Significant Effect of the Posterior Tibial Slope on the Weight-Bearing, Midflexion In Vivo Kinematics After Cruciate-Retaining Total Knee Arthroplasty

Fujimoto, Eisaku; Sasashige, Yoshiaki; Tomita, Tadanori; Iwamoto, K.; Masuda, Yasuji; Hisatome, Takashi

doi:10.1016/j.arth.2013.10.018

Cited by 50 publications

(56 citation statements)

References 26 publications

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“…As reported by Fujimoto et al, an increase in the posterior tibial slope generates a greater posterior force on the femur during weight-bearing in CR TKA. 27 Without the ACL, the posterior force shifts the femur to an equilibrium position. However, in BCR TKA, the ACL resists this posterior force.…”

Section: Discussionmentioning

confidence: 99%

Does Component Alignment Affect Patient Reported Outcomes following Bicruciate Retaining Total Knee Arthroplasty? An In Vivo Three-Dimensional Analysis

Peng

Arauz

et al. 2019

J Knee Surg

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AbstractThis is an experimental study. Anterior cruciate ligament (ACL) and posterior cruciate ligament (PCL) retaining bicruciate retaining (BCR) total knee arthroplasty (TKA) have the potential to restore normal knee kinematics and thus improve patient outcome. Limited studies have examined the relationship between component alignment and patient-reported outcome measures (PROM). This study aims to determine (1) accurate three-dimensional (3D) component alignment of BCR TKA and (2) whether the component alignment of BCR TKA affects PROMs. The 3D modeling analysis was performed based on computed tomography images from 29 BCR TKAs. Component orientations were quantified for femoral and tibial components in the sagittal, axial, and coronal planes. The knee society scores (KSS) were collected preoperatively and postoperatively at 1-year follow-up. Multiple comparisons were performed to analyze the relationship between component alignment and patient outcomes. High variability was observed in the tibial component alignment (root–mean-square values: axial plane 6.6 degrees, sagittal plane 5.1 degrees, and coronal plane 4.0 degrees). At 1-year follow-up, significant improvement in KSS was noted in BCR TKA patients (p < 0.001). However, regression analysis adjusting for baseline KSS demonstrated the postoperative KSS was negatively associated with the posterior tibial slope (B [slope of the output of the regression analysis] = 2.597, p = 0.006). Patients with greater posterior tibial slopes were reported poorer postoperative functions at 1-year follow-up. Excessive posterior tibial slope may generate greater posterior force on the femur that leads to continuous overloading of the preserved ACL, suggesting optimal sagittal plane alignment of the tibial component may be important for the optimization of postoperative functions of BCR TKA patients.

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Section: Discussionmentioning

confidence: 99%

Does Component Alignment Affect Patient Reported Outcomes following Bicruciate Retaining Total Knee Arthroplasty? An In Vivo Three-Dimensional Analysis

Peng

Arauz

et al. 2019

J Knee Surg

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“…A second point of criticism on KA is, that even with resection of the anterior cruciate ligament in TKA, the natural knee kinematics cannot be restored with the prosthesis. There are good arguments to reduce the tibial slope compared to the natural situation to maintain the anteroposterior stability and rollback kinematics of the knee [ 13 , 29 ]. There is evidence that large tibial slope affects the knee stability and implant longevity [ 27 ].…”

Section: Discussion and Current Evidencementioning

confidence: 99%

Individualized alignment in total knee arthroplasty using image-based robotic assistance

