Value of personalized extramedullary positioning technique on tibia side for coronal alignment of tibial prosthesis in total knee arthroplasty_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

XIONG Changjun ¹ , LI Peng ² , ZHANG Yanchao ³ , DU Yinqiao ³ , LI Tiejian ³ ,  GAO Zhisen ³ ,  ZHOU Yonggang ³

1. Department of Orthopedics, Hubei 672 Orthopedic Hospital of Integrated Chinese & Western Medicine (Orthopedic Hospital Affiliated to Hubei University of Traditional Chinese Medicine), Wuhan Hubei, 430079, P. R. China;
2. Department of Orthopedics, the Third Affiliated Hospital of Guangzhou University of Traditional Chinese Medicine, Guangzhou Guangdong, 510240, P. R. China;
3. Senior Department of Orthopedics, the Fourth Medical Center of Chinese PLA General Hospital, Beijing, 100048, P. R. China;

Corresponding?author：

GAO Zhisen, Email: zhisengao1015@163.com; ZHOU Yonggang, Email: zhouyg@263.net

Keywords：

Total knee arthroplasty; personalized extramedullary positioning technique; tibial prosthesis; coronal alignment

DOI：

10.7507/1002-1892.202108105

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Objective To explore the coronal alignment of tibial prosthesis after osteotomy using personalized extramedullary positioning technique on tibia side in total knee arthroplasty (TKA). Methods A clinical data of 170 patients (210 knees) who underwent primary TKA between January 2020 and June 2021 and met the selection criteria was retrospectively analyzed. Personalized and traditional extramedullary positioning techniques were used in 93 cases (114 knees, personalized positioning group) and 77 cases (96 knees, traditional positioning group), respectively. The personalized extramedullary positioning was based on the anatomical characteristics of the tibia, a personalized positioning point was selected as the proximal extramedullary positioning point on the articular surface of the tibial plateau. There was no significant difference between the two groups in gender, age, body mass index, surgical side, course of osteoarthritis, and Kellgren-Lawrence classification (P>0.05). The preoperative tibial bowing angle (TBA) formed by the proximal and distal tibial coronal anatomical axes in the personalized positioning group was measured and the tibia axis was classified, and the distribution of personalized positioning point was analyzed. The pre- and post-operative hip-knee-ankle angle (HKA), the lateral distal tibial angle (LDTA), and the postoperative tibia component angle (TCA), the excellent rate of tibial prosthesis alignment in coronal position were compared between the two groups. Results In the personalized positioning group, 58 knees (50.88%) were straight tibia, 35 knees (30.70%) were medial bowing tibia, and 21 knees (18.42%) were lateral bowing tibia. The most positioning points located on the highest point of the lateral intercondylar spine (62.07%) in the straight tibia group, while in the medial bowing tibia and lateral bowing tibia groups, most positioning points located in the area between the medial and lateral intercondylar spines (51.43%) and the lateral slope of the lateral intercondylar spine (57.14%), respectively. The difference in HKA between pre- and post-operation in the two groups was significant (P<0.05); while the difference in LDTA was not significant (P>0.05). There was no significant difference in preoperative LDTA and HKA and the difference between pre- and post-operation between groups (P>0.05). But there was significant difference in postoperative TCA between groups (P<0.05). The postoperative tibial plateau prosthesis in the traditional positioning group was more prone to varus than the personalized positioning group. The excellent rates of tibial prosthesis alignment in coronal position were 96.5% (110/114) and 87.5% (84/96) in personalized positioning group and traditional positioning group, respectively, showing a significant difference between groups (χ²=7.652, P=0.006). Conclusion It is feasible to use personalized extramedullary positioning technique for coronal osteotomy on the tibia side in TKA. Compared with the traditional extramedullary positioning technique, the personalized extramedullary positioning technique has a higher excellent rate of tibial prosthesis alignment in coronal position.

Citation： XIONG Changjun, LI Peng, ZHANG Yanchao, DU Yinqiao, LI Tiejian, GAO Zhisen, ZHOU Yonggang. Value of personalized extramedullary positioning technique on tibia side for coronal alignment of tibial prosthesis in total knee arthroplasty. Chinese Journal of Reparative and Reconstructive Surgery, 2022, 36(2): 177-182. doi: 10.7507/1002-1892.202108105 Copy

1.	Meding JB, Berend ME, Ritter MA, et al. Intramedullary vs extramedullary femoral alignment guides: a 15-year follