Skip to main content
Top
Published in: Surgical and Radiologic Anatomy 3/2013

01-04-2013 | Original Article

Effect of medial tibial torsion on the sagittal alignment of lower legs in patients with medial knee osteoarthritis

Authors: Atsushi Takahashi, Toshimi Aizawa, Takashi Aki, Mitsuhiro Kashiwaba, Masayuki Kamimura, Shin Hitachi, Eiji Itoi

Published in: Surgical and Radiologic Anatomy | Issue 3/2013

Login to get access

Abstract

Purpose

The fibular axis (FA) and anterior tibial cortex (ATC) are good determinants of the sagittal mechanical axis (MA) of lower legs during total knee arthroplasty (TKA).When compared with healthy subjects, a significant medial tibial torsion has been reported in patients with medial knee osteoarthritis; this should affect the alignment of lower legs. The purpose of this study was to clarify the effect of the medial torsion on relationship between sagittal MA and intraoperative references (FA and ATC).

Methods

Fifty knees of 50 patients with medial knee osteoarthritis who underwent primary TKA were included in this study. Using preoperative computed tomographic data, the tibial torsion angle was measured in the axial plane. The angle between FA and MA, and the angle between ATC and MA were also measured in the sagittal plane.

Results

The tibial torsion angle was 7.9° ± 7.2° (range −11.3° to −24.3°). The angle between MA and FA was −1.8° ± 0.8° (range −0.1° to −4.3°), and the angle between MA and ATC was 4.6° ± 0.5° (range 3.1° to 5.5°). The population variance was significantly larger for the angle between MA and FA than that between MA and ATC (P = 0.0160). There was a significant positive correlation between the tibial torsion angle and the angle between MA and FA (R 2 = 0.5111, P < 0.0001).