et al. 2018

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IntroductionOver the past decades many innovations were introduced in total knee arthroplasty (TKA) focusing on implant longevity and higher procedural precision; however, there are still a high number of dissatisfied patients. It was reported that better anatomical alignment may result in improved patient outcome; however, current technologies have limitations to achieve this. The aim of this video article is to describe the technique of individualized alignment in TKA with the use of image-based robotic assistance.MethodsThe technology is based on an individual patient knee model computed from segmented computed tomography (CT) scans. A preoperative planning of prosthesis position is conducted following the principle of kinematic alignment. Intraoperatively the soft tissue envelope is recorded and the computer predicts the gap balance based on the virtual planning. The prosthesis position is then adapted to achieve balanced gaps and to avoid soft tissue release. This technique is shown in a cadaver operation and clinical examples of two patients are described.ResultsWith the combination of anatomically oriented prosthesis positioning and minor adaptations with respect to the soft tissue, an individualized alignment is achieved with reduced need of soft tissue release. The robotic-assisted surgery guarantees a precise implementation of the planning. The initial experience showed a promising outcome in short-term follow-up.Video onlineThe online version of this article (10.1007/s00132-018-3637-1) contains a video on patient individualized alignment in total knee arthroplasty. The article and video are available in the electronic full text archive at SpringerMedizin.de under http://www.springermedizin.de/der-orthopaede. The video can be found at the end of the article as supplementary material.

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“…Evaluation of the sagittal plane of the knee has recently gained popularity because its modification has effects on biomechanics and articular stability, greatly influencing the results of many knee procedures, such as anterior cruciate ligament reconstruction [ 1 , 2 ], posterior cruciate ligament reconstruction, posterolateral corner reconstruction, high tibial osteotomy [ 3 ], unicondylar knee arthroplasty [ 4 , 5 ], and total knee arthroplasty [ 6 – 12 ].…”

Section: Introductionmentioning

confidence: 99%

Do ethnicity and gender influence posterior tibial slope?

et al. 2017

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Background Ethnicity and gender can affect posterior tibial slope; however, studies on this topic have limitations and are in disagreement. The aim of the present study was to evaluate posterior tibial slope in a large group of consecutive patients, determining whether ethnicity and gender can influence its value. Secondly, to determine intra-and inter-rater reliability of the two radiographic methods adopted. Materials and methods Posterior tibial slope was calculated (rater 1) in lateral view X-rays of the knee according to the posterior tibial cortex (PTC) and tibial proximal anatomical axis (TPAA) methods. Data were matched with ethnicity and gender. For determination of intra-and interrater reliability, 50 random X-rays were selected, and blindly measured by two other raters (2 and 3). Results A total of 581 radiographs were included (413 white and 168 black knees). Comparing white and black subjects, a statistically significant difference was found for both PTC (4.9 ± 1.2 vs 7.1 ± 2.9, p \ 0.0001), and for TPAA (7.7 ± 1.1 vs 10.2 ± 3.0, p \ 0.0001). In white subjects, an influence of gender was found only for TPAA (6.4 ± 1.1 in males vs 7.6 ± 1.1 in females, p \ 0.0001). In black subjects, an influence of gender was found only for PTC (7.4 ± 3.0 in males vs 6.2 ± 2.9 in females, p = 0.01). Intra-rater reliability was good for both methods for rater 1, and very good for rater 2. Inter-rater reliability among the 3 raters was very good for both methods. Conclusions Differences in posterior tibial slope between different ethnic groups exist. Differences observed between genders are conflicting and might be too small to have implications in clinical practice. The TPAA method is recommended for the evaluation of posterior tibial slope because of higher intra-and inter-rater reliability. Level of evidence 3 Case-control study.

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Significant Effect of the Posterior Tibial Slope on the Weight-Bearing, Midflexion In Vivo Kinematics After Cruciate-Retaining Total Knee Arthroplasty

Cited by 50 publications

References 26 publications

Does Component Alignment Affect Patient Reported Outcomes following Bicruciate Retaining Total Knee Arthroplasty? An In Vivo Three-Dimensional Analysis

Does Component Alignment Affect Patient Reported Outcomes following Bicruciate Retaining Total Knee Arthroplasty? An In Vivo Three-Dimensional Analysis

Individualized alignment in total knee arthroplasty using image-based robotic assistance

Do ethnicity and gender influence posterior tibial slope?

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