Top

Archives of Orthopaedic and Trauma Surgery

Published in:

01-03-2020 | Knee Arthroplasty

The entry point of intramedullary tibia cutting guide should vary according to the individual tibia morphology in TKA

Authors: Sung-Mok Oh, Seong-Il Bin, Bum-Sik Lee, Jong-Min Kim

Published in: Archives of Orthopaedic and Trauma Surgery | Issue 3/2020

Abstract

Introduction

In total knee arthroplasty (TKA) using the intramedullary tibial cutting guide (IMTCG), the positioning of the IMTCG is important for accurate tibial bone resection. The aim of this study was to evaluate the ideal entry point of IMTCG and affecting radiologic factors.

Materials and methods

From May 2017 to February 2018, 91 consecutive TKAs for osteoarthritis were included. From preoperative full-length radiographs, we measured the medial proximal tibia angle (MPTA), lateral distal tibia angle (LDTA), tibial bowing angle (TBA), medial to lateral width of the tibial plateau, tibial length, and ideal coronal entry point. In preoperative short knee lateral radiographs, we measured the anterior to posterior length of the tibial plateau, tibial posterior slope angle (TPSA), metaphysio-diaphyseal angle (MDA), and ideal sagittal entry point. The ideal coronal and sagittal entry points were defined as the points crossing the tibial plateau and tibial anatomical axis on the coronal and sagittal radiographs, respectively.

Results

The ideal entry point was 51.4 ± 4.3% (SD) from the medial margin and 27.0 ± 5.8% (SD) from the anterior margin of the tibial plateau. However, the range varied from 39.8 to 60.5% on the coronal plane and from 9.6 to 37.7% on the sagittal plane, respectively. As the MPTA (rho = − 0.490) and TBA (rho = − 0.433) were increased, the coronal entry point moved medially. As TPSA (rho = − 0.761) and MDA (rho = − 0.495) were increased, the sagittal entry point moved anteriorly.

Conclusions

The ideal entry point of IMTCG should vary according to the individual tibial morphology.

Antony J, Tetsworth K, Hohmann E (2017) Influence of sagittal plane component alignment on kinematics after total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 25:1686–1691. https://doi.org/10.1007/s00167-016-4098-x CrossRefPubMed

Bellemans J, Robijns F, Duerinckx J, Banks S, Vandenneucker H (2005) The influence of tibial slope on maximal flexion after total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 13:193–196. https://doi.org/10.1007/s00167-004-0557-x CrossRefPubMed

Ritter MA, Davis KE, Meding JB, Pierson JL, Berend ME, Malinzak RA (2011) The effect of alignment and BMI on failure of total knee replacement. J Bone Joint Surg Am 93:1588–1596. https://doi.org/10.2106/JBJS.J.00772 CrossRefPubMed

Kim YH, Park JW, Kim JS, Park SD (2014) The relationship between the survival of total knee arthroplasty and postoperative coronal, sagittal and rotational alignment of knee prosthesis. Int Orthop 38:379–385. https://doi.org/10.1007/s00264-013-2097-9 CrossRefPubMed

Gromov K, Korchi M, Thomsen MG, Husted H, Troelsen A (2014) What is the optimal alignment of the tibial and femoral components in knee arthroplasty? Acta Orthop 85:480–487. https://doi.org/10.3109/17453674.2014.940573 CrossRefPubMedPubMedCentral

Tsukeoka T, Tsuneizumi Y, Lee TH (2014) Accuracy of the second metatarsal as a landmark for the extramedullary tibial cutting guide in total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 22:2969–2974. https://doi.org/10.1007/s00167-014-3254-4 CrossRefPubMed

Mizu-uchi H, Matsuda S, Miura H, Higaki H, Okazaki K, Iwamoto Y (2006) The effect of ankle rotation on cutting of the tibia in total knee arthroplasty. J Bone Joint Surg Am 88:2632–2636. https://doi.org/10.2106/JBJS.E.01288 CrossRefPubMed

Kuroda Y, Ishida K, Matsumoto T, Sasaki H, Matsuzaki T, Oka S, Takayama K, Tei K, Matsushita T, Tsumura N, Kuroda R, Kurosaka M (2015) Fibular axes are not a reliable landmark for tibial mechanical axes of osteoarthritic knees that underwent total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 23:3362–3367. https://doi.org/10.1007/s00167-014-3170-7 CrossRefPubMed

Laskin RS (2003) Instrumentation pitfalls: you just can't go on autopilot! J Arthroplasty 18:18–22. https://doi.org/10.1054/arth.2003.50066 CrossRefPubMed

10.

