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Variability of Sagittal Plane Proximal Tibial Morphology and Its Effect on Stem Placement in Total Knee Arthroplasty

The tibial joint line is offset posteriorly relative to the tibial sagittal anatomic axis. This can have consequences when using stemmed implants during total knee arthroplasty. We retrospectively analyzed native knee lateral radiographs in 100 patients. The distance between the sagittal anatomic ax...

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Autores principales: Secrist, Eric S., Rowe, Taylor, Li, Katherine K., Fehring, Thomas K.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Elsevier 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8685910/
https://www.ncbi.nlm.nih.gov/pubmed/34977307
http://dx.doi.org/10.1016/j.artd.2021.10.018
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author Secrist, Eric S.
Rowe, Taylor
Li, Katherine K.
Fehring, Thomas K.
author_facet Secrist, Eric S.
Rowe, Taylor
Li, Katherine K.
Fehring, Thomas K.
author_sort Secrist, Eric S.
collection PubMed
description The tibial joint line is offset posteriorly relative to the tibial sagittal anatomic axis. This can have consequences when using stemmed implants during total knee arthroplasty. We retrospectively analyzed native knee lateral radiographs in 100 patients. The distance between the sagittal anatomic axis and the center of a simulated tibial resection was calculated as a percentage of overall tibial width. Analysis of 5 manufacturers’ baseplates showed that the tibial stem attached on average 10% anterior to the midline. We measured the impingement point of a 12-mm-diameter stem starting from this position. The tibial joint surface was offset posteriorly from the anatomic axis in all patients by an average of 23.5% of the tibial width (range: 13.1%-33.2%). A 12-mm tibial stem would impinge within 40 mm in 2% (2/100) of patients and within 60 mm in 19% (19/100). There was a weak but statistically significant correlation between proximal tibial offset and distance to impingement. During total knee arthroplasty, the center of the cut tibia is offset posteriorly from the sagittal anatomic axis. In patients with high offset, tibial stem extensions can impinge against the posterior tibia, causing baseplate malpositioning, diminished cement mantle, or fracture.
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spelling pubmed-86859102021-12-30 Variability of Sagittal Plane Proximal Tibial Morphology and Its Effect on Stem Placement in Total Knee Arthroplasty Secrist, Eric S. Rowe, Taylor Li, Katherine K. Fehring, Thomas K. Arthroplast Today Surgical Technique The tibial joint line is offset posteriorly relative to the tibial sagittal anatomic axis. This can have consequences when using stemmed implants during total knee arthroplasty. We retrospectively analyzed native knee lateral radiographs in 100 patients. The distance between the sagittal anatomic axis and the center of a simulated tibial resection was calculated as a percentage of overall tibial width. Analysis of 5 manufacturers’ baseplates showed that the tibial stem attached on average 10% anterior to the midline. We measured the impingement point of a 12-mm-diameter stem starting from this position. The tibial joint surface was offset posteriorly from the anatomic axis in all patients by an average of 23.5% of the tibial width (range: 13.1%-33.2%). A 12-mm tibial stem would impinge within 40 mm in 2% (2/100) of patients and within 60 mm in 19% (19/100). There was a weak but statistically significant correlation between proximal tibial offset and distance to impingement. During total knee arthroplasty, the center of the cut tibia is offset posteriorly from the sagittal anatomic axis. In patients with high offset, tibial stem extensions can impinge against the posterior tibia, causing baseplate malpositioning, diminished cement mantle, or fracture. Elsevier 2021-12-15 /pmc/articles/PMC8685910/ /pubmed/34977307 http://dx.doi.org/10.1016/j.artd.2021.10.018 Text en © 2021 The Authors https://creativecommons.org/licenses/by-nc-nd/4.0/This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).
spellingShingle Surgical Technique
Secrist, Eric S.
Rowe, Taylor
Li, Katherine K.
Fehring, Thomas K.
Variability of Sagittal Plane Proximal Tibial Morphology and Its Effect on Stem Placement in Total Knee Arthroplasty
title Variability of Sagittal Plane Proximal Tibial Morphology and Its Effect on Stem Placement in Total Knee Arthroplasty
title_full Variability of Sagittal Plane Proximal Tibial Morphology and Its Effect on Stem Placement in Total Knee Arthroplasty
title_fullStr Variability of Sagittal Plane Proximal Tibial Morphology and Its Effect on Stem Placement in Total Knee Arthroplasty
title_full_unstemmed Variability of Sagittal Plane Proximal Tibial Morphology and Its Effect on Stem Placement in Total Knee Arthroplasty
title_short Variability of Sagittal Plane Proximal Tibial Morphology and Its Effect on Stem Placement in Total Knee Arthroplasty
title_sort variability of sagittal plane proximal tibial morphology and its effect on stem placement in total knee arthroplasty
topic Surgical Technique
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8685910/
https://www.ncbi.nlm.nih.gov/pubmed/34977307
http://dx.doi.org/10.1016/j.artd.2021.10.018
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