Preoperative Measurement of Tibial Resection in Total Knee Arthroplasty Improves Accuracy of Postoperative Limb Alignment Restoration

Abstract

Background:Accuracy of implant placement in total knee arthroplasty (TKA) is crucial. Traditional extramedullary alignment instruments are fairly effective for achieving the desired mean tibial component coronal alignment. We modified the traditional tibial plateau resection technique and evaluated its effect on alignment restoration.Methods:Two hundred and eighty-two primary TKAs in our hospital between January 2013 and December 2014 were enrolled in this retrospective study. Group A consisted of 128 primary TKAs performed by one senior surgeon. Preoperative measurement of the tibial resection was conducted on radiographs, and the measured thicknesses of the lateral and medial plateau resection were used to place the tibial alignment guide. Group B consisted of 154 primary TKAs performed by the other senior surgeon, using a traditional tibial plateau resection technique. In all patients, an extramedullary guide was used for tibial resection, and preoperative and postoperative full-leg standing radiographs were used to assess the hip-knee-ankle angle (HKA), femoral component alignment angle (FA), and tibial component alignment angle (TA). A deviation ≥3° was considered unsatisfactory. Data were analyzed by unpaired Student's t-test.Results:The mean postoperative HKA and TA angles were significantly different between Groups A and B (178.2 ± 3.2° vs. 177.0 ± 3.0°, t = 2.54, P = 0.01; 89.3 ± 1.8° vs. 88.3 ± 2.0°, t = 3.75, P = 0.00, respectively). The mean postoperative FA was 88.9 ± 2.5° in Group A and 88.9 ± 2.6° in Group B, and no significant difference was detected (t = 0.10, P = 0.92). There were 90 (70.3%) limbs with restoration of the mechanical axis to within 3° of neutral alignment and 38 (29.7%) outliers (>3° deviation) in Group A, whereas there were 89 (57.8%) limbs with restoration of the mechanical axis to within 3° of neutral alignment and 65 (42.2%) outliers (>3° deviation) in Group B. The severity of the preoperative alignment deformity was a strong predictor for postoperative alignment.Conclusions:Using conventional surgical instruments, preoperative measurement of resection thickness of the tibial plateau on radiographs could improve the accuracy of conventional surgical techniques.

Improving Tibial Component Coronal Alignment During Total Knee Arthroplasty with the Use of a Double‐Check Technique

“…), no matter whether in the conventional TKA group or the double‐check TKA group, the distribution trend is slightly greater for varus than valgus. Other reports show the same situation. It has been reported that residual varus alignment after TKA in varus knees is acceptable, but valgus alignment after TKA in varus knees is not allowed.…”

“…Macdonald et al reported that modified sawblades (thicker and stiffer), a new saw guide, and the technique of constraining the saw from the pivot point of the blade improved the result of tibial cutting compared with the conventional sawing techniques. Wu et al reported that preoperative measurement of the difference between the resection thicknesses of the medial and lateral tibial plateaus for the proximal tibial cut could improve the accuracy of tibial component alignment and postoperative limb alignment restoration compared with conventional techniques. Cinotti et al reported that the alignment of the tibial component may be improved using a surgical technique in which the extramedullary rod is set in line with anatomical landmarks in the proximal tibia only without any other instrumentation.…”

Comparison of Valgus Correction Angle between Patients with Developmental Dysplasia Hip and Normal Volunteers Measured by Three-Dimensional Reconstruction and X-Ray

“…For the patients with tibial or femoral torsion, the accurate profile of the tibial plateau is hard to distinguish. Conventional CT scan data can provide these patients with accurate preoperative measurements, but it requires patients to maintain special body orientation during scanning [5,20,21]. Compared with the methods in BioMed Research International 2D, 3D reconstruction technology based on CT can be more intuitive to analyze and calculate the clinical parameters in any plane and angle as needed.…”

Application of Proximal Tibial Bone Cutting Block Without Guide Rod In Total Knee Arthroplasty: A Technical Note

“…Total knee arthroplasty (TKA) is an effective method for the end-stage knee osteoarthritis (KOA). The correct direction and thickness of the tibia bone cutting are associated with the success of the operation [1,2]. Proper posterior slope angle (PSA) can achieve the femoral condyle rollback motion [3,4].…”