Excessive Sagittal Slope of the Tibia Component during Kinematic Alignment—Safety and Functionality at a Minimum 2-Year Follow-Up
Abstract
:1. Introduction
2. Materials and Methods
2.1. Technique
2.2. Radiographic Analysis
2.3. Follow-Up Examination
2.4. Statistical Analysis
3. Results
4. Discussion
Study Limitations
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
- Varacallo, M.; Luo, T.D.; Johanson, N.A. Total Knee Arthroplasty Techniques. In StatPearls [Internet]; StatPearls Publishing: Treasure Island, FL, USA, 2022. Available online: https://www.ncbi.nlm.nih.gov/books/NBK499896/ (accessed on 5 August 2022).
- Bourne, R.B.; Chesworth, B.M.; Davis, A.M.; Mahomed, N.N.; Charron, K.D. Patient satisfaction after total knee arthroplasty: Who is satisfied and who is not? Clin. Orthop. Relat. Res. 2010, 468, 57–63. [Google Scholar] [CrossRef] [PubMed]
- Klit, J.; Jacobsen, S.; Rosenlund, S.; Sonne-Holm, S.; Troelsen, A. Total knee arthroplasty in younger patients evaluated by alternative outcome measures. J. Arthroplast. 2014, 29, 912–917. [Google Scholar] [CrossRef] [PubMed]
- Gunaratne, R.; Pratt, D.N.; Banda, J.; Fick, D.P.; Khan, R.J.K.; Robertson, B.W. Patient Dissatisfaction Following Total Knee Arthroplasty: A Systematic Review of the Literature. J. Arthroplast. 2017, 32, 3854–3860. [Google Scholar] [CrossRef] [PubMed]
- Scott, C.E.; Oliver, W.M.; MacDonald, D.; Wade, F.A.; Moran, M.; Breusch, S.J. Predicting dissatisfaction following total knee arthroplasty in patients under 55 years of age. Bone Jt. J. 2016, 98-B, 1625–1634. [Google Scholar] [CrossRef] [PubMed]
- Nam, D.; Nunley, R.M.; Barrack, R.L. Patient dissatisfaction following total knee replacement: A growing concern? Bone Jt. J. 2014, 96-B, 96–100. [Google Scholar] [CrossRef]
- Nisar, S.; Palan, J.; Rivière, C.; Emerton, M.; Pandit, H. Kinematic alignment in total knee arthroplasty. EFORT Open Rev. 2020, 5, 380–390. [Google Scholar] [CrossRef]
- Calliess, T.; Bauer, K.; Stukenborg-Colsman, C.; Windhagen, H.; Budde, S.; Ettinger, M. PSI kinematic versus non-PSI mechanical alignment in total knee arthroplasty: A prospective, randomized study. Knee Surg. Sports Traumatol. Arthrosc. 2017, 25, 1743–1748. [Google Scholar] [CrossRef]
- Yoon, J.R.; Han, S.B.; Jee, M.K.; Shin, Y.S. Comparison of kinematic and mechanical alignment techniques in primary total knee arthroplasty: A meta-analysis. Medicine 2017, 96, e8157. [Google Scholar] [CrossRef]
- Howell, S.M.; Roth, J.D.; Hull, M.L. Kinematic Alignment in Total Knee Arthroplasty; Elsevier: Philadelphia, PA, USA, 2012. [Google Scholar]
- Sappey-Marinier, E.; Pauvert, A.; Batailler, C.; Swan, J.; Cheze, L.; Servien, E.; Lustig, S. Kinematic versus mechanical alignment for primary total knee arthroplasty with minimum 2 years follow-up: A systematic review. SICOT J. 2020, 6, 18. [Google Scholar] [CrossRef]
- Vendittoli, P.A.; Martinov, S.; Blakeney, W.G. Restricted Kinematic Alignment, the Fundamentals, and Clinical Applications. Front. Surg. 2021, 8, 697020. [Google Scholar] [CrossRef]
- Laforest, G.; Kostretzis, L.; Kiss, M.O.; Vendittoli, P.A. Restricted kinematic alignment leads to uncompromised osseointegration of cementless total knee arthroplasty. Knee Surg. Sports Traumatol. Arthrosc. 2022, 30, 705–712. [Google Scholar] [CrossRef] [PubMed]
- The “Linked Soft Tissue Guided Technique”: A Novel Method for Cutting the Tibia While Performing a Kinematic Femoral Alignment in Total Knee Arthroplasty-Bar-Ziv-Annals of Joint [Internet]. Available online: https://aoj.amegroups.com/article/view/5377/html (accessed on 9 May 2022).
