A sagittal reference line using the preoperative radiograph in total knee arthroplasty

Kim, Hee-June; Kim, Jeong-Woo; Shin, Ji‐Yeon; Kim, Junekyu; Lee, Hyun-Joo; Park, Kyeong-Hyeon; Kyung, Hee-Soo

doi:10.1177/2309499020924143

Cited by 3 publications

(2 citation statements)

References 21 publications

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“…An extramedullary guide was used for the tibial resection. The tibial slope was initially targeted at 3° of PTS in the sagittal plane, with a reference line connecting the fibular head and lateral malleolus 16 . Tibial component rotation was determined based on a reference line passing through the medial third of the tibial tubercle and second metatarsal or middle of the talus.…”

Section: Surgical Techniques and Rehabilitationmentioning

confidence: 99%

“…The tibial slope was initially targeted at 3 degrees of PTS in the sagittal plane, with a reference line connecting the fibular head and lateral malleolus. 16 Tibial component rotation was determined based on a reference line passing through the medial third of the tibial tubercle and second metatarsal or middle of the talus. Following bone resection, trial implants were inserted, and mediolateral and flexion-extension balancing was achieved with additional procedures.…”

Section: Surgical Techniques and Rehabilitationmentioning

confidence: 99%

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Similar Midterm Outcomes of Total Knee Arthroplasties with Anterior and Posterior Tibial Slopes Performed on Paired Knees at a Minimum Follow-up of 5 Years

et al. 2023

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A small posterior tibial slope (PTS) is generally recommended in posterior stabilized (PS) total knee arthroplasty (TKA). An unwanted anterior tibial slope (ATS), which can affect postoperative results, may be created in PS TKA because of the inaccuracy of surgical instruments and techniques, as well as high inter-patient variability. We compared mid-term clinical and radiographic results of PS TKAs with ATS and PTS performed on paired knees using the same prosthesis. One-hundred-twenty-four patients who underwent TKAs with ATS and PTS on paired knees using ATTUNE® posterior-stabilized prostheses were retrospectively reviewed after a minimum follow-up period of 5 years. The mean follow-up period was 5.4 years. The Knee Society Knee and Function scores, Western Ontario and McMaster Universities Osteoarthritis Index, Feller and Kujalar scores, and range of motion (ROM) were evaluated. The preferred TKA out of ATS and PTS was also investigated. The hip-knee-ankle angle (HKA), component positions, tibial slope, posterior femoral offset (PFO), Insall–Salvati ratio (ISR), and knee sagittal angle were measured by radiography. There were no significant differences in the clinical results, including ROM, between TKAs with ATS and PTS preoperatively and at the last follow-up. Regarding patient preference, 58 patients (46.8%) were satisfied with bilateral knees, 30 (24.2%) preferred knees with ATS, and 36 (29%) preferred knees with PTS. There was no significant difference in the rate of preference between TKAs with ATS and PTS (p=0.539). Except for the postoperative tibial slope (-1.8° vs. 2.5°, p<0.001), there were also no significant differences in the radiographic results, including the knee sagittal angle, preoperatively and at the last follow-up. The mid-term outcomes were similar between PS TKAs with ATS and PTS performed on paired knees at a minimum of 5 years of follow-up. Non-severe ATS did not affect mid-term outcomes in PS TKA with proper soft tissue balancing and the current prosthesis of improved design. However, a long-term follow-up study is required to confirm the safety of non-severe ATS in PS TKA.

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Section: Surgical Techniques and Rehabilitationmentioning

confidence: 99%

Section: Surgical Techniques and Rehabilitationmentioning

confidence: 99%

Similar Midterm Outcomes of Total Knee Arthroplasties with Anterior and Posterior Tibial Slopes Performed on Paired Knees at a Minimum Follow-up of 5 Years

et al. 2023

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Surgical Instruments

Tsukeoka

2024

Advances in Total Knee Arthroplasty

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Proposing a Precision-Enhancing Method for Sagittal Plane Alignment During Total Knee Arthroplasty

Park,

Lim,

Chang

2024

Preprint

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Background Achieving appropriate alignment after total knee arthroplasty (TKA) is crucial for long-term survival of implant but alignment in sagittal plane is relatively not well studied. The purpose of this study was to (1) propose the preoperative sagittal planning method of TKA using X-ray, (2) validate its accuracy and (3) find factors contributing to inaccurate sagittal placement of the component. Methods Preoperative sagittal planning for the femoral and tibial component was conducted using simple X-ray images. The postoperative X-ray taken 6 weeks after surgery was used to validate the proposed method. The angle between the reference line and the expected resection line before surgery was defined as the preoperative gamma angle for the femur and delta angle for the tibia. Postoperatively, the angle between the same reference line and the actual component was defined as the postoperative gamma and delta angles, respectively. The target angle range for the difference between the preoperative and postoperative gamma and delta angles was set as -2° to 2°. Demographic and radiologic factors between groups that fell within and outside the target angle range were compared. Results Total 75 cases (80.6%) met the target angle range of distal femur resection. Femoral component tended to be placed in more flexed position than planned. Anterior femoral notching was not observed in all cases. Total 89 cases (95.7%) met the target angle range of proximal tibia resection. There were no differences in demographic and radiologic factors between those who were in the target range for femoral or tibial component placement and those who were not. No risk factors were found in additional logistic regression. Conclusions The proposed planning method in this study showed reasonable level of accuracy in sagittal plane placement of the prosthesis during TKA. Since this method does not require any programs and additional costs, it could be a good alternative in situations where robotic-assisted TKA is not available.

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A sagittal reference line using the preoperative radiograph in total knee arthroplasty

Cited by 3 publications

References 21 publications

Similar Midterm Outcomes of Total Knee Arthroplasties with Anterior and Posterior Tibial Slopes Performed on Paired Knees at a Minimum Follow-up of 5 Years

Similar Midterm Outcomes of Total Knee Arthroplasties with Anterior and Posterior Tibial Slopes Performed on Paired Knees at a Minimum Follow-up of 5 Years

Surgical Instruments

Proposing a Precision-Enhancing Method for Sagittal Plane Alignment During Total Knee Arthroplasty

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