Conclusion

The angle between FA and MA in the sagittal plane increased in patients with large medial tibial torsion.
Literature
1.
go back to reference Akagi M, Mori S, Nishimura S, Nishimura A, Asano T, Hamanishi C (2005) Variability of extraarticular tibial rotation references for total knee arthroplasty. Clin Orthop Relat Res 436:172–176PubMedCrossRef Akagi M, Mori S, Nishimura S, Nishimura A, Asano T, Hamanishi C (2005) Variability of extraarticular tibial rotation references for total knee arthroplasty. Clin Orthop Relat Res 436:172–176PubMedCrossRef
2.
go back to reference Akagi M, Oh M, Nonaka T, Tsujimoto H, Asano T, Hamanishi C (2004) An anteroposterior axis of the tibia for total knee arthroplasty. Clin Orthop Relat Res 420:213–219PubMedCrossRef Akagi M, Oh M, Nonaka T, Tsujimoto H, Asano T, Hamanishi C (2004) An anteroposterior axis of the tibia for total knee arthroplasty. Clin Orthop Relat Res 420:213–219PubMedCrossRef
3.
go back to reference Chauhan SK, Clark GW, Lloyd S, Scott RG, Breidahl W, Sikorski JM (2004) Computer-assisted total knee replacement. A controlled cadaver study using a multi-parameter quantitative CT assessment of alignment (the Perth CT Protocol). J Bone Joint Surg Br 86:818–823PubMedCrossRef Chauhan SK, Clark GW, Lloyd S, Scott RG, Breidahl W, Sikorski JM (2004) Computer-assisted total knee replacement. A controlled cadaver study using a multi-parameter quantitative CT assessment of alignment (the Perth CT Protocol). J Bone Joint Surg Br 86:818–823PubMedCrossRef
4.
go back to reference Han HS, Chang CB, Seong SC, Lee S, Lee MC (2008) Evaluation of anatomic references for tibial sagittal alignment in total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 16:373–377PubMedCrossRef Han HS, Chang CB, Seong SC, Lee S, Lee MC (2008) Evaluation of anatomic references for tibial sagittal alignment in total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 16:373–377PubMedCrossRef
5.
go back to reference Han HS, Kang SB, Jo CH, Kim SH, Lee JH (2010) The accuracy of intramedullary tibial guide of sagittal alignment of PCL-substituting total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 18(10):1334–1338PubMedCrossRef Han HS, Kang SB, Jo CH, Kim SH, Lee JH (2010) The accuracy of intramedullary tibial guide of sagittal alignment of PCL-substituting total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 18(10):1334–1338PubMedCrossRef
6.
go back to reference Jojima H, Whiteside LA, Ogata K (2004) Effect of tibial slope or posterior cruciate ligament release on knee kinematics. Clin Orthop Relat Res 426:194–198PubMedCrossRef Jojima H, Whiteside LA, Ogata K (2004) Effect of tibial slope or posterior cruciate ligament release on knee kinematics. Clin Orthop Relat Res 426:194–198PubMedCrossRef
7.
go back to reference Kansara D, Markel DC (2006) The effect of posterior tibial slope on range of motion after total knee arthroplasty. J Arthroplast 21:809–813CrossRef Kansara D, Markel DC (2006) The effect of posterior tibial slope on range of motion after total knee arthroplasty. J Arthroplast 21:809–813CrossRef
8.
go back to reference Kellgren JK, Lawrenc JS (1957) Radiological assessment of osteoarthritis. Ann Rheum Dis 16:494–501PubMedCrossRef Kellgren JK, Lawrenc JS (1957) Radiological assessment of osteoarthritis. Ann Rheum Dis 16:494–501PubMedCrossRef
9.
go back to reference Lombardi AV Jr, Berend KR, Aziz-Jacobo J, Davis MB (2008) Balancing the flexion gap: relationship between tibial slope and posterior cruciate ligament release and correlation with range of motion. J Bone Joint Surg Am 90(Suppl 4):121–132PubMedCrossRef Lombardi AV Jr, Berend KR, Aziz-Jacobo J, Davis MB (2008) Balancing the flexion gap: relationship between tibial slope and posterior cruciate ligament release and correlation with range of motion. J Bone Joint Surg Am 90(Suppl 4):121–132PubMedCrossRef
10.
go back to reference Longstaff LM, Sloan K, Stamp N, Scaddan M, Beaver R (2009) Good alignment after total knee arthroplasty leads to faster rehabilitation and better function. J Arthroplast 24:570–578CrossRef Longstaff LM, Sloan K, Stamp N, Scaddan M, Beaver R (2009) Good alignment after total knee arthroplasty leads to faster rehabilitation and better function. J Arthroplast 24:570–578CrossRef
11.
go back to reference Malviya A, Lingard EA, Weir DJ, Deehan DJ (2009) Predicting range of movement after knee replacement: the importance of posterior condylar offset and tibial slope. Knee Surg Sports Traumatol Arthrosc 17:491–498PubMedCrossRef Malviya A, Lingard EA, Weir DJ, Deehan DJ (2009) Predicting range of movement after knee replacement: the importance of posterior condylar offset and tibial slope. Knee Surg Sports Traumatol Arthrosc 17:491–498PubMedCrossRef