- Paley, D. Normal Lower Limb Alignment and Joint Orientation. In Principles of Deformity Correction; Springer: Berlin/Heidelberg, Germany, 2002; pp. 1–18. [Google Scholar] [CrossRef]
- Liu, C.; Zhao, G.; Chen, K.; Lyu, J.; Chen, J.; Shi, J.; Huang, G.; Chen, F.; Wei, Y.; Wang, S.; et al. Tibial component coverage affects tibial bone resorption and patient-reported outcome measures for patients following total knee arthroplasty. J. Orthop. Surg. Res. 2021, 16, 134. [Google Scholar] [CrossRef] [PubMed]
- Kim, K.H.; Bin, S.I.; Kim, J.M. The Correlation between Posterior Tibial Slope and Maximal Angle of Flexion after Total Knee Arthroplasty. Knee Surg. Relat. Res. 2012, 24, 158–163. [Google Scholar] [CrossRef]
- Lyman, S.; Lee, Y.Y.; McLawhorn, A.S.; Islam, W.; MacLean, C.H. What Are the Minimal and Substantial Improvements in the HOOS and KOOS and JR Versions after Total Joint Replacement? Clin. Orthop. 2018, 476, 2432–2441. [Google Scholar] [CrossRef] [PubMed]
- Clement, N.D.; MacDonald, D.; Simpson, A.H.R.W. The minimal clinically important difference in the Oxford knee score and Short Form 12 score after total knee arthroplasty. Knee Surg. Sports Traumatol. Arthrosc. 2014, 22, 1933–1939. [Google Scholar] [CrossRef]
- Okamoto, S.; Mizu-uchi, H.; Okazaki, K.; Hamai, S.; Nakahara, H.; Iwamoto, Y. Effect of Tibial Posterior Slope on Knee Kinematics, Quadriceps Force, and Patellofemoral Contact Force After Posterior-Stabilized Total Knee Arthroplasty. J. Arthroplast. 2015, 30, 1439–1443. [Google Scholar] [CrossRef] [PubMed]
- Shi, X.; Shen, B.; Kang, P.; Yang, J.; Zhou, Z.; Pei, F. The effect of posterior tibial slope on knee flexion in posterior-stabilized total knee arthroplasty. Knee Surg. Sports Traumatol. Arthrosc. 2013, 21, 2696–2703. [Google Scholar] [CrossRef] [PubMed]
- Kansara, D.; Markel, D.C. The effect of posterior tibial slope on range of motion after total knee arthroplasty. J. Arthroplast. 2006, 21, 809–813. [Google Scholar] [CrossRef] [PubMed]
- Lombardi, A.V., Jr.; Berend, K.R.; Aziz-Jacobo, J.; Davis, M.B. Balancing the flexion gap: Relationship between tibial slope and posterior cruciate ligament release and correlation with range of motion. J. Bone Jt. Surg. Am. 2008, 90 (Suppl. 4), 121–132. [Google Scholar] [CrossRef] [PubMed]
- Nunley, R.M.; Nam, D.; Johnson, S.R.; Barnes, C.L. Extreme variability in posterior slope of the proximal tibia: Measurements on 2395 CT scans of patients undergoing UKA? J. Arthroplast. 2014, 29, 1677–1680. [Google Scholar] [CrossRef]
- Yoo, J.H.; Chang, C.B.; Shin, K.S.; Seong, S.C.; Kim, T.K. Anatomical references to assess the posterior tibial slope in total knee arthroplasty: A comparison of 5 anatomical axes. J. Arthroplast. 2008, 23, 586–592. [Google Scholar] [CrossRef] [PubMed]
