasty

Authors: Yuichi Kuroda, Koji Takayama, Kazunari Ishida, Shinya Hayashi, Shingo Hashimoto, Masanori Tsubosaka, Takehiko Matsushita, Takahiro Niikura, Kotaro Nishida, Ryosuke Kuroda, Tomoyuki Matsumoto

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

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Abstract

Purpose

This study aimed to determine the correlation between the change in joint line height calculated from the resected bone and insert thickness during surgery and the change in limb alignment following unicompartmental knee arthroplasty (UKA). It was hypothesized that joint line elevation is correlated with the change in limb alignment.

Methods

A total of 74 consecutive patients diagnosed with either isolated medial compartmental osteoarthritis (38 patients) or spontaneous osteonecrosis of the knee (36 patients) were included. The thickness of the proximal tibial and distal femoral bony cuts was measured during surgery; using these values, the medial joint line elevation of the tibia (MJLET) and medial joint line reduction of the femur (MJLRF) were defined. The correlation between the amount of change in the hip–knee–ankle (HKA) angle before and after surgery (δHKA) and the thickness of the tibial insert (TI), MJLET, or MJLRF were evaluated.

Results

The mean values of δHKA, TI, MJLET, and MJLRF were 5.0° ± 2.6°, 8.5 ± 0.8, 4.4 ± 1.3, and 0.0 ± 1.1 mm, respectively. The δHKA had a significant, but weak-positive correlation with the TI (P = 0.02), and moderate-positive correlation with MJLET (P < 0.001). However, no correlation was observed between δHKA and MJLRF.

Conclusions

The MJLET measured during surgery had a significant moderate-positive correlation with the change in limb alignment following medial UKA. For clinical relevance, the surgeon can predict postoperative limb alignment after UKA by considering, intraoperatively, both the insert thickness and the depth of resection at the proximal tibia thus minimizing technical error to obtain an optimal alignment after UKA.

