Tibial component sizing and alignment of TKR components does not significantly affect patient reported outcome measures at six months. A case series of 474 participants

Ahmed, Imran; Paraoan, Vlad; Bhatt, Dveej; Mishra, Bhanu; Khatri, Chetan; Griffin, Damian R.; Metcalfe, Andrew; Barlow, Timothy

doi:10.1016/j.ijsu.2018.02.039

Cited by 10 publications

(17 citation statements)

References 37 publications

(45 reference statements)

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“…Because an undersized baseplate will surely fit the tibial cut surface without any overhang but adversely induce insufficient interface coverage and potential malrotation. On the other hand, it is still unclear to what extent of tibial overhang will lead to clinical symptoms requiring revision surgery, some studies have found that sizing of the tibial components does not significantly affect postoperative outcomes, less than 3 mm of overhang were considered mild overhang and can be acceptable in some cases 2,6,10,[25][26][27][28] . Based on the above premises, both manual and automatic positioning for tibial baseplate has been reported previously.…”

Section: Discussionmentioning

confidence: 99%

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: 99%

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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“…2). According to previous studies, over-hang could be classified into three groups: anatomically sized, 0 mm ≤ distance < 1 mm; mild over-hang, 1 mm ≤ distance < 3 mm; severe overhang, distance ≥3 mm [11,12].…”

Section: Radiographic Measurementmentioning

confidence: 99%

“…For tibial component coverage, it is well known that tibial component over-hang causes soft tissue irritation, postoperative pain, limited knee flexion, and poor patient-reported outcome measures (PROMS) (the Knee Injury and Osteoarthritis Outcome score (KOOS score), the Knee Society score (KSS score), and the Western Ontario and McMaster Universities Osteoarthritis Index score (WOMAC)) [9,10]. However, some studies did not show the same results, and the effect of tibial component over-hang on postoperative PROMS is still under debate [11,12]. Many studies have shown that the tibial component under-hang can result in the sinking of the prosthesis and increase the risk of aseptic loosening [13,14].…”

Section: Introductionmentioning

confidence: 99%

Tibial component coverage affects tibial bone resorption and patient-reported outcome measures for patients following total knee arthroplasty

et al. 2021

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Purpose The aim of this study is to investigate the prognostic value of tibial component coverage (over-hang and under-hang) and the alignment of total knee arthroplasty (TKA) components 1 week after surgery. We select patient-reported outcome measures (PROMS) (the Knee Society score (KSS score) and the Western Ontario and McMaster Universities Osteoarthritis Index-pain score (WOMAC pain score)) and tibial bone resorption (TBR) 2 years after surgery as the end points. Methods The study retrospectively analyzed 109 patients undergoing TKA (fixed-bearing prosthesis with asymmetrical tibial tray) from January 2014 to December 2017 in Huashan Hospital. By using standard long-leg X-rays, anteroposterior (AP) and lateral X-rays of the knee, tibial component coverage (under-hang or over-hang), AP tibial-femoral anatomical angle (AP-TFA), AP femoral angle (AP-FA), AP tibial angle (AP-TA), and lateral tibial angle (L-TA) were measured at 1 week after surgery, while TBR was measured through postoperative 1-week and 2-year AP and lateral radiographs of the knee on three sides (medial side, lateral side on AP radiograph, and anterior side on lateral radiograph). The Pearson correlation analysis, simple linear regression, multiple linear regression, the Student’s t test, and one-way ANOVA together with Tukey’s post hoc test (or Games-Howell post hoc test) were used in the analyses. Results Tibial under-hang was more likely to appear in our patients following TKA (42%, medially, 39%, laterally, and 25%, anteriorly). In multivariate linear regression analysis of TBR, tibial under-hang (negative value) 1 week after surgery was positively correlated with TBR 2 years later on the medial (p = 0.003) and lateral (p = 0.026) side. Tibial over-hang (positive value) 1 week after surgery on the medial side was found negatively related with KSS score (p = 0.004) and positively related with WOMAC pain score (p = 0.036) 2 years later in multivariate linear regression analysis of PROMS. Both scores were better in the anatomically sized group than in the mild over-hang group (or severe over-hang) (p < 0.001). However, no significant relationship was found between the alignment of TKA components at 1 week after surgery and the end points (TBR and PROMS) 2 years later. Conclusion Under-hang of the tibial component on both the medial and lateral sides can increase the risk of TBR 2 years later. Over-hang of tibial component on the medial side decreases the PROMS (KSS score and WOMAC pain score) 2 years later. An appropriate size of tibial component during TKA is extremely important for patient’s prognosis, while the alignment of components might not be as important.