Tsukeoka T, Lee TH, Tsuneizumi Y, Suzuki M (2014) The tibial crest as a practical useful landmark in total knee arthroplasty. Knee 21:283–289. https://doi.org/10.1016/j.knee.2012.09.002 CrossRefPubMed

11.

Reed MR, Bliss W, Sher JL, Emmerson KP, Jones SM, Partington PF (2002) Extramedullary or intramedullary tibial alignment guides: a randomised, prospective trial of radiological alignment. J Bone Joint Surg Br 84:858–860CrossRef

12.

Abraham R, Malkani AL, Lewis J, Beck D (2007) An anatomical study of tibial metaphyseal/diaphyseal mismatch during revision total knee arthroplasty. J Arthroplasty 22:241–244. https://doi.org/10.1016/j.arth.2006.06.001 CrossRefPubMed

13.

Bono JV, Roger DJ, Laskin RS, Peterson MG, Paulsen CA (1995) Tibial intramedullary alignment in total knee arthroplasty. Am J Knee Surg 8:7–11 (discussion 11–12)

14.

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 18:1334–1338. https://doi.org/10.1007/s00167-010-1152-y CrossRefPubMed

15.

Maestro A, Harwin SF, Sandoval MG, Vaquero DH, Murcia A (1998) Influence of intramedullary versus extramedullary alignment guides on final total knee arthroplasty component position: a radiographic analysis. J Arthroplast 13:552–558CrossRef

16.

Chang CB, Choi JY, Koh IJ, Seo ES, Seong SC, Kim TK (2010) What should be considered in using standard knee radiographs to estimate mechanical alignment of the knee? Osteoarth Cartil 18:530–538. https://doi.org/10.1016/j.joca.2009.12.004 CrossRef

17.

Yau WP, Chiu KY, Tang WM, Ng TP (2007) Coronal bowing of the femur and tibia in Chinese: its incidence and effects on total knee arthroplasty planning. J Orthop Surg (Hong Kong) 15:32–36. https://doi.org/10.1177/230949900701500108 CrossRef

18.

Chiu KY, Zhang SD, Zhang GH (2000) Posterior slope of tibial plateau in Chinese. J Arthroplasty 15:224–227CrossRef

19.

Matsuda S, Miura H, Nagamine R, Urabe K, Ikenoue T, Okazaki K, Iwamoto Y (1999) Posterior tibial slope in the normal and varus knee. Am J Knee Surg 12:165–168PubMed

20.

Meric G, Gracitelli GC, Aram L, Swank M, Bugbee WD (2015) Tibial slope is highly variable in patients undergoing primary total knee arthroplasty: analysis of 13,546 computed tomography scans. J Arthroplast 30:1228–1232. https://doi.org/10.1016/j.arth.2015.02.012 CrossRef

21.

Mohanty SS, Rao NN, Dash KK, Bhosale SK (2013) Correlation of posterior tibial slope with metaphysio-diaphyseal angle in total knee arthroplasty: a radiological study. Indian J Orthop 47:67–71. https://doi.org/10.4103/0019-5413.106910 CrossRefPubMedPubMedCentral

22.

Perka N, Kopf S, Hommel H (2019) A whole leg radiograph is not necessary for postoperative determination of the mechanical leg axis after total knee arthroplasty. Arch Orthop Trauma Surg 139:1455–1460. https://doi.org/10.1007/s00402-019-03256-x CrossRefPubMed

23.

Singh AK, Nedopil AJ, Howell SM, Hull ML (2018) Does alignment of the limb and tibial width determine relative narrowing between compartments when planning mechanically aligned TKA? Arch Orthop Trauma Surg 138:91–97. https://doi.org/10.1007/s00402-017-2824-6 CrossRefPubMed

24.

Thienpont E, Schwab PE, Cornu O, Bellemans J, Victor J (2017) Bone morphotypes of the varus and valgus knee. Arch Orthop Trauma Surg 137:393–400. https://doi.org/10.1007/s00402-017-2626-x CrossRefPubMed

25.