Level of evidence

Diagnostic study, level II.
Literature
1.
go back to reference Akizuki S, Mueller JK, Horiuchi H, Matsunaga D, Shibakawa A, Komistek RD (2009) In vivo determination of kinematics for subjects having a Zimmer Unicompartmental High Flex Knee System. J Arthroplast 24(6):963–971CrossRef Akizuki S, Mueller JK, Horiuchi H, Matsunaga D, Shibakawa A, Komistek RD (2009) In vivo determination of kinematics for subjects having a Zimmer Unicompartmental High Flex Knee System. J Arthroplast 24(6):963–971CrossRef
2.
go back to reference Aleto TJ, Berend ME, Ritter MA, Faris PM, Meneghini RM (2008) Early failure of unicompartmental knee arthroplasty leading to revision. J Arthroplast 23(2):159–163CrossRef Aleto TJ, Berend ME, Ritter MA, Faris PM, Meneghini RM (2008) Early failure of unicompartmental knee arthroplasty leading to revision. J Arthroplast 23(2):159–163CrossRef
3.
go back to reference Arguello-Cuenca JM, Vaquero-Martin J, Corella F, Calvo JA, Rodriganez L (2012) Clinical and functional outcome of unicompartmental knee arthroplasty: influence of the mechanical axis correction. Rev Esp Cir Ortop Traumatol 56(1):32–37PubMed Arguello-Cuenca JM, Vaquero-Martin J, Corella F, Calvo JA, Rodriganez L (2012) Clinical and functional outcome of unicompartmental knee arthroplasty: influence of the mechanical axis correction. Rev Esp Cir Ortop Traumatol 56(1):32–37PubMed
4.
go back to reference Hernigou P, Deschamps G (2004) Alignment influences wear in the knee after medial unicompartmental arthroplasty. Clin Orthop Relat Res 423:161–165CrossRef Hernigou P, Deschamps G (2004) Alignment influences wear in the knee after medial unicompartmental arthroplasty. Clin Orthop Relat Res 423:161–165CrossRef
5.
go back to reference Herry Y, Batailler C, Lording T, Servien E, Neyret P, Lustig S (2017) Improved joint-line restitution in unicompartmental knee arthroplasty using a robotic-assisted surgical technique. Int Orthop 41(11):2265–2271CrossRef Herry Y, Batailler C, Lording T, Servien E, Neyret P, Lustig S (2017) Improved joint-line restitution in unicompartmental knee arthroplasty using a robotic-assisted surgical technique. Int Orthop 41(11):2265–2271CrossRef
6.
go back to reference Hopgood P, Martin CP, Rae PJ (2004) The effect of tibial implant size on post-operative alignment following medial unicompartmental knee replacement. Knee 11(5):385–388CrossRef Hopgood P, Martin CP, Rae PJ (2004) The effect of tibial implant size on post-operative alignment following medial unicompartmental knee replacement. Knee 11(5):385–388CrossRef
7.
go back to reference Insall JN, Dorr LD, Scott RD, Scott WN (1989) Rationale of the Knee Society clinical rating system. Clin Orthop Relat Res 248:13–14 Insall JN, Dorr LD, Scott RD, Scott WN (1989) Rationale of the Knee Society clinical rating system. Clin Orthop Relat Res 248:13–14
8.
go back to reference Kennedy WR, White RP (1987) Unicompartmental arthroplasty of the knee. Postoperative alignment and its influence on overall results. Clin Orthop Relat Res 221:278–285 Kennedy WR, White RP (1987) Unicompartmental arthroplasty of the knee. Postoperative alignment and its influence on overall results. Clin Orthop Relat Res 221:278–285
9.
go back to reference Kim KT, Lee S, Kim TW, Lee JS, Boo KH (2012) The influence of postoperative tibiofemoral alignment on the clinical results of unicompartmental knee arthroplasty. Knee Surg Relat Res 24(2):85–90CrossRef Kim KT, Lee S, Kim TW, Lee JS, Boo KH (2012) The influence of postoperative tibiofemoral alignment on the clinical results of unicompartmental knee arthroplasty. Knee Surg Relat Res 24(2):85–90CrossRef
10.
go back to reference Kim SJ, Bae JH, Lim HC (2012) Factors affecting the postoperative limb alignment and clinical outcome after Oxford unicompartmental knee arthroplasty. J Arthroplast 27(6):1210–1215CrossRef Kim SJ, Bae JH, Lim HC (2012) Factors affecting the postoperative limb alignment and clinical outcome after Oxford unicompartmental knee arthroplasty. J Arthroplast 27(6):1210–1215CrossRef
11.
go back to reference Klemme WR, Galvin EG, Petersen SA (1994) Unicompartmental knee arthroplasty. Sequential radiographic and scintigraphic imaging with an average five-year follow-up. Clin Orthop Relat Res 301:233–238 Klemme WR, Galvin EG, Petersen SA (1994) Unicompartmental knee arthroplasty. Sequential radiographic and scintigraphic imaging with an average five-year follow-up. Clin Orthop Relat Res 301:233–238
12.
