Tibial Slope is Highly Variable in Patients Undergoing Primary Total Knee Replacement: Analysis of 13,546 Computed Tomography Scans (original) (raw)
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Antero-posterior axis of tibia in patient undergoing total knee replacement in Indian population
Journal of Clinical Orthopaedics and Trauma, 2017
Introduction: Aim of this CT-based study was to find out a reliable anatomical axis for proper rotational placement of the tibial component during knee replacement surgery in the Indian population. Material and methods: CT scanning was performed pre-operatively on all the 45 patients (13 men, 32 women, total 68 knees) due to undergo knee replacement for osteo-arthritic knees. The tibial anteroposterior (AP) axis is defined as a line drawn perpendicular to the surgical epicondylar femoral axis and passing through the center of posterior cruciate ligament (PCL) attachment. Angles between various anatomic landmarks and the defined tibial AP axis were identified. Results: The mean angle between line connecting the medial border of patellar tendon and centre of PCL and the defined tibial AP axis was 0.06 (À5 to 7; SD 2.65) and was closest to defined AP axis of tibia. This axis remained the closest irrespective of the varying femoro-tibial angle and severity of tibial bowing. Discussion: In our patients, the line connecting the medial border of patellar tendon to the centre of the PCL has been found to be an independent, reliable and reproducible rotational axis for placing the tibial trial and definitivite prosthesis. This is particularly helpful for those surgeons, who prepare the femur earlier than the tibial cut and trial. Conclusion: This tibial AP axis along with other anatomical landmarks is a reliable and reproducible landmark for implanting the tibial prosthesis in a proper rotational alignment in the Indian population.
The High Variability of Tibial Rotational Alignment in Total Knee Arthroplasty
Clinical Orthopaedics and Related Research, 2006
Although various techniques are advocated to establish tibial rotational alignment during total knee arthroplasty, it is unknown which is most repeatable. We evaluated the precision and accuracy of five tibial rotational alignment techniques to determine whether computer-assisted navigation systems can reduce variability of tibial component rotational alignment when compared to traditional instrumentation. Eleven orthopaedic surgeons used four computer-assisted techniques that required identification of anatomical landmarks and one that used traditional extramedullary instrumentation to establish tibial rotational alignment axes on 10 cadaver legs. Two computer-assisted techniques (axes between the most medial and lateral border of the tibial plateau, and between the posterior cruciate ligament [PCL] and the anterior tibial crest) and the traditional technique were least variable, with standard deviations of 9.9°, 10.8°, and 12.1°, respectively. Computer-assisted techniques referencing the tibial tubercle (axes between the PCL and the medial border or medial 1 ⁄3 of the tubercle) were most variable, with standard deviations of 27.4°and 28.1°. The axis between the medial border of the tibial tubercle and the PCL was internally rotated compared to the other techniques. None of the techniques consistently established tibial rotational alignment, and navigation systems that establish rotational alignment by identifying anatomic landmarks were not more reliable than traditional instrumentation.
International Orthopaedics, 2019
Aim of the study To identify the most reliable anatomical landmarks and imaging techniques for assessing the rotation of the tibial component in total knee arthroplasty (TKA). Methods An extensive literature review (from January 2016 to March 2019) was performed. We included studies about primary TKA with details concerning the anatomical landmarks used for implanting the tibial component and also imaging studies assessing tibial component rotation. The final selection comprises only thirty-five articles consistent with the inclusion criteria. Results Extra-articular landmarks are not always reliable (even though the tibial tubercle is one of the most popular extra-articular landmarks used to assess the rotation of the tibial component), mainly because they vary and can lead to malrotation of the tibial component. Akagi's line (an intra-articular landmark) is considered to be the most reliable and easy to find during surgery and likewise is not affected by articular deformities. The anterior tibial cortex (intra-articular landmark) also proved to be accurate and reliable with the main advantage being that is palpable after tibial resection. Radiography provides a good and inexpensive option for imaging, but it is insufficient. Magnetic resonance imaging (MRI) is used in some cases but not routinely for assessing TKA components or their orientation. Computed tomography (CT), used together with a well-defined protocol (Berger's method being the preferred choice), remains the Bgold standard^for evaluating the rotation of the tibial component after TKA. Conclusion Currently, the most accurate and reliable anatomical landmarks are represented by Akagi's line and the anterior cortex of the tibia. Post-operatively, through CT and well-established protocols, the rotation of the tibial component can be accurately determined.
SICOT-J
Introduction: The surgical trans epicondylar axis (sTEA) is considered the gold standard for optimum rotation of the femoral component; however, no consensus exists on tibial component positioning. The objectives of this study were to determine the relationship of sTEA to various femoral and tibial reference axes in varus osteoarthritis (OA) knees and (ii) to study the intra-observer and inter-observer variability of the axis relationships. Materials and methods: The study was done on preoperative computerised tomogram (CT) scans of 110 varus knees to assess the rotational relationships respectively of femoral side sTEA with whitesides line (WSL), posterior condylar axis (PCA), clinical trans epicondylar axis (cTEA) and on the tibial side sTEA with posterior tibial margin (PTM), anterior condylar axis (ACA), Akagi’s line and line from the geometric centre of the tibial plateau to 1/3rd tibial tubercle (line GC 1/3rd TT). Results: On the femoral side the mean angles of sTEA with WSL,...
