Accuracy of Tibial Positioning in the Frontal Plane: a Prospective Study Comparing Conventional and Innovative Techniques in Total Knee Arthroplasty

Overview

Journal Arch Orthop Trauma Surg

Specialties Emergency Medicine
General Surgery
Orthopedics

Date 2020 Mar 4

PMID 32124032

Citations 9

Authors

R K Zahn

F Graef

J L Conrad

L Renner

C Perka

H Hommel

Affiliations

Soon will be listed here.

Abstract

Background: Coronal alignment of the tibial component determines functional outcome and survival in total knee arthroplasty (TKA). Innovative techniques for tibial instrumentation have been developed to improve accuracy and reduce the rate of outliers.

Methods: In a prospective study, 300 patients were allocated to four different groups using a randomization process (two innovative and two conventional) techniques of tibial instrumentation (conventional: extramedullary, intramedullary; innovative: navigation and patient-specific instrumentation (PSI); n = 75 for each group). The aims were to reconstruct the medial proximal tibial angle (MPTA) to 90° and the mechanical tibio-femoral axis (mTFA) to 0°. Both angles were evaluated and compared between all groups three months after the surgery. Patients who presented with a postoperative mTFA > 3° were classified as outliers.

Results: The navigation and intramedullary technique both demonstrated that they were significantly more precise in reconstructing a neutral mTFA and MPTA compared to the other two techniques. The odd's ratio (OR) for producing outliers was highest for the PSI method (PSI OR = 5.5, p < 0.05; extramedullary positioning OR = 3.7, p > 0.05; intramedullary positioning OR = 1.7, p > 0.05; navigation OR = 0.04, p < 0.05). We could only observe significant differences between pre- and postoperative MPTA in the navigation and intramedullary group. The MPTA showed a significant negative correlation with the mTFA in all groups preoperatively and in the extramedullary, intramedullary and PSI postoperatively.

Conclusion: The navigation and intramedullary instrumentation provided the precise positioning of the tibial component. Outliers were most common within the PSI and extramedullary technique. Optimal alignment is dependent on the technique of tibial instrumentation and tibial component positioning determines the accuracy in TKA since mTFA correlated with MPTA pre- and postoperatively.

Citing Articles

The Alignment of the Tibial Component in Total Knee Arthroplasty: Is a Technology-Assisted System Better Than Conventional Instrumentation?.

Hernandez-Vaquero D, Noriega-Fernandez A, Roncero-Gonzalez S Cureus. 2024; 16(2):e54745.

PMID: 38524042 PMC: 10960967. DOI: 10.7759/cureus.54745.

Fostering Excellence in Knee Arthroplasty: Developing Optimal Patient Care Pathways and Inspiring Knowledge Transfer of Advanced Surgical Techniques.

Migliorini F, Feierabend M, Hofmann U J Healthc Leadersh. 2023; 15:327-338.

PMID: 38020721 PMC: 10676205. DOI: 10.2147/JHL.S383916.

Customized-individually-made origin® implants in total knee arthroplasty allow a reliable solution for accurate reproduction of planned implant positioning.

Sajan M, Moussa M, Lefevre N, Payan C, Valentin E, Meyer A J Exp Orthop. 2023; 10(1):123.

PMID: 38015319 PMC: 10684845. DOI: 10.1186/s40634-023-00706-9.

Comparison of clinical outcomes of VISIONAIRE patient-specific instrumentation with conventional instrumentation in total knee arthroplasty: a systematic literature review and meta-analysis.

Tibesku C, Haas S, Saunders C, Harwood D Arch Orthop Trauma Surg. 2022; 143(7):4379-4393.

PMID: 36449066 PMC: 10293358. DOI: 10.1007/s00402-022-04698-6.

Increasing grades of frontal deformities in knee osteoarthritis are not associated with ligamentous ankle instabilities.

Graef F, Ruhling M, Gwinner C, Hommel H, Tsitsilonis S, Perka C Knee Surg Sports Traumatol Arthrosc. 2022; 31(5):1704-1713.

PMID: 35666304 PMC: 10090006. DOI: 10.1007/s00167-022-07021-3.

References

Kim Y, Park J, Kim J, Park S . The relationship between the survival of total knee arthroplasty and postoperative coronal, sagittal and rotational alignment of knee prosthesis. Int Orthop. 2013; 38(2):379-85. PMC: 3923934. DOI: 10.1007/s00264-013-2097-9. View

Li Z, Esposito C, Koch C, Lee Y, Padgett D, Wright T . Polyethylene Damage Increases With Varus Implant Alignment in Posterior-stabilized and Constrained Condylar Knee Arthroplasty. Clin Orthop Relat Res. 2017; 475(12):2981-2991. PMC: 5670063. DOI: 10.1007/s11999-017-5477-4. View

Srivastava A, Lee G, Steklov N, Colwell Jr C, Ezzet K, DLima D . Effect of tibial component varus on wear in total knee arthroplasty. Knee. 2011; 19(5):560-3. DOI: 10.1016/j.knee.2011.11.003. View

