Impact of tibial baseplate malposition on kinematics, contact forces and ligament tensions in TKA: A numerical analysis

Fottner, Andreas; Woiczinski, Matthias; Schröder, Christian; Schmidutz, Florian; Weber, Patrick; Müller, Peter E.; Jansson, Volkmar; Steinbrück, Arnd

doi:10.1016/j.jmbbm.2019.103564

Cited by 12 publications

(6 citation statements)

References 40 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…It is not only the functional flexion–extension axis of the knee [ 2 , 18 ] but also the femoral rotational axis [ 10 ]. Installing femoral and tibial component in accordance with SEA is consistent with biomechanical characteristics [ 12 , 22 ]. On the tibial side, due to the inability of the surgeons to locate the SEA directly on the proximal tibial osteotomy surface, the researchers have attempted to establish optimal tibial rotational axes using appropriate intra- or extra-articular anatomical landmarks, such as the medial boundary of the tibial tuberosity [ 16 , 20 ], the medial third boundary of the tibial tuberosity [ 20 , 23 ], the anterior cortex of the tibia [ 16 ], the anterior tibial crest [ 19 , 21 ] and the tibial posterior condylar [ 23 , 25 , 26 ].…”

Section: Introductionsupporting

confidence: 61%

Gender differences affect the location of the patellar tendon attachment site for tibial rotational alignment in total knee arthroplasty

Zhang

Zhou

et al. 2022

J Orthop Surg Res

View full text Add to dashboard Cite

Purpose This study was carried out to investigate the accuracy of referring different locations of the patellar tendon attachment site and the geometrical center of the osteotomy surface for tibial rotational alignment and observe the influences of gender differences on the results. Methods Computed tomography scans of 135 osteoarthritis patients (82 females and 53 males) with varus deformity was obtained to reconstruct three-dimensional (3D) models preoperatively. The medial boundary, medial one-sixth, and medial one-third of the patellar tendon attachment site were marked on the tibia. These points were projected on the tibial osteotomy plane and connected to the geometrical center (GC) of the osteotomy plane or the middle of the posterior cruciate ligament (PCL) to construct six tibial rotational axes (Akagi line, MBPT, MSPT1, MSPT2, MTPT1 and MTPT2). The mismatch angle between the vertical line of the SEA projected on the proximal tibial osteotomy surface and six different reference axes was measured. In additional, the effect of gender differences on rotational alignment for tibial component were assessed. Results Relative to the SEA, rotational mismatch angles were − 1.8° ± 5.1° (Akagi line), − 2.5° ± 5.3° (MBPT), 2.8° ± 5.3° (MSPT1), 4.5° ± 5.4° (MSPT2), 7.3° ± 5.4° (MTPT1), and 11.6° ± 5.8° (MTPT2) for different tibial rotational axes in all patients. All measurements differed significantly between the male and female. The tibial rotational axes with the least mean absolute deviation for the female or male were Akagi line or MSPT, respectively. There was no significant difference in whether the GC of the osteotomy surface or the midpoint of PCL termination was chosen as the posterior anatomical landmark when the medial boundary or medial one-sixth point of the patellar tendon attachment site was selected as the anterior anatomical landmark. Conclusion When referring patellar tendon attachment site as anterior anatomical landmarks for tibial rotational alignment, the influence of gender difference on the accuracy needs to be taken into account. The geometric center of the tibial osteotomy plane can be used as a substitute for the middle of the PCL termination when reference the medial boundary or medial one-sixth of the patellar tendon attachment site.

show abstract

Section: Introductionsupporting

confidence: 61%

Gender differences affect the location of the patellar tendon attachment site for tibial rotational alignment in total knee arthroplasty

Zhang

Zhou

et al. 2022

J Orthop Surg Res

View full text Add to dashboard Cite

show abstract

“…Due to the lack of a standard anatomical marker, the alignment of tibial prosthesis rotation may not be as easy to determine as the rotation of femoral prosthesis. The usage of a variety of anatomical markers for tibia rotation increases the chance of a mismatch between the rotation of the tibia and femoral prosthesis, which could lead to unfavorable clinical results due to postoperative pain, reduced range of motion, instability and a higher rate of early loosening [11, 21]. Malrotation of the tibial prosthesis has been considered as the early cause for postoperative pain, which may be the reason for a substantial part of those 20% revision TKAs [15, 17, 32].…”

Section: Discussionmentioning

confidence: 99%

Different rotational alignment of tibial component should be selected for varied tibial tubercle locations in total knee arthroplasty