12.
go back to reference Matziolis G, Krocker D, Weiss U, Tohtz S, Perka C (2007) A prospective, randomized study of computer-assisted and conventional total knee arthroplasty. Three-dimensional evaluation of implant alignment and rotation. J Bone Joint Surg Am 89:236–243PubMedCrossRef Matziolis G, Krocker D, Weiss U, Tohtz S, Perka C (2007) A prospective, randomized study of computer-assisted and conventional total knee arthroplasty. Three-dimensional evaluation of implant alignment and rotation. J Bone Joint Surg Am 89:236–243PubMedCrossRef
13.
go back to reference Nagamine R, Miyanishi K, Miura H, Urabe K, Matsuda S, Iwamoto Y (2003) Medial torsion of the tibia in Japanese patients with osteoarthritis of the knee. Clin Orthop Relat Res 408:218–224PubMedCrossRef Nagamine R, Miyanishi K, Miura H, Urabe K, Matsuda S, Iwamoto Y (2003) Medial torsion of the tibia in Japanese patients with osteoarthritis of the knee. Clin Orthop Relat Res 408:218–224PubMedCrossRef
14.
go back to reference Puloski SK, McCalden RW, MacDonald SJ, Rorabeck CH, Bourne RB (2001) Tibial post wear in posterior stabilized total knee arthroplasty. An unrecognized source of polyethylene debris. J Bone Joint Surg Am 83-A:390–397PubMed Puloski SK, McCalden RW, MacDonald SJ, Rorabeck CH, Bourne RB (2001) Tibial post wear in posterior stabilized total knee arthroplasty. An unrecognized source of polyethylene debris. J Bone Joint Surg Am 83-A:390–397PubMed
15.
go back to reference Sikorski JM (2008) Alignment in total knee replacement. J Bone Joint Surg Br 90:1121–1127PubMed Sikorski JM (2008) Alignment in total knee replacement. J Bone Joint Surg Br 90:1121–1127PubMed
16.
go back to reference Tamari K, Briffa NK, Tinley P, Aoyagi K (2007) Variations in torsion of the lower limb in Japanese and Caucasians with and without knee osteoarthritis. J Rheumatol 34:145–150PubMed Tamari K, Briffa NK, Tinley P, Aoyagi K (2007) Variations in torsion of the lower limb in Japanese and Caucasians with and without knee osteoarthritis. J Rheumatol 34:145–150PubMed
17.
go back to reference Waelchli B, Romero J (2001) Dislocation of the polyethylene inlay due to anterior tibial slope in revision total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 9:296–298PubMedCrossRef Waelchli B, Romero J (2001) Dislocation of the polyethylene inlay due to anterior tibial slope in revision total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 9:296–298PubMedCrossRef
18.
go back to reference Whiteside LA, Amador DD (1988) The effect of posterior tibial slope on knee stability after Ortholoc total knee arthroplasty. J Arthroplast 3(Suppl):S51–S57CrossRef Whiteside LA, Amador DD (1988) The effect of posterior tibial slope on knee stability after Ortholoc total knee arthroplasty. J Arthroplast 3(Suppl):S51–S57CrossRef
19.
go back to reference Yagi T (1994) Tibial torsion in patients with medial-type osteoarthritic knees. Clin Orthop Relat Res 302:52–56PubMed Yagi T (1994) Tibial torsion in patients with medial-type osteoarthritic knees. Clin Orthop Relat Res 302:52–56PubMed
20.
go back to reference Yoo JH, Chang CB, Shin KS, Seong SC, Kim TK (2008) Anatomical references to assess the posterior tibial slope in total knee arthroplasty: a comparison of 5 anatomical axes. J Arthroplast 23:586–592CrossRef Yoo JH, Chang CB, Shin KS, Seong SC, Kim TK (2008) Anatomical references to assess the posterior tibial slope in total knee arthroplasty: a comparison of 5 anatomical axes. J Arthroplast 23:586–592CrossRef
21.
go back to reference Yoshioka Y, Siu DW, Scudamore RA, Cooke TD (1989) Tibial anatomy and functional axes. J Orthop Res 7:132–137PubMedCrossRef Yoshioka Y, Siu DW, Scudamore RA, Cooke TD (1989) Tibial anatomy and functional axes. J Orthop Res 7:132–137PubMedCrossRef
Metadata
Title
Effect of medial tibial torsion on the sagittal alignment of lower legs in patients with medial knee osteoarthritis
Authors
Atsushi Takahashi
Toshimi Aizawa
Takashi Aki
Mitsuhiro Kashiwaba
Masayuki Kamimura
Shin Hitachi
Eiji Itoi
Publication date
01-04-2013
Publisher
Springer-Verlag
Published in
Surgical and Radiologic Anatomy / Issue 3/2013
Print ISSN: 0930-1038
Electronic ISSN: 1279-8517
DOI
https://doi.org/10.1007/s00276-012-1011-2

Other articles of this Issue 3/2013

Surgical and Radiologic Anatomy 3/2013 Go to the issue