The Journal of Arthroplasty, 2011
To analyze the morphology of the tibial plateau, we studied 100 computed tomographic scans of arthritic knees and measured the mediolateral (ML) and anteroposterior (AP) dimensions as well as their aspect ratio using 3 reference axes of rotation: transepicondylar axis (TEA), posterior tibial margin (PTM), and anterior tibial tuberosity (ATT) axis. Relative to the TEA, the PTM was internally rotated by 1.6°± 5.1°, and the ATT externally rotated by 14.8°± 7.2°. The AP and ML dimensions and aspect ratio differ significantly when the reference axis was ATT compared with PTM or TEA and variations were greater while using ATT axis. Our data demonstrate (1) that design of the tibial component restricts the choice of rotational alignment and (2) that ATT is not a reliable landmark for rotation of the tibial component.
Revista Brasileira de Ortopedia (English Edition), 2015
Objectives: To evaluate the results obtained through using an intramedullary or extramedullary guide for sectioning the tibia in total knee arthroplasty procedures, with a view to identifying the accuracy of these guides and whether one might be superior to the other. Methods: This was a randomized double-blind prospective study on 41 total knee arthroplasty procedures performed between August 2011 and March 2012. The angle between the base of the tibial component and the mechanical axis of the tibia was measured during the immediate postoperative period by means of radiography in anteroposterior view on the tibia that encompassed the knee and ankle. Results: There was no demographic difference between the two groups evaluated. The mean alignment of the tibial component in the patients of group A (intramedullary) was 90.3 • (range: 84-97 •). In group B (extramedullary), it was 88.5 • (range: 83-94 •). Conclusion: In our study, we did not find any difference regarding the precision or accuracy of either of the guides. Some patients present an absolute or relative contraindication against using one or other of the guides. However, for the other cases, neither of the guides was superior to the other one.
The Journal of Arthroplasty, 2010
The best operative technique for achieving appropriate postoperative alignment following total knee arthroplasty (TKA) remains controversial, with proponents of extramedullary, intramedullary and computer-assisted techniques. One hundred ninety-two consecutive patients undergoing TKA were prospectively evaluated with full-length lower extremity radiographs. Patients underwent cemented TKA using femoral and tibial intramedullary instrumentation. Digital radiographs were analyzed using PACS (AGFA Healthcare, Ridgefield Park, NJ) software. Tibial component alignment was measured in the coronal and sagittal planes. Tibial component slope averaged 3.89°+ 1.96 for the cruciate-retaining components and averaged 1.7°+ 1.92 for PS components. The average coronal tibial component alignment was 90.00°, and 99% were within 3°o f neutral mechanical alignment with only 2 (1%) outliers. Intramedullary instrumentation resulted in excellent postoperative tibial component and lower extremity alignment.
The position and orientation of total knee replacement components
The Journal of Bone and Joint Surgery. British volume, 2011
We studied the intra- and interobserver reliability of measurements of the position of the components after total knee replacement (TKR) using a combination of radiographs and axial two-dimensional (2D) and three-dimensional (3D) reconstructed CT images to identify which method is best for this purpose. A total of 30 knees after primary TKR were assessed by two independent observers (an orthopaedic surgeon and a radiologist) using radiographs and CT scans. Plain radiographs were highly reliable at measuring the tibial slope, but showed wide variability for all other measurements; 2D-CT also showed wide variability. 3D-CT was highly reliable, even when measuring rotation of the femoral components, and significantly better than 2D-CT. Interobserver variability in the measurements on radiographs were good (intraclass correlation coefficient (ICC) 0.65 to 0.82), but rotational measurements on 2D-CT were poor (ICC 0.29). On 3D-CT they were near perfect (ICC 0.89 to 0.99), and significant...
Southern Clinics of Istanbul Eurasia, 2018
The purpose of this study was to evaluate the consistency of the angle between the posterior condylar line (PCL) and the transepicondylar axis (TEA) measured during surgery (sTEA) with that of the clinical transepicondylar axis (cTEA) measured using computerized tomography (CT) before primary total knee arthroplasty (TKA). Methods: The records of patients who had undergone primary TKA between 2013 and 2105 and with a preoperative CT measurement of the knee were evaluated. During surgery, following the distal femoral incision, PCL and sTEA lines were drawn on the surface with a ruler and a pencil and recorded with a digital camera. The angle between the cTEA, or the line joining the most prominent points of the medial and lateral epicondyles, and the PCL was measured using a picture archiving communication system (PACS). Results: The study group consisted of 9 knees of 9 patients (1 male, 8 female; mean age: 67 years, range: 59-80 years). The photographs indicating the angle between the sTEA line and the PCL revealed external rotation in 9 knees (100%), with a mean angle of 2.67±1.41° (range: 1-6°). The preoperative axial CT images also demonstrated external rotation in 9 knees (100%), with a mean angle of 4.67±1.41° (range: 2-7°). Conclusion: There was a difference between the sTEA, which is used to determine the rotation of femoral component during TKA, and the cTEA measured preoperatively using CT. It is safe to use 1 of these 2 techniques to check the result of the other. In the future, measurements made using CT will be used to design personalized anatomical prostheses.
The Bone & Joint Journal, 2011
We studied the intra- and interobserver reliability of measurements of the position of the components after total knee replacement (TKR) using a combination of radiographs and axial two-dimensional (2D) and three-dimensional (3D) reconstructed CT images to identify which method is best for this purpose. A total of 30 knees after primary TKR were assessed by two independent observers (an orthopaedic surgeon and a radiologist) using radiographs and CT scans. Plain radiographs were highly reliable at measuring the tibial slope, but showed wide variability for all other measurements; 2D-CT also showed wide variability. 3D-CT was highly reliable, even when measuring rotation of the femoral components, and significantly better than 2D-CT. Interobserver variability in the measurements on radiographs were good (intraclass correlation coefficient (ICC) 0.65 to 0.82), but rotational measurements on 2D-CT were poor (ICC 0.29). On 3D-CT they were near perfect (ICC 0.89 to 0.99), and significant...