Zeng H, Ying X, Chen G, Yang X, Lin D, Li Z . Extramedullary versus intramedullary tibial alignment technique in total knee arthroplasty: A meta-analysis of randomized controlled trials. Clinics (Sao Paulo). 2015; 70(10):714-9. PMC: 4602384. DOI: 10.6061/clinics/2015(10)10. View

Woon J, Zeng I, Calliess T, Windhagen H, Ettinger M, Waterson H . Outcome of kinematic alignment using patient-specific instrumentation versus mechanical alignment in TKA: a meta-analysis and subgroup analysis of randomised trials. Arch Orthop Trauma Surg. 2018; 138(9):1293-1303. DOI: 10.1007/s00402-018-2988-8. View

Hommel H, Perka C . Gap-balancing technique combined with patient-specific instrumentation in TKA. Arch Orthop Trauma Surg. 2015; 135(11):1603-8. DOI: 10.1007/s00402-015-2315-6. View

Tsukeoka T, Lee T, Tsuneizumi Y, Suzuki M . The tibial crest as a practical useful landmark in total knee arthroplasty. Knee. 2012; 21(1):283-9. DOI: 10.1016/j.knee.2012.09.002. View

Weiser L, Ruppel A, Nuchtern J, Sellenschloh K, Zeichen J, Puschel K . Extra- vs. intramedullary treatment of pertrochanteric fractures: a biomechanical in vitro study comparing dynamic hip screw and intramedullary nail. Arch Orthop Trauma Surg. 2015; 135(8):1101-6. DOI: 10.1007/s00402-015-2252-4. View

Gbejuade H, White P, Hassaballa M, Porteous A, Robinson J, Murray J . Do long leg supine CT scanograms correlate with weight-bearing full-length radiographs to measure lower limb coronal alignment?. Knee. 2013; 21(2):549-52. DOI: 10.1016/j.knee.2013.05.009. View

10.

Kannan A, Hawdon G, McMahon S . Effect of flexion and rotation on measures of coronal alignment after TKA. J Knee Surg. 2012; 25(5):407-10. DOI: 10.1055/s-0032-1313756. View

11.

Radtke K, Becher C, Noll Y, Ostermeier S . Effect of limb rotation on radiographic alignment in total knee arthroplasties. Arch Orthop Trauma Surg. 2009; 130(4):451-7. DOI: 10.1007/s00402-009-0999-1. View

12.

Chang C, Choi J, Koh I, Seo E, Seong S, Kim T . What should be considered in using standard knee radiographs to estimate mechanical alignment of the knee?. Osteoarthritis Cartilage. 2010; 18(4):530-8. DOI: 10.1016/j.joca.2009.12.004. View

13.

Sobti A, Maniar S, Chaudhari S, Shetty V . Reliable and reproducible technique to mark center of ankle in total knee arthroplasty. J Clin Orthop Trauma. 2015; 6(2):144-6. PMC: 4411347. DOI: 10.1016/j.jcot.2015.02.001. View

14.

Cashman J, Carty F, Synnott K, Kenny P . Intramedullary versus extramedullary alignment of the tibial component in the Triathlon knee. J Orthop Surg Res. 2011; 6:44. PMC: 3179736. DOI: 10.1186/1749-799X-6-44. View

15.

Feeley I, Hegarty A, Hickey A, Glynn A . Impact of Use of Intramedullary and Extramedullary Guides on Tibial Component Geometry in Total Knee Replacements: A Systematic Review and Meta-Analysis. J Knee Surg. 2015; 29(6):487-96. DOI: 10.1055/s-0035-1566732. View

16.

Rahm S, Camenzind R, Hingsammer A, Lenz C, Bauer D, Farshad M . Postoperative alignment of TKA in patients with severe preoperative varus or valgus deformity: is there a difference between surgical techniques?. BMC Musculoskelet Disord. 2017; 18(1):272. PMC: 5480120. DOI: 10.1186/s12891-017-1628-8. View

17.

Jung W, Seo J, Kim D, Balabadra S, Mandot U, Kumar D . Optimal rotational positioning of tibial component in total knee arthroplasty: determined by linker surgical technique using a high definition CT. Arch Orthop Trauma Surg. 2020; 140(3):401-408. DOI: 10.1007/s00402-020-03340-7. View

18.

Zhu M, Lindsay E, Keenan A, Monk P, Munro J . The use of accelerometer-based navigation for coronal TKA alignment: a prospective, single surgeon comparative study. Arch Orthop Trauma Surg. 2019; 140(9):1169-1174. DOI: 10.1007/s00402-019-03295-4. View

19.

Loh B, Chen J, Yew A, Pang H, Tay D, Chia S . The accuracy of a hand-held navigation system in total knee arthroplasty. Arch Orthop Trauma Surg. 2017; 137(3):381-386. DOI: 10.1007/s00402-016-2612-8. View

20.

Kim Y, Park J, Kim J . 2017 Chitranjan S. Ranawat Award: Does Computer Navigation in Knee Arthroplasty Improve Functional Outcomes in Young Patients? A Randomized Study. Clin Orthop Relat Res. 2018; 476(1):6-15. PMC: 5919243. DOI: 10.1007/s11999.0000000000000000. View