EFFECT OF MEDIAL 1/3 ANATOMICAL ORIENTATION OF TIBIAL TUBERCLE ON ROTATIONAL ALIGNMENT OF Gemini MK-Ⅱ TIBIAL COMPONENTS IN TOTAL KNEE ARTHROPLASTY_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

SUNZhenhui ¹ , SUNYunbo ¹ , RENZhishuai ¹ , LIUJun ² ,  WANGLei ²

1. Department of Joint Surgery, Tianjin People's Hospital, Tianjin, 300000, P. R. China;
2. Department of Joint Surgery, Tianjin Hospital;

Corresponding author：

WANGLei, Email: wanglei12074@sina.com

Keywords：

Total knee arthroplasty; Tibial prosthesis; Rotational alignment; Tibial tubercle

DOI：

10.7507/1002-1892.20150230

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Objective To investigate the effect of medial 1/3 anatomical orientation of the tibial tubercle on the rotational alignment of Gemini MK-Ⅱ tibial components in total knee arthroplasty (TKA). Methods Between March 2011 and December 2012, 61 cases (67 knees) of varus knee osteoarthritis underwent Gemini MK-Ⅱ knee arthroplasty, and the clinical data were retrospectively analyzed. There were 12 males and 49 females, with an average age of 67.6 years (range, 50-82 years). The body mass index ranged from 20.9 to 33.7 kg/m2 (mean, 28.2 kg/m2). Unilateral TKA was performed in 55 cases and bilateral TKA in 6 cases. The duration of knee osteoarthritis ranged from 2 to 30 years (mean, 12.1 years). According to radiographic changes, 56 knees were rated as Kellgren-Lawrence grade Ⅲ and 11 knees as grade IV. During TKA, the tibial rotational alignment was determined by medial 1/3 anatomical orientation of the tibial tubercle. The anteroposterior and lateral X-ray films and CT scan were taken to measure the tibial rotational angle (TRA) at pre-and post-operation and to analyze the relative factors for TRA by Pearson correlation analysis. Results All the patients were followed up 18-41 months (mean, 20.5 months). The range of motion (ROM) significantly increased from (98.806±16.969)° preoperatively to (116.806±11.458)° at last follow-up (t=-11.760, P=0.000). The knee society score (KSS) significantly increased from 111.239±20.344 to 160.522±17.872 at last follow-up (t=-27.271, P=0.000). The anatomical tibiofemoral angle (ATFA), posterior condylar angle (PCA), and TRA were all improved after TKA, showing significant differences when compared with preoperative ones (P<0.05). Rotational malalignment was observed in 11 knees (16.42%) before TKA, and in 14 knees (20.90%) at 1 week after TKA, showing no significant difference (χ²=0.443, P=0.506). There were 8 knees (11.94%) of internal rotation (>8°) and 6 knees (8.96%) of external rotation (>8°). The postoperative tibial prosthesis TRA had no correlation with the preoperative ATFA and tibial plateau TRA, the postoperative PCA and ATFA (r=-0.174, P=0.159; r=0.220, P=0.074; r=0.237, P=0.053; r=-0.095, P=0.442). Conclusion In patients with varus knee osteoarthritis, medial 1/3 anatomical orientation of the tibial tubercle will contribute to the development of tibial rotational malalignment when TKA is performed by using Gemini MK-Ⅱ tibial components.

Citation： SUNZhenhui, SUNYunbo, RENZhishuai, LIUJun, WANGLei. EFFECT OF MEDIAL 1/3 ANATOMICAL ORIENTATION OF TIBIAL TUBERCLE ON ROTATIONAL ALIGNMENT OF Gemini MK-Ⅱ TIBIAL COMPONENTS IN TOTAL KNEE ARTHROPLASTY. Chinese Journal of Reparative and Reconstructive Surgery, 2015, 29(9): 1062-1066. doi: 10.7507/1002-1892.20150230 Copy

