Does lateral versus medial exposure influence total knee tibial component final external rotation? A CT based study

Passeron, D.; Gaudot, Fabrice; Boisrenoult, Philippe; Fallet, L.; Beaufils, Philippe

doi:10.1016/j.otsr.2009.06.003

Cited by 5 publications

(3 citation statements)

References 12 publications

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“…The improvement in the malrotation rate may be attributed to the specific design modification, increased number of baseplate sizes, and proper positioning strategies. Nevertheless, the anatomic difference between healthy individuals in our study and patients with degenerative changes from previous researches should also be noted since it might have an impact on the level of resection and the surgical approach, which may further influence the rotational alignment of the tibial prosthesis 33,34 . It is also worth noticing that original researches related to aligning reference, prosthesis design, and surgical technics in the modern TKA system was usually based on normal anthropometric measurements 7,35 , that is why we enrolled healthy subjects in order to provide a perspective on malrotation from normal conditions.…”

Section: Discussionmentioning

confidence: 86%

Approximating the maximum tibial coverage in total knee arthroplasty does not necessarily result in implant malrotation

Shao

Wang

et al. 2020

Sci Rep

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Traditionally, the practice of the tibial component placement in total knee arthroplasty has focused on achieving maximum coverage without malrotation. However, the concept of maximizing coverage has not been well defined or researched and yet biased results are often produced. This study aimed to evaluate the effect of a prioritizing maximum coverage positioning strategy on the rotational alignment by using a strict computer algorithm. Computed tomographic scans of 103 tibial specimens were used to reconstruct three-dimensional tibia models. A virtual surgery was performed to generate the resection plane with a posterior slope of 7° on the proximal tibia. Symmetrical and anatomical tibial components were placed and analyzed with an automated program designed for approximating the maximum coverage based on the coherent point drift algorithm. We found that the average tibial coverage achieved across all specimens and implants was 85.62 ± 3.65%, ranging from 83.64 ± 4.10% to 86.69 ± 3.07%. When placed for maximal tibial coverage, the mean degree of rotation related to the Insall line was − 0.73° ± 4.53° for all subjects, 23% of the tibial components were malrotated. The average percentage position of the baseplate anteroposterior axis over the patellar tendon was 26.95 ± 14.71% from the medial edge. These results suggest that with specific design and proper placement of the component, approximating the maximum tibial coverage in total knee arthroplasty does not necessarily result in implant malrotation. the current tibial baseplates have shown good performance on the coverage when aligned parallel to the Insall line with the anteroposterior axis positioned between the medial 1/3 and medial 1/6 of the patella tendon. Insufficient implant coverage and bone support at the osteotomy level could increase the amount of bleeding into the articular cavity of the knee in the immediate postoperative period, which may also increase osteolysis from wear by debris in the long term follow-up, finally resulting in subsidence and instability 1,2. Meanwhile, proper tibial rotation is another key factor that is crucial to the kinematic alignment and long-term survivorship of the prosthesis 3-5. Ideally, a satisfying total knee arthroplasty (TKA) ought to maximize tibial coverage without causing tibial malrotation. Several studies have evaluated both tibial coverage and rotational alignment with virtual matching by using preoperative imageological data 6-13. These studies mainly focused on the comparison between anatomic and symmetric designs which had always been a controversial issue. However, the various definitions of the malrotation and coverage maximizing methods applied in these studies make it hard to draw a firm conclusion on the compromise between coverage and ideal rotation while the latter has an inherent priority 8,14. Theoretically, maximizing coverage usually requires a larger size of the tibial baseplate, which under normal circumstances

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Section: Discussionmentioning

confidence: 86%

Approximating the maximum tibial coverage in total knee arthroplasty does not necessarily result in implant malrotation

Shao

Wang

et al. 2020

Sci Rep

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“…The findings are in agreement with Passeron et al who, using the self‐adjustment method for the tibial component positioning, reported similar results in a small‐sized prospective study using measurement on transverse CT slices (2D). They found that LPA led to significantly more external rotation in tibial TKA components [28]. However, in here the Berger method was used, which is considered as less reliable than measurements on 3D reconstructed CT [18, 32].…”

Section: Discussionmentioning

confidence: 99%

“…The present study did not take into account the postoperative clinical outcomes. While an internally rotated tibial component is known to be a major cause of pain, reduced knee flexion and higher rates of revision TKA [4,5,23,25,27], an externally rotated tibial component seems to improve the patellofemoral tracking [28]. Hirschmann et al compared the clinical outcomes at a two-year follow-up of 143 patients who undergone TKA with LPA (n = 76) and MPA (n = 67).…”

Section: Discussionmentioning

confidence: 99%

Medial parapatellar approach leads to internal rotation of tibial component in total knee arthroplasty

Schiapparelli

Amsler

Hirschmann

2017

Knee Surg Sports Traumatol Arthrosc

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4 There Is an Optimal Rotational Alignment in Total Knee Replacement: Tibial Rotation Does Matter!

Pujol

Berhouet

Boisrenoult

et al. 2015

The Unhappy Total Knee Replacement

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Does lateral versus medial exposure influence total knee tibial component final external rotation? A CT based study

Abstract: Prospective; comparative; non-randomized study; level 3.

Cited by 5 publications

References 12 publications

Approximating the maximum tibial coverage in total knee arthroplasty does not necessarily result in implant malrotation

Approximating the maximum tibial coverage in total knee arthroplasty does not necessarily result in implant malrotation

Medial parapatellar approach leads to internal rotation of tibial component in total knee arthroplasty

4 There Is an Optimal Rotational Alignment in Total Knee Replacement: Tibial Rotation Does Matter!

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