Clin Orthop Surg.  2017 Dec;9(4):458-464. 10.4055/cios.2017.9.4.458.

Lateralization of Tibial Plateau Reference Point Improves Accuracy of Tibial Resection in Total Knee Arthroplasty in Patients with Proximal Tibia Vara

• Thippana R
• Kumar MN

• KMID: 2412246
• DOI: http://doi.org/10.4055/cios.2017.9.4.458

Abstract

BACKGROUND
The tibial cut referenced to the center of the intercondylar eminence often leads to varus malalignment in the presence of preexisting proximal tibia vara. The purpose of this study was to investigate the effect of lateralization of the lateral tibial plateau reference point (based on the amount of proximal tibia vara) on the postoperative coronal plane alignment.
METHODS
In this prospective cohort study, 62 patients (95 knees) with osteoarthritis and proximal tibia vara underwent primary total knee arthroplasty using a lateral tibial plateau reference point for the extramedullary jig. The pre- and postoperative radiographs were obtained for measurement of mechanical axis deviation, degree of tibia vara, proximal lateral reference point of the tibial condyle, and coronal alignment of the femoral and tibial components. The distance between the tibial reference point and the center of the intercondylar eminence was measured intraoperatively.
RESULTS
The mean tibia vara was 7.1° (standard deviation [SD], 2.3°). The mean lateral displacement of the reference point was 7 mm (SD, 2.2 mm). Postoperative tibiofemoral angle was 6° to 10° of valgus in 94% of cases. There was a strong correlation between the magnitude of tibia vara and the amount of lateralization of the tibial reference point (R² = 0.79, p < 0.001).
CONCLUSIONS
In total knee arthroplasty patients with proximal tibia vara, reasonable accuracy can be achieved with use of the extramedullary jig for tibial component alignment by lateralizing the proximal tibial reference point.

Keyword

Knee arthroplasty; Tibia vara; Tibial deformity; Tibial axis

MeSH Terms

Aged
Aged, 80 and over
Anatomic Landmarks
Arthroplasty, Replacement, Knee/instrumentation/*methods
Female
Humans
Knee Joint/diagnostic imaging/surgery
Male
Middle Aged
Osteoarthritis, Knee/diagnostic imaging/*surgery
Prospective Studies
Radiography
Tibia/*abnormalities/diagnostic imaging/*surgery

Figure

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  Fig. 1 Preoperative scanogram showing bilateral osteoarthritis of the knees with proximal tibia vara. The longer line represents the anatomical axis of the tibia. The shorter line is drawn from the center of the line along the tibial plateau and perpendicular to the plateau. The angle between the two lines is the magnitude of proximal tibia vara.

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  Fig. 2 Diagrammatic representation of the method of determining the lateral tibial reference point. (a): Line drawn along the tibial articular surface, (b): line drawn along the anatomical axis of the tibia, (c): line drawn perpendicular to line (a) at the center of the tibial intercondylar eminence, (p): center of the intercondylar eminence, (q): point of intersection of lines (a) and (b), angle α: angle between lines (b) and (c), x: distance of the reference point from (p).

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  Fig. 3 Extent of exposure of the lateral tibial condyle required for correct placement of the extramedullary jig.

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  Fig. 4 Intraoperative photograph showing the lateral condylar reference line which is 10 mm lateral to the center of the intercondylar eminence.

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  Fig. 5 Placement of the jig co-linear with the lateral condyle reference mark and secured with the lateral pin.

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  Fig. 6 Alignment of the extramedullary rod at the center of the ankle.

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  Fig. 7 Confirmation of the correct alignment of the jig prior to insertion of a medial pin.

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  Fig. 8 Relationship between proximal tibia vara and the lateral tibial plateau reference point.

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  Fig. 9 (A) Postoperative radiograph showing suboptimal medial component angle of 87.7° with the use of the central intercondylar reference point in a patient with proximal tibia vara. (B) Postoperative radiograph showing medial tibial component angle of 90.4° obtained using the lateral tibial condylar reference point in the contralateral knee of the same patient.

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