1.	Meding JB, Meding LK, Ritter MA, et al. Pain relief and functional improvement remain 20 years after knee arthroplasty. Clin Orthop Relat Res, 2012, 470(1):144-149.
2.	Bell SW, Young P, Drury C, et al. Component rotational alignment in unexplained painful primary total knee arthroplasty. Knee, 2014, 21(1):272-277.
3.	Bhattee G, Moonot P, Govindaswamy R, et al. Does malrotation of components correlate with patient dissatisfaction following secondary patellar resurfacing? Knee, 2014, 21(1):247-251.
4.	孙振辉, 刘军, 王沛. 人工全膝关节置换术后疼痛的诊断和治疗研究进展. 中国修复重建外科杂志, 2010, 24(6):708-713.
5.	Watanabe S, Sato T, Omori G, et al. Change in tibiofemoral rotational alignment during total knee arthroplasty. J Orthop Sci, 2014, 19(4):571-578.
6.	Bédard M, Vince KG, Redfern J, et al. Internal rotation of the tibial component is frequent in stiff total knee arthroplasty. Clin Orthop Relat Res, 2011, 469(8):2346-2355.
7.	Nicoll D, Rowley DI. Internal rotational error of the tibial component is a major cause of pain after total knee replacement. J Bone Joint Surg (Br), 2010, 92(9):1238-1244.
8.	沈锋, 王谦, 黄建明, 等. GEMINI MKⅡ全膝关节置换术的临床应用. 中国骨与关节损伤杂志, 2010, 25(3):207-210.
9.	汪强, 孙俊英, 薛峰, 等. 采用Gemini MKⅡ旋转活动平台假体行全膝关节置换. 中国组织工程研究, 2014, 18(13):2018-2023.
10.	Zha GC, Sun JY, Dong SJ. Less anterior knee pain with a routine lateral release in total knee arthroplasty without patellar resurfacing: a prospective, randomized study. Knee Surg Sports Traumatol Arthrosc, 2014, 22(3):517-525.
11.	王磊, 孙振辉, 孙云波, 等. 屈膝90°外侧胫股关节间隙确定内翻膝人工全膝关节置换术胫骨截骨量的临床研究. 中国修复重建外科杂志, 2014, 28(12):1453-1458.
12.	Berger RA, Rubash HE, Seel MJ, et al. Determining the rotational alignment of the femoral component in total knee arthroplasty using the epicondylar axis. Clin Orthop Relat Res, 1993, (286):40-47.
13.	Akagi M, Oh M, Nonaka T, et al. An anteroposterior axis of the tibia for total knee arthroplasty. Clin Orthop Relat Res, 2004, (420):213-219.
14.	Ritter MA, Faris PM, Keating EM, et al. Postoperative alignment of total knee replacement. Its effect on survival. Clin Orthop Relat Res, 1994, (299):153-156.
15.	Manjunath KS, Gopalakrishna KG, Vineeth G. Evaluation of alignment in total knee arthroplasty:a prospective study. Eur J Orthop Surg Traumatol, 2015, 25(5):895-903.
16.	Heyse TJ, Tibesku CO. Improved tibial component rotation in TKA using patient-specific instrumentation. Arch Orthop Trauma Surg, 2015, 135(5):697-701.
17.	Lützner J, Krummenauer F, Günther KP, et al. Rotational alignment of the tibial component in total knee arthroplasty is better at the medial third of tibial tuberosity than at the medial border. BMC Musculoskelet Disord, 2010, 11:57.
18.	Barrack RL, Schrader T, Bertot AJ, et al. Component rotation and anterior knee pain after total knee arthroplasty. Clin Orthop Relat Res, 2001, (392):46-55.
19.	Howell SM, Chen J, Hull ML. Variability of the location of the tibial tubercle affects the rotational alignment of the tibial component in kinematically aligned total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc, 2013, 21(10):2288-2295.
20.	Berhouet J, Beaufils P, Boisrenoult P, et al. Rotational positioning of the tibial tray in total knee arthroplasty:a CT evaluation. Orthop Traumatol Surg Res, 2011, 97(7):699-704.
21.	Chotanaphuti T, Panichcharoen W, Laoruengthana A. Comparative study of anatomical landmark technique and self-aligned tibial component rotation determined by computer-assisted TKA. J Med Assoc Thai, 2012, 95 Suppl 10:S37-41.
22.	Kawahara S, Okazaki K, Matsuda S, et al. Medial sixth of the patellar tendon at the tibial attachment is useful for the anterior reference in rotational alignment of the tibial component. Knee Surg Sports Traumatol Arthrosc, 2014, 22(5):1070-1075.
23.	史博, 孙振辉, 杨涛, 等. 内翻型膝关节骨性关节炎患者胫股关节扭转和胫骨假体旋转定位研究. 中国矫形外科杂志, 2013, 21(23): 2339-2344.