Paley D, Herzenberg JE, Tetsworth K, McKie J, Bhave A (1994) Deformity planning for frontal and sagittal plane corrective osteotomies. Orthop Clin North Am 25:425–465PubMed

26.

Kobayashi H, Akamatsu Y, Kumagai K, Kusayama Y, Aratake M, Saito T (2017) Influence of coronal bowing on the lower alignment and the positioning of component in navigation and conventional total knee arthroplasty. Orthop Traumatol Surg Res 103:251–256. https://doi.org/10.1016/j.otsr.2016.11.017 CrossRefPubMed

27.

Utzschneider S, Goettinger M, Weber P, Horng A, Glaser C, Jansson V, Muller PE (2011) Development and validation of a new method for the radiologic measurement of the tibial slope. Knee Surg Sports Traumatol Arthrosc 19:1643–1648. https://doi.org/10.1007/s00167-011-1414-3 CrossRefPubMed

28.

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 Arthroplasty 23:586–592. https://doi.org/10.1016/j.arth.2007.05.006 CrossRefPubMed

29.

Lee BS, Cho HI, Bin SI, Kim JM, Jo BK (2018) Femoral component varus malposition is associated with tibial aseptic loosening after TKA. Clin Orthop Relat Res 476:400–407. https://doi.org/10.1007/s11999.0000000000000012 CrossRefPubMedPubMedCentral

30.

Brys DA, Lombardi AV, Jr., Mallory TH, Vaughn BK (1991) A comparison of intramedullary and extramedullary alignment systems for tibial component placement in total knee arthroplasty. Clin Orthop Relat Res 175–179

31.

Cashman JP, Carty FL, Synnott K, Kenny PJ (2011) Intramedullary versus extramedullary alignment of the tibial component in the Triathlon knee. J Orthop Surg Res 6:44. https://doi.org/10.1186/1749-799X-6-44 CrossRefPubMedPubMedCentral

32.

Chin PL, Yang KY, Yeo SJ, Lo NN (2005) Randomized control trial comparing radiographic total knee arthroplasty implant placement using computer navigation versus conventional technique. J Arthroplast 20:618–626. https://doi.org/10.1016/j.arth.2005.04.004 CrossRef

33.

da Rocha Moreira Rezende B, Fuchs T, Nishi RN, Hatem MA, da Silva LM, Fuchs R, de Alencar PG (2015) Alignment of the tibial component in total knee arthroplasty procedures using an intramedullary or extramedullary guide: double-blind randomized prospective study. Rev Bras Ortop 50:168–173. https://doi.org/10.1016/j.rboe.2015.02.013

34.

Teter KE, Bregman D, Colwell CW, Jr. (1995) Accuracy of intramedullary versus extramedullary tibial alignment cutting systems in total knee arthroplasty. Clin Orthop Relat Res 106–110

Title: The entry point of intramedullary tibia cutting guide should vary according to the individual tibia morphology in TKA
Authors: Sung-Mok Oh
Seong-Il Bin
Bum-Sik Lee
Jong-Min Kim
Publication date: 01-03-2020
Publisher: Springer Berlin Heidelberg
Published in: Archives of Orthopaedic and Trauma Surgery / Issue 3/2020
Print ISSN: 0936-8051
Electronic ISSN: 1434-3916
DOI: https://doi.org/10.1007/s00402-019-03324-2

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

The entry point of intramedullary tibia cutting guide should vary according to the individual tibia morphology in TKA

Abstract

Introduction

Materials and methods

Results

Conclusions

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Introduction

Materials and methods

Results

Conclusions

Please log in to get access to this content

Other articles of this Issue 3/2020

Inducing life-like distal radius fractures in human cadaveric specimens: a tool for enhanced surgical training

Low-profile locking-plate vs. the conventional AO system: early comparative results in wrist arthrodesis

Correction to: Ex situ reconstruction of comminuted radial head fractures: is it truly worth a try?

Optimal rotational positioning of tibial component in total knee arthroplasty: determined by linker surgical technique using a high definition CT

Second-look arthroscopic findings and clinical outcomes of meniscal repair with concomitant anterior cruciate ligament reconstruction: comparison of suture and meniscus fixation device

Corrective osteotomies of femur and tibia: which factors influence bone healing?