Dai

Yin

et al. 2021

Knee Surg Sports Traumatol Arthrosc

View full text Add to dashboard Cite

PurposeThe main purpose of this study was to identify how the accuracy of the tibial rotation reference axes varied in populations with different tibial tubercle locations. We hypothesized that the accuracy of the axes of tibial rotation would be affected by the changes of tibial tubercle locations. MethodsSurgical epicondylar axis (SEA), medial third of the patellar tendon (1/3MPT), medial third of the tibial tuberosity (1/3MTT), medial border of the tibial tuberosity (MTT) and Akagi line were drawn. The angle between SEA and horizontal line with the angle between the four tibial rotation axes and the horizontal line was compared by T test. Then, the correlation between TTTG with the angles between the four axes and SEA vertical lines was analyzed. The TTTG was divided into three subgroups (TTTG < 10 mm, 10 mm ≤ TTTG < 15 mm, TTTG ≥ 15 mm), then t test was performed for the angles between the vertical lines of the SEA and the four rotation axes of the tibia in each group. ResultsAmong the four tibial rotation axes, only the difference between MTT and the line perpendicular to SEA had no statistical significance (NS.). The four tibial rotational axes were all positively correlated with TTTG (p < 0.001). When TTTG ≥ 15 mm, Akagi line was 2.5° ± 6.9°internally rotated to the line perpendicular to SEA, while the 1/3MPT and MTT was 0.9° ± 5.3°and 1.3° ± 5.9°externally rotated to the line perpendicular to the SEA when TTTG < 10 mm and 10 mm ≤ TTTG < 15 mm, respectively. ConclusionsMTT showed the best consistency with SEA. TT‐TG had a significant positive correlation with all four tibial rotational axes. In patients with TTTG < 10 mm, 10 mm ≤ TTTG < 15 mm and TTTG ≥ 15 mm, the 1/3MPT, MTT and Akagi line demonstrated good alignment consistency with SEA, respectively.

show abstract

“…A study by Fottner et al 64 has found that, using computer simulation, malpositioning of the tibial baseplate component mostly affects ligament tension (posterior cruciate and collateral ligaments) which influences the tibia and femur kinematics and their contact forces. This has its effect on poorer clinical outcomes following surgery, including pain, higher rate of early loosening, instability and reduced range of motion.…”

Section: Component Malpositioningmentioning

confidence: 99%

Literature review of the causes of pain following total knee replacement surgery: prosthesis, inflammation and arthrofibrosis

Chung

Ali

et al. 2020

EFORT Open Reviews

View full text Add to dashboard Cite

Adverse knee pain occurs in 10–34% of all total knee replacements (TKR), and 20% of TKR patients experience more pain post-operatively than pre-operatively. Knee pain is amongst the top five reasons for knee replacement revision in the United Kingdom. The number of TKRs is predicted to continue increasing due to the ageing population. A narrative literature review was performed on the different causes of pain following TKR. A database search on Scopus, PubMed, and Google Scholar was conducted to look for articles related to TKR, pain, and cause. Articles were selected based on relevance, publication date, quality of research and validation. Relevant sections were added to the review. One hundred and fourteen articles were identified and potential causes of TKR pain included: arthrofibrosis, aseptic loosening, avascular necrosis, central sensitization, component malpositioning, infection, instability, nerve damage, overstuffing, patellar maltracking, polyethylene wear, psychological factors and unresurfaced patella. It is important to tailor our approach to address the individual causes of pain. Certain controllable risk factors can be managed pre-operatively to minimize post-operative pain. Risk factors help to predict adverse pain outcomes and identify specific causes. There are multiple causes of pain following TKR. Some factors will require further extensive studies, and as pain is a commonly attributed reason for TKR revision, its underlying aetiologies should be explored. Understanding these factors helps to develop effective methods for diagnosis, prevention and management of TKR pain, which help to improve patient outcomes. Cite this article: EFORT Open Rev 2020;5:534-543. DOI: 10.1302/2058-5241.5.200031

show abstract

Impact of tibial baseplate malposition on kinematics, contact forces and ligament tensions in TKA: A numerical analysis

Cited by 12 publications

References 40 publications

Gender differences affect the location of the patellar tendon attachment site for tibial rotational alignment in total knee arthroplasty

Gender differences affect the location of the patellar tendon attachment site for tibial rotational alignment in total knee arthroplasty

Different rotational alignment of tibial component should be selected for varied tibial tubercle locations in total knee arthroplasty

Literature review of the causes of pain following total knee replacement surgery: prosthesis, inflammation and arthrofibrosis

Contact Info

Product

Resources

About