- Singh, G.; Tan, J.H.; Sng, B.Y.; Awiszus, F.; Lohmann, C.H.; Nathan, S.S. Restoring the anatomical tibial slope and limb axis may maximise post-operative flexion in posterior-stabilised total knee replacements. Bone Jt. J. 2013, 95-B, 1354–1358. [Google Scholar] [CrossRef] [PubMed]
- Catani, F.; Leardini, A.; Ensini, A.; Cucca, G.; Bragonzoni, L.; Toksvig-Larsen, S.; Giannini, S. The stability of the cemented tibial component of total knee arthroplasty: Posterior cruciate-retaining versus posterior-stabilized design. J. Arthroplast. 2004, 19, 775–782. [Google Scholar] [CrossRef]
- Adıyeke, L.; Kafadar, A.B.; Erdoğan, Ö.; Gündüz, Ç.D. The effect of tibial slope angle on clinical and functional results after mobile bearing total knee arthroplasty. J. Orthop. Trauma Rehabil. 2022, 29, 22104917221075828. [Google Scholar] [CrossRef]
- Nedopil, A.J.; Howell, S.M.; Hull, M.L. What mechanisms are associated with tibial component failure after kinematically-aligned total knee arthroplasty? Int. Orthop. 2017, 41, 1561–1569. [Google Scholar] [CrossRef]
- Ciliberti, F.K.; Cesarelli, G.; Guerrini, L.; Gunnarsson, A.E.; Forni, R.; Aubonnet, R.; Recenti, M.; Jacob, D.; Jónsson, J.H.; Cangiano, V.; et al. The role of bone mineral density and cartilage volume to predict knee cartilage degeneration. Eur. J. Transl. Myol. 2022, 32, 10678. [Google Scholar] [CrossRef] [PubMed]
- Ciliberti, F.K.; Guerrini, L.; Gunnarsson, A.E.; Recenti, M.; Jacob, D.; Cangiano, V.; Tesfahunegn, Y.A.; Islind, A.S.; Tortorella, F.; Tsirilaki, M.; et al. CT- and MRI-Based 3D Reconstruction of Knee Joint to Assess Cartilage and Bone. Diagnostics. 2022, 12, 279. [Google Scholar] [CrossRef]
- Recenti, M.; Ricciardi, C.; Edmunds, K.; Gislason, M.K.; Gargiulo, P. Machine learning predictive system based upon radiodensitometric distributions from mid-thigh CT images. Eur. J. Transl. Myol. 2020, 30, 8892. [Google Scholar] [CrossRef]
- Brooks, P. Seven cuts to the perfect total knee. Orthopedics 2009, 32, e1000642. [Google Scholar] [CrossRef]
- Matsumoto, T.; Takayama, K.; Ishida, K.; Hayashi, S.; Hashimoto, S.; Kuroda, R. Radiological and clinical comparison of kinematically versus mechanically aligned total knee arthroplasty. Bone Jt. J. 2017, 99, 640–646. [Google Scholar] [CrossRef]
- Chambers, A.W.; Wood, A.R.; Kosmopoulos, V.; Sanchez, H.B.; Wagner, R.A. Effect of posterior tibial slope on flexion and anterior-posterior tibial translation in posterior cruciate-retaining total knee arthroplasty. J. Arthroplast. 2016, 31, 103–106. [Google Scholar] [CrossRef] [PubMed]