1. Meding JB, Meding LK, Ritter MA, et al. Pain relief and functional improvement remain 20 years after knee arthroplasty. Clin Orthop Relat Res, 2012, 470(1):144-149.
2. Bell SW, Young P, Drury C, et al. Component rotational alignment in unexplained painful primary total knee arthroplasty. Knee, 2014, 21(1):272-277.
3. Bhattee G, Moonot P, Govindaswamy R, et al. Does malrotation of components correlate with patient dissatisfaction following secondary patellar resurfacing? Knee, 2014, 21(1):247-251.
4. 孙振辉, 刘军, 王沛. 人工全膝关节置换术后疼痛的诊断和治疗研究进展. 中国修复重建外科杂志, 2010, 24(6):708-713.
5. Watanabe S, Sato T, Omori G, et al. Change in tibiofemoral rotational alignment during total knee arthroplasty. J Orthop Sci, 2014, 19(4):571-578.
6. Bédard M, Vince KG, Redfern J, et al. Internal rotation of the tibial component is frequent in stiff total knee arthroplasty. Clin Orthop Relat Res, 2011, 469(8):2346-2355.
7. Nicoll D, Rowley DI. Internal rotational error of the tibial component is a major cause of pain after total knee replacement. J Bone Joint Surg (Br), 2010, 92(9):1238-1244.
8. 沈锋, 王谦, 黄建明, 等. GEMINI MKⅡ全膝关节置换术的临床应用. 中国骨与关节损伤杂志, 2010, 25(3):207-210.
9. 汪强, 孙俊英, 薛峰, 等. 采用Gemini MKⅡ旋转活动平台假体行全膝关节置换. 中国组织工程研究, 2014, 18(13):2018-2023.
10. Zha GC, Sun JY, Dong SJ. Less anterior knee pain with a routine lateral release in total knee arthroplasty without patellar resurfacing: a prospective, randomized study. Knee Surg Sports Traumatol Arthrosc, 2014, 22(3):517-525.
11. 王磊, 孙振辉, 孙云波, 等. 屈膝90°外侧胫股关节间隙确定内翻膝人工全膝关节置换术胫骨截骨量的临床研究. 中国修复重建外科杂志, 2014, 28(12):1453-1458.
12. Berger RA, Rubash HE, Seel MJ, et al. Determining the rotational alignment of the femoral component in total knee arthroplasty using the epicondylar axis. Clin Orthop Relat Res, 1993, (286):40-47.
13. Akagi M, Oh M, Nonaka T, et al. An anteroposterior axis of the tibia for total knee arthroplasty. Clin Orthop Relat Res, 2004, (420):213-219.
14. Ritter MA, Faris PM, Keating EM, et al. Postoperative alignment of total knee replacement. Its effect on survival. Clin Orthop Relat Res, 1994, (299):153-156.
15. Manjunath KS, Gopalakrishna KG, Vineeth G. Evaluation of alignment in total knee arthroplasty:a prospective study. Eur J Orthop Surg Traumatol, 2015, 25(5):895-903.
16. Heyse TJ, Tibesku CO. Improved tibial component rotation in TKA using patient-specific instrumentation. Arch Orthop Trauma Surg, 2015, 135(5):697-701.
17. Lützner J, Krummenauer F, Günther KP, et al. Rotational alignment of the tibial component in total knee arthroplasty is better at the medial third of tibial tuberosity than at the medial border. BMC Musculoskelet Disord, 2010, 11:57.
18. Barrack RL, Schrader T, Bertot AJ, et al. Component rotation and anterior knee pain after total knee arthroplasty. Clin Orthop Relat Res, 2001, (392):46-55.
19. Howell SM, Chen J, Hull ML. Variability of the location of the tibial tubercle affects the rotational alignment of the tibial component in kinematically aligned total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc, 2013, 21(10):2288-2295.
20. Berhouet J, Beaufils P, Boisrenoult P, et al. Rotational positioning of the tibial tray in total knee arthroplasty:a CT evaluation. Orthop Traumatol Surg Res, 2011, 97(7):699-704.
21. Chotanaphuti T, Panichcharoen W, Laoruengthana A. Comparative study of anatomical landmark technique and self-aligned tibial component rotation determined by computer-assisted TKA. J Med Assoc Thai, 2012, 95 Suppl 10:S37-41.
22. Kawahara S, Okazaki K, Matsuda S, et al. Medial sixth of the patellar tendon at the tibial attachment is useful for the anterior reference in rotational alignment of the tibial component. Knee Surg Sports Traumatol Arthrosc, 2014, 22(5):1070-1075.
23. 史博, 孙振辉, 杨涛, 等. 内翻型膝关节骨性关节炎患者胫股关节扭转和胫骨假体旋转定位研究. 中国矫形外科杂志, 2013, 21(23): 2339-2344.

Chinese Journal of Reparative and Reconstructive Surgery

EFFECT OF MEDIAL 1/3 ANATOMICAL ORIENTATION OF TIBIAL TUBERCLE ON ROTATIONAL ALIGNMENT OF Gemini MK-Ⅱ TIBIAL COMPONENTS IN TOTAL KNEE ARTHROPLASTY

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