The Prevalence of Posterolateral Tibial Baseplate Overhang: An Anatomical CT Study

Overview

Journal J Orthop

Specialty Orthopedics

Date 2021 Mar 8

PMID 33679017

Citations 4

Authors

Sanar S Yokhana

D Alex Hamilton

Sasha A Stine

Lauren N Stimson

Abdul K Zalikha

Chaoyang Chen

Hussein F Darwiche

Affiliations

Soon will be listed here.

Abstract

Introduction: Total Knee Arthroplasty (TKA) is used in patients with osteoarthritis who have failed conservative management to reduce pain, improve functional outcomes and ultimately quality of life. However, less than optimal patient satisfaction has led to continued improvements in design and technology of TKA. One factor that can limit patient satisfaction is postero-lateral overhang of the tibial baseplate. The purpose of our study is to utilize pre-operative CT scans to assess the prevalence of posterolateral tibial overhang with the use of a symmetric tibial baseplate component in a popular knee system with robotic assistance.

Methods: Ninety-eight (98) consecutive patients who underwent robotic-assisted total knee arthroplasty (TKA) were included in this study. Using both the most medial aspect of the tibial tubercle and the medial ⅓ of the tibial tubercle as reference points, we quantified the extent of posterolateral overhang when determining the rotation of the tibial component.

Results: Using the most medial aspect of the tibial tubercle as a reference point for rotation of the tibial baseplate, 63% of the instances of reviewed CT scans (369/588) had posterolateral overhang. Furthermore, 81% (406/588) had posterolateral overhang when using the medial ⅓ aspect of the tibial tubercle as the reference for rotation of the tibial baseplate. The average posterolateral tibial baseplate overhang was 1.5 mm (range 0-8 mm) when using the most medial aspect of the tibial tubercle and 2.4 mm (range 0-8 mm) when using the medial ⅓ tibial tubercle as the centering point for the tibial baseplate.

Discussion: Tibial baseplate overhang could lead to potential pain from irritation of soft tissues. To our knowledge, this is the first study that was able to valencquantify the amount of tibial baseplate overhang using pre-operative CT scans. Rotational alignment of the tibial baseplate needs to be balanced to ensure minimal lateral overhang while achieving sufficient external rotation of the tibial component. An asymmetric tibial component may provide a compromise in certain situations.

Level Of Evidence: Diagnostic level IV case series.

Citing Articles

Symmetric versus asymmetric tibial components: A systematic review of comparative studies.

Haddad B, Tarazi A, Alzoubi R, Alqawasmi M, Ammar A, Kalare Z J Orthop Surg Res. 2024; 19(1):756.

PMID: 39543656 PMC: 11562716. DOI: 10.1186/s13018-024-05256-z.

Comparison of the coverage and rotation of asymmetrical and symmetrical tibial components: a systematic review and meta-analysis.

Zhang Z, Zhang T, Zhang L, Chen Z, Zhao H, Kuang J BMC Musculoskelet Disord. 2024; 25(1):336.

PMID: 38671454 PMC: 11046884. DOI: 10.1186/s12891-024-07466-2.

Favorable outcomes of posterior cruciate-stabilized inserts over ultracongruent inserts in total knee arthroplasty.

Obana K, Wong K, Shimoda B, Rimm J, Stickley C, Nakasone C Arch Orthop Trauma Surg. 2023; 143(9):5857-5865.

PMID: 36928502 DOI: 10.1007/s00402-023-04837-7.

Preliminary Study on Immediate Postoperative CT Images and Values of the Modular Polyetheretherketone Based Total Knee Arthroplasty: An Observational First-in-Human Trial.

Cai Z, Qu X, Zhao Y, Yuan Z, Zheng L, Long T Front Surg. 2022; 9:809699.

PMID: 35237649 PMC: 8882580. DOI: 10.3389/fsurg.2022.809699.

References

Innocenti B, Truyens E, Labey L, Wong P, Victor J, Bellemans J . Can medio-lateral baseplate position and load sharing induce asymptomatic local bone resorption of the proximal tibia? A finite element study. J Orthop Surg Res. 2009; 4:26. PMC: 2718929. DOI: 10.1186/1749-799X-4-26. View

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

Bourne R, Chesworth B, Davis A, Mahomed N, Charron K . Patient satisfaction after total knee arthroplasty: who is satisfied and who is not?. Clin Orthop Relat Res. 2009; 468(1):57-63. PMC: 2795819. DOI: 10.1007/s11999-009-1119-9. View

Gunaratne R, Pratt D, Banda J, Fick D, Khan R, Robertson B . Patient Dissatisfaction Following Total Knee Arthroplasty: A Systematic Review of the Literature. J Arthroplasty. 2017; 32(12):3854-3860. DOI: 10.1016/j.arth.2017.07.021. View