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“…Extensive work has been undertaken to identify patient factors (e.g., male/female sex, co‐morbidities, mental health, and preoperative patient expectations) and surgical factors (e.g., implant design and surgical technique) that predict poor outcome following TKA. Increasingly, however, the role of patient biology as a potential driver of pain, stiffness and dissatisfaction is being considered …”

mentioning

confidence: 99%

“…1 While the majority of patients have a successful outcome, with reduced pain and improved function, 2 a significant proportion (10-20%) develop problems including joint stiffness, reduced range of knee motion and pain, which can ultimately require revision surgery. 3 Extensive work has been undertaken to identify patient factors (e.g., male/female sex, co-morbidities, mental health, and preoperative patient expectations) 4 and surgical factors (e.g., implant design and surgical technique) 5 that predict poor outcome following TKA. Increasingly, however, the role of patient biology as a potential driver of pain, stiffness and dissatisfaction is being considered.…”

mentioning

confidence: 99%

Chronic, Active Inflammation in Patients With Failed Total Knee Replacements Undergoing Revision Surgery

Paish

Baldock

Gillespie

et al. 2019

Journal Orthopaedic Research

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Chronic pain and restricted knee motion is a significant problem following the total knee arthroplasty (TKA). The molecular pathogenesis of pain post‐TKA is not known and no targeted therapeutic intervention is available. The aim of this study was to investigate whether pro‐inflammatory mediators are elevated in revision knee patients, indicating an active, ongoing inflammatory process that may contribute to pain. Twelve key markers (pro‐inflammatory cytokines granulocyte‐macrophage colony‐stimulating factor [GM‐CSF], interleukin 5 [IL‐5], IL‐8 and IL‐10, chemokines CCL2, CCL3, CCL4, and CCL13, mediators of angiogenesis Flt‐1, vascular endothelial growth factor, and cell migration vascular cell adhesion molecule 1 and intercellular adhesion molecule 1) were measured in knee tissue and synovial fluid (SF) from primary TKA (n = 29) and revision patients (n = 32). Indications for surgery were osteoarthritis (OA) for primary TKA, and component loosening (n = 11), stiffness (n = 11), laxity pattern (n = 8), or progression of OA in patella resurfacing (n = 3) for revision surgery. Pain levels (WOMAC score) were higher in revision than primary patients (p ≤ 0.05). Time from primary to revision ranged from 8 months to 30 years (median 10 years). All markers were elevated in revision TKA; there was no trend toward decreasing levels with greater time from primary surgery for any marker studied in SF. Similar results were seen in knee tissue. We found no differences comparing indications for revision surgery (p ≥ 0.05). The elevation of inflammatory mediators in painful post‐TKA knees requiring revision suggests active, chronic inflammation. Characterization of upregulated markers provides rationale for targeted therapy, even many years from the primary surgery. © 2019 The Authors. Journal of Orthopaedic Research ® published by Wiley Periodicals, Inc. on behalf of Orthopaedic Research Society. J Orthop Res 37:2316–2324, 2019

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Tibial component sizing and alignment of TKR components does not significantly affect patient reported outcome measures at six months. A case series of 474 participants

Abstract: Tibial component sizing and alignment does not significantly affect short-term function, as measured by OKS, after total knee replacement. Dissatisfaction after TKR is likely due to other factors other than alignment of implant.

Cited by 10 publications

References 37 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

Tibial component coverage affects tibial bone resorption and patient-reported outcome measures for patients following total knee arthroplasty

Chronic, Active Inflammation in Patients With Failed Total Knee Replacements Undergoing Revision Surgery

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