- Kang, K.T.; Kwon, S.K.; Son, J.; Kwon, O.R.; Lee, J.S.; Koh, Y.G. The increase in posterior tibial slope provides a positive biomechanical effect in posterior-stabilized total knee arthroplasty. Knee Surg. Sports Traumatol. Arthrosc. 2018, 26, 3188–3195. [Google Scholar] [CrossRef] [PubMed]
Variable | Moderate (n = 112) | Excessive (n = 225) | p-Value |
---|---|---|---|
Age | 69.4 (SD 9.2) | 70.98 (7.2) | 0.095 |
Gender (female) | 74 (66.1%) | 147 (65.3%) | 0.497 |
BMI (kg/m) | 31.56 (5.3) | 31.79 (5.02) | 0.707 |
CCI | 0.88 (1.08) | 0.88 (1.16) | 0.997 |
Anesthesia (spinal) | 83 (74.1%) | 161 (71.6%) | 0.36 |
Operative duration (minute) | 83.6 (22.3) | 83.25 (20.4) | 0.886 |
LOS | 4.25 (2.3) | 4.16 (2.6) | 0.745 |
Extension | 4.52 (5.9) | 3.86 (4.7) | 0.469 |
Flexion | 111.29 (15.1) | 108.08 (16.6) | 0.246 |
VAS | 8.18 (1.4) | 8.02 (1.4) | 0.349 |
OKS | 12.99 (7.2) | 13.8 (7.8) | 0.356 |
KOOS TOTAL | 29.36 (15.4) | 28.11 (14.6) | 0.468 |
Time to follow-up (m) | 41.71 (8.9) | 39.17 (9.6) | 0.02 |
Preoperative | Postoperative | |||||
---|---|---|---|---|---|---|
Moderate | Excessive | p-Value | Moderate | Excessive | p-Value | |
PTS | 9.6 (5.4) | 11.79 (5.4) | 0.001 | 2.87 (1.8) | 9.19 (2.9) | <0.001 |
MPTA | 85.14 (3.3) | 85.2 (3.6) | 0.876 | 86.14 (3.02) | 86.64 (3.1) | 0.16 |
LDFA | 89.53 (3.8) | 89.46 (4.02) | 0.889 | 85.64 (4.7) | 84.22 (3.7) | 0.007 |
HKA | 9.47 (4.83) | 10.24 (5.02) | 0.185 | 2.91 (2.9) | 1.92 (3.44) | 0.029 |
MCID | Moderate (n = 112) | Excessive (n = 225) | p-Value |
---|---|---|---|
OKS | 68 (60.7%) | 128 (56.8%) | 0.287 |
KOOS Symptoms | 67 (84.0%) | 113 (82.0%) | 0.028 |
KOOS Pain | 58 (73.1%) | 106 (83.6%) | 0.333 |
KOOS Function | 65 (85.3%) | 118 (83.6%) | 0.238 |
KOOS QOL | 64 (88.5%) | 128 (90.2%) | 0.276 |
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Bar Ziv, Y.; Livshits, G.; Lamykin, K.; Khatib, S.; Ben Sira, Y.; Rabau, O.; Shohat, N.; Essa, A. Excessive Sagittal Slope of the Tibia Component during Kinematic Alignment—Safety and Functionality at a Minimum 2-Year Follow-Up. J. Pers. Med. 2022, 12, 1407. https://doi.org/10.3390/jpm12091407
Bar Ziv Y, Livshits G, Lamykin K, Khatib S, Ben Sira Y, Rabau O, Shohat N, Essa A. Excessive Sagittal Slope of the Tibia Component during Kinematic Alignment—Safety and Functionality at a Minimum 2-Year Follow-Up. Journal of Personalized Medicine. 2022; 12(9):1407. https://doi.org/10.3390/jpm12091407
Chicago/Turabian StyleBar Ziv, Yaron, Gilad Livshits, Konstantin Lamykin, Salah Khatib, Yuval Ben Sira, Oded Rabau, Noam Shohat, and Ahmad Essa. 2022. "Excessive Sagittal Slope of the Tibia Component during Kinematic Alignment—Safety and Functionality at a Minimum 2-Year Follow-Up" Journal of Personalized Medicine 12, no. 9: 1407. https://doi.org/10.3390/jpm12091407