Bonnin M, Saffarini M, Shepherd D, Bossard N, Dantony E . Oversizing the tibial component in TKAs: incidence, consequences and risk factors. Knee Surg Sports Traumatol Arthrosc. 2015; 24(8):2532-40. DOI: 10.1007/s00167-015-3512-0. View

Graw B, Harris A, Tripuraneni K, Giori N . Rotational references for total knee arthroplasty tibial components change with level of resection. Clin Orthop Relat Res. 2010; 468(10):2734-8. PMC: 3049615. DOI: 10.1007/s11999-010-1330-8. View

Price A, Alvand A, Troelsen A, Katz J, Hooper G, Gray A . Knee replacement. Lancet. 2018; 392(10158):1672-1682. DOI: 10.1016/S0140-6736(18)32344-4. View

Cho K, Seon J, Jang W, Park C, Song E . Robotic versus conventional primary total knee arthroplasty: clinical and radiological long-term results with a minimum follow-up of ten years. Int Orthop. 2018; 43(6):1345-1354. DOI: 10.1007/s00264-018-4231-1. View

Eckhoff D, Jacofsky D, Springer B, Dunbar M, Cherian J, Elmallah R . Bilateral Symmetrical Comparison of Femoral and Tibial Anatomic Features. J Arthroplasty. 2016; 31(5):1083-90. DOI: 10.1016/j.arth.2015.11.021. View

10.

Seil R, Pape D . Causes of failure and etiology of painful primary total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc. 2011; 19(9):1418-32. DOI: 10.1007/s00167-011-1631-9. View

11.

Abraham R, Malkani A, Lewis J, Beck D . An anatomical study of tibial metaphyseal/diaphyseal mismatch during revision total knee arthroplasty. J Arthroplasty. 2007; 22(2):241-4. DOI: 10.1016/j.arth.2006.06.001. View

12.

Kang K, Son J, Kwon O, Koh Y . Malpositioning of Prosthesis: Patient-specific Total Knee Arthroplasty Versus Standard Off-the-Shelf Total Knee Arthroplasty. J Am Acad Orthop Surg Glob Res Rev. 2018; 1(4):e020. PMC: 6132303. DOI: 10.5435/JAAOSGlobal-D-17-00020. View

13.

Barrett W . The need for gender-specific prostheses in TKA: does size make a difference?. Orthopedics. 2006; 29(9 Suppl):S53-5. View

14.

Lim H, Song E, Seon J, Park K, Shin Y, Yang H . Causes of Aseptic Persistent Pain after Total Knee Arthroplasty. Clin Orthop Surg. 2017; 9(1):50-56. PMC: 5334027. DOI: 10.4055/cios.2017.9.1.50. View

15.

de Boer J, Blankevoort L, Kingma I, Vorster W . In vitro study of inter-individual variation in posterior slope in the knee joint. Clin Biomech (Bristol). 2009; 24(6):488-92. DOI: 10.1016/j.clinbiomech.2009.03.008. View

16.

Tang Q, Zhou Y, Yang D, Xu H, Liu Q . The offset of the tibial shaft from the tibial plateau in Chinese people. J Bone Joint Surg Am. 2010; 92(10):1981-7. DOI: 10.2106/JBJS.I.00969. View

17.

Simsek M, Akkaya M, Gursoy S, Isik C, Zahar A, Tarabichi S . Posterolateral overhang affects patient quality of life after total knee arthroplasty. Arch Orthop Trauma Surg. 2017; 138(3):409-418. DOI: 10.1007/s00402-017-2850-4. View

18.

Hitt K, Shurman 2nd J, Greene K, McCarthy J, Moskal J, Hoeman T . Anthropometric measurements of the human knee: correlation to the sizing of current knee arthroplasty systems. J Bone Joint Surg Am. 2003; 85-A Suppl 4:115-22. View

19.

Scott C, Oliver W, MacDonald D, Wade F, Moran M, Breusch S . Predicting dissatisfaction following total knee arthroplasty in patients under 55 years of age. Bone Joint J. 2016; 98-B(12):1625-1634. DOI: 10.1302/0301-620X.98B12.BJJ-2016-0375.R1. View

20.

Steinbruck A, Schroder C, Woiczinski M, Muller T, Muller P, Jansson V . Influence of tibial rotation in total knee arthroplasty on knee kinematics and retropatellar pressure: an in vitro study. Knee Surg Sports Traumatol Arthrosc. 2015; 24(8):2395-401. DOI: 10.1007/s00167-015-3503-1. View