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Knee Surgery, Sports Traumatology, Arthroscopy
Erschienen in: Knee Surgery, Sports Traumatology, Arthroscopy 5/2019

11.07.2018 | Knee

Bony landmarks with tibial cutting surface are useful to avoid rotational mismatch in total knee arthroplasty

verfasst von: Yuan Ma, Hideki Mizu-uchi, Tetsuro Ushio, Satoshi Hamai, Yukio Akasaki, Koji Murakami, Yasuharu Nakashima

Erschienen in: Knee Surgery, Sports Traumatology, Arthroscopy | Ausgabe 5/2019

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Abstract

Purpose

The purpose of this study was to define various anteroposterior axes of the tibial component as references and to evaluate their accuracy and variability using virtual surgery. It was hypothesized that (1) Akagi’s Line could result in high accuracy and low variability in varus osteoarthritic knees; (2) anteroposterior axes defined by using the tibial bony cutting surface as a landmark might be good substitutes for Akagi’s Line; and (3) extra-articular bony landmarks might influence the variability of the anteroposterior axis.

Methods

Three-dimensional bone models were reconstructed from the preoperative computed tomography data of 111 osteoarthritic knees with varus deformities. Seven different anteroposterior axes of the tibial component were defined: Akagi’s Line, Axis MED, Axis 1/6MED, Axis 1/3MED, Axis of Oval Shape, Axis of Anterior Crest, and Axis Second Metatarsus. The rotational mismatch angle was measured between the tibial anteroposterior axis and the line perpendicular to the transepicondylar axis projected on the cutting surface (positive value: external rotation of the tibial anteroposterior axis).

Results

The average rotational mismatch angles (referring to the projected anatomical/surgical epicondylar axes) were − 2.7° ± 5.8°/1.0° ± 6.0° (Akagi’s Line), − 4.2° ± 7.7°/− 0.5° ± 7.8°, 2.9° ± 7.2°/6.6° ± 7.2°, 9.8° ± 7.0°/13.5° ± 6.8° (Axis MED, Axis 1/6MED, Axis 1/3MED), − 5.1° ± 7.9°/− 1.4° ± 7.8° (Axis of Oval Shape), and 19.3 ± 9.5°/23.0° ± 9.6°, − 2.0° ± 11.3°/1.7° ± 11.4° (Axis Anterior Crest, Axis Second Metatarsus), respectively.

Conclusions

Akagi’s Line provided the best accuracy and least variability in varus osteoarthritic knees. Axis 1/6MED and Axis MED are good substitutes for Akagi’s Line due to the difficulty of identifying the attachment site of the posterior cruciate ligament after the proximal tibia has been cut. Extra-articular bony landmarks should not be used for alignment due to their high variability. This study will aid surgeons in choosing the proper anteroposterior axis of the tibial component to reduce rotational mismatch and thus achieve good clinical knee outcomes.

Levels of evidence

III.
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Metadaten
Titel
Bony landmarks with tibial cutting surface are useful to avoid rotational mismatch in total knee arthroplasty
verfasst von
Yuan Ma
Hideki Mizu-uchi
Tetsuro Ushio
Satoshi Hamai
Yukio Akasaki
Koji Murakami
Yasuharu Nakashima
Publikationsdatum
11.07.2018
Verlag
Springer Berlin Heidelberg
Erschienen in
Knee Surgery, Sports Traumatology, Arthroscopy / Ausgabe 5/2019
Print ISSN: 0942-2056
Elektronische ISSN: 1433-7347
DOI
https://doi.org/10.1007/s00167-018-5052-x

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