go back to reference Kuwashima U, Okazaki K, Tashiro Y, Mizu-Uchi H, Hamai S, Okamoto S et al (2015) Correction of coronal alignment correlates with reconstruction of joint height in unicompartmental knee arthroplasty. Bone Jt Res 4(8):128–133CrossRef Kuwashima U, Okazaki K, Tashiro Y, Mizu-Uchi H, Hamai S, Okamoto S et al (2015) Correction of coronal alignment correlates with reconstruction of joint height in unicompartmental knee arthroplasty. Bone Jt Res 4(8):128–133CrossRef
13.
go back to reference Ridgeway SR, McAuley JP, Ammeen DJ, Engh GA (2002) The effect of alignment of the knee on the outcome of unicompartmental knee replacement. J Bone Jt Surg Br 84(3):351–355CrossRef Ridgeway SR, McAuley JP, Ammeen DJ, Engh GA (2002) The effect of alignment of the knee on the outcome of unicompartmental knee replacement. J Bone Jt Surg Br 84(3):351–355CrossRef
14.
go back to reference Scott RD, Cobb AG, McQueary FG, Thornhill TS (1991) Unicompartmental knee arthroplasty. Eight- to 12-year follow-up evaluation with survivorship analysis. Clin Orthop Relat Res 271:96–100 Scott RD, Cobb AG, McQueary FG, Thornhill TS (1991) Unicompartmental knee arthroplasty. Eight- to 12-year follow-up evaluation with survivorship analysis. Clin Orthop Relat Res 271:96–100
15.
go back to reference Squire MW, Callaghan JJ, Goetz DD, Sullivan PM, Johnston RC (1999) Unicompartmental knee replacement. A minimum 15 year followup study. Clin Orthop Relat Res 367:61–72CrossRef Squire MW, Callaghan JJ, Goetz DD, Sullivan PM, Johnston RC (1999) Unicompartmental knee replacement. A minimum 15 year followup study. Clin Orthop Relat Res 367:61–72CrossRef
16.
go back to reference Tashiro Y, Matsuda S, Okazaki K, Mizu-Uchi H, Kuwashima U, Iwamoto Y (2014) The coronal alignment after medial unicompartmental knee arthroplasty can be predicted: usefulness of full-length valgus stress radiography for evaluating correctability. Knee Surg Sports Traumatol Arthrosc 22(12):3142–3149CrossRef Tashiro Y, Matsuda S, Okazaki K, Mizu-Uchi H, Kuwashima U, Iwamoto Y (2014) The coronal alignment after medial unicompartmental knee arthroplasty can be predicted: usefulness of full-length valgus stress radiography for evaluating correctability. Knee Surg Sports Traumatol Arthrosc 22(12):3142–3149CrossRef
17.
go back to reference Vasso M, Del Regno C, D’Amelio A, Viggiano D, Corona K, Schiavone Panni A (2015) Minor varus alignment provides better results than neutral alignment in medial UKA. Knee 22(2):117–121CrossRef Vasso M, Del Regno C, D’Amelio A, Viggiano D, Corona K, Schiavone Panni A (2015) Minor varus alignment provides better results than neutral alignment in medial UKA. Knee 22(2):117–121CrossRef
18.
go back to reference Weale AE, Murray DW, Baines J, Newman JH (2000) Radiological changes five years after unicompartmental knee replacement. J Bone Jt Surg Br 82(7):996–1000CrossRef Weale AE, Murray DW, Baines J, Newman JH (2000) Radiological changes five years after unicompartmental knee replacement. J Bone Jt Surg Br 82(7):996–1000CrossRef
19.
go back to reference Weber P, Schroder C, Laubender RP, Baur-Melnyk A, von Schulze Pellengahr C, Jansson V et al (2013) Joint line reconstruction in medial unicompartmental knee arthroplasty: development and validation of a measurement method. Knee Surg Sports Traumatol Arthrosc 21(11):2468–2473CrossRef Weber P, Schroder C, Laubender RP, Baur-Melnyk A, von Schulze Pellengahr C, Jansson V et al (2013) Joint line reconstruction in medial unicompartmental knee arthroplasty: development and validation of a measurement method. Knee Surg Sports Traumatol Arthrosc 21(11):2468–2473CrossRef
20.
go back to reference Wen PF, Guo WS, Gao FQ, Zhang QD, Yue JA, Cheng LM et al (2017) Effects of lower limb alignment and tibial component inclination on the biomechanics of lateral compartment in unicompartmental knee arthroplasty. Chin Med J (Engl) 130(21):2563–2568CrossRef Wen PF, Guo WS, Gao FQ, Zhang QD, Yue JA, Cheng LM et al (2017) Effects of lower limb alignment and tibial component inclination on the biomechanics of lateral compartment in unicompartmental knee arthroplasty. Chin Med J (Engl) 130(21):2563–2568CrossRef
Metadata
Title
Medial joint line elevation of the tibia measured during surgery has a significant correlation with the limb alignment changes following medial unicompartmental knee arthroplasty
Authors
Yuichi Kuroda
Koji Takayama
Kazunari Ishida
Shinya Hayashi
Shingo Hashimoto
Masanori Tsubosaka
Takehiko Matsushita
Takahiro Niikura
Kotaro Nishida
Ryosuke Kuroda
Tomoyuki Matsumoto
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/s00167-018-4935-1

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