Bone Anatomy and Rotational Alignment in Total Knee Arthroplasty

Uehara, Kazunori; Kadoya, Y.; Kobayashi, Akio; Ohashi, Hirotsugu; Yamano, Yoshiki

doi:10.1097/00003086-200209000-00018

Cited by 137 publications

(88 citation statements)

References 7 publications

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“…Akagi et al [22] reported that the anteroposterior axis was more reliably identified on CT images than the TMA, whereas other authors found their results for this axis to be more consistent when using particular methods, such as those involving osteometric apparatus (24 AE 9.3 ) [3] or CT-based scanning (28 AE 10.0 ) [23], and these findings are similar to our own results (Table I). However, Eckhoff et al found that, when using the TMA to measure tibial torsion, it showed less variation, ranging from 15 to 30 [24].…”

Section: Discussionsupporting

confidence: 89%

“…The SD of our measurements (6.1 ) was slightly greater than that reported in the literature (2.6 to 5.4 ) [3,16,21], but it should be noted that the TTA did not have any outliers when the data were represented by a box plot. We also found an average angle of 16 between the tip of the tibial tuberosity and the TA, which corresponds to the ideal tibial component orientation of 18 from the tibial tuberosity as given by Berger et al in support of the use of this axis [16].…”

Section: Discussioncontrasting

confidence: 69%

“…Various techniques are used to ensure optimal alignment, but there is a lack of reliability and repeatability [1]. In a study of 109 TKAs, 50% were found to have tibial malrotation of more than 5 [3], which is sufficient to result in knee pain, a poor range of motion and instability [4,5]. Moreover, rotational malalignment causes abnormal eccentric loading of the tibial component during flexion of the knee, when the femur rides upwards on the disk-shaped tibial components.…”

Section: Introductionmentioning

confidence: 99%

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Reliability of frames of reference used for tibial component rotation in total knee arthroplasty

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Deakin

Payne

et al. 2011

Computer Aided Surgery

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This study evaluated seven different frames of reference used for tibial component rotation in total knee arthroplasty (TKA) to determine which ones showed good reliability between bone specimens.An optoelectronic system based around a computer-assisted surgical navigation system was used to measure and locate 34 individual anatomical landmarks on 40 tibias. Each particular frame of reference was reconstructed from a group of data points taken from the surface of each bone. The transverse axis was used as the baseline to which the other axes were compared, and the differences in angular rotation between the other six reference frames and the transverse axis were calculated.There was high variability in the tibial rotational alignment associated with all frames of reference. Of the references widely used in current TKA procedures, the tibial tuberosity axis and the anterior condylar axis had lower standard deviations (6.1 and 7.3 , respectively) than the transmalleolar axis and the posterior condylar axis (9.3 for both). In conclusion, we found high variability in the frames of reference used for tibial rotation alignment. However, the anterior condylar axis and transverse axis may warrant further tests with the use of navigation. Combining different frames of reference such as the tibial tuberosity axis, anterior condylar axis and transverse axis may reduce the range of errors found in all of these measurements.

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Section: Discussionsupporting

confidence: 89%

Section: Discussioncontrasting

confidence: 69%

Section: Introductionmentioning

confidence: 99%

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Reliability of frames of reference used for tibial component rotation in total knee arthroplasty

Page

Deakin

Payne

et al. 2011

Computer Aided Surgery

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“…the posterior tibial condylar line the transcondylar tibial line, or the line between the tibial spines). More recently, various sagittal planes have been described including a line perpendicular to the posterior joint surface passing through the medial third of the tibial tubercle 7 and a line passing through the middle of the posterior cruciate ligament perpendicularly to the projected femoral transepicondylar axis (Akagi's line). 8 Unfortunately, many of these references vary among patients are difficult to establish and are, therefore, unreliable.…”

Section: Introductionmentioning

confidence: 99%

Rotational Alignment Landmarks in Primary Total Knee Arthroplasty

Baldini

Indelli²,

Manfredini³

et al. 2014

The Duke Orthopaedic Journal

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Purpose: We hypothesized that the anterior tibial surface curvature is a more reliable landmark for correct tibial component rotational positioning in TKA respect to the 'Akagi' line and the medial third of the tibial tubercle.Methods: Three independent investigators reviewed 124 knee MRI scans, identifying independently the femoral transepicondylar axis (TEA), the femoral posterior condylar axis (PCA), a line connecting the middle of the posterior cruciate ligament and the medial edge of the patellar tendon attachment (Akagi's line), the medial third of the tibial tubercle and the anterior tibial surface curvature. The most appropriate tibial baseplate tracing for the NexGen Total Knee System (Zimmer, Warsaw, USA) was superimposed matching the anterior tibial cortex with its anterior surface. At this point, the rotation of the tibial plate tracing was calculated in respect to the TEA, the medial third of the tibial tubercle line, the Akagi's line and the PCA. Customized software was created and used for analysis of the MRI datasets. Results:The investigators agreed on the localization of the Akagi's line in 64% of the cases within 3° and in 85% of the cases within 5° (minimum -16°, maximum -7°): this landmark might lead to internal rotation of the tibial component. The observers agreed on the localization of the medial third of the tibial tubercle in 29% of the cases within 3° and, in 70% of the cases, within 5° (minimum -4°, maximum +4°): this landmark might lead to external rotation of the tibial component. The investigators agreed on the localization of the anterior tibial surface curvature in 89% of the cases within 3° and in 99% of the cases within 5° (minimum -1°, maximum +4°): component alignment along the anterior cortex guaranteed full matching ±3° to the epicondylar axis in 75% of the knees. Conclusion:Alignment of the tibial component, when based on the anterior tibial surface, was more reliable and easier identifiable than either the Akagi's line or the medial third of the tibial tubercle. Level of evidence:Level 3 (Retrospective cohort study).

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“…Churchill et al [6] suggested a line passing through the most medial and lateral portions of the epicondyles, the transepicondylar axis (TEA), best approximates the actual flexion-extension axis (FEA) of the knee. Using this TEA as a surrogate for the actual axis of flexion is attractive because these landmarks can be palpated by a surgeon intraoperatively and are not altered by joint surface degeneration [1,4,23,24,27]. With their two-dimensional (2-D) analysis, Churchill et al [6] concluded there was a statistically insignificant difference of 3°± 1°between the TEA and the true FEA.…”

Section: Introductionmentioning

confidence: 99%

Cylindrical Axis, Not Epicondyles, Approximates Perpendicular to Knee Axes

Hancock

Winston

Bach

et al. 2013

Clinical Orthopaedics &Amp; Related Research

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Background The transepicondylar axis (TEA) is often used as a surrogate for the flexion-extension axis, ie, the axis around which the tibia moves in space, because of a belief that both axes lie perpendicular to the mechanical axis. However, studies suggest the cylindrical axis (CA), defined as a line equidistant from contact points on the medial and lateral condylar surfaces from 10 o to 120 o flexion, more closely approximates the axis around which the tibia moves in space.Questions/purposes We examined the TEA and CA angles relative to mechanical axes to determine whether one more consistently and closely approximates the surgical goal of orthogonality to the mechanical axis. Methods Three-dimensional (3-D) models were reconstructed from CT scans of five cadaver limbs. Three observers repeated three measurement sets to locate the TEA, CA, and femoral mechanical and tibial mechanical axes. Angles of the TEA and CA relative to the mechanical axes were calculated in two-dimensions (2-D) and as 3-D projections and compared for differences in magnitude and variance. Results Angles between CA and the mechanical axes were closer to 90°than the TEA in 2-D (92°versus 94°for the femur, 93°versus 94°for the tibia) and 3-D (88°versus 87°for the femur, 88°versus 86°for the tibia). Variance of the TEA was higher than the CA in 2-D. Conclusions The CA forms angles more orthogonal to the mechanical axes of the thigh and leg than the TEA. Clinical Relevance Although we found a consistently greater deviation of the TEA from the mechanical axis than the CA with small differences, future studies will need to determine whether these differences are biomechanically or clinically important.

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Bone Anatomy and Rotational Alignment in Total Knee Arthroplasty

Cited by 137 publications

References 7 publications

Reliability of frames of reference used for tibial component rotation in total knee arthroplasty

Reliability of frames of reference used for tibial component rotation in total knee arthroplasty

Rotational Alignment Landmarks in Primary Total Knee Arthroplasty

Cylindrical Axis, Not Epicondyles, Approximates Perpendicular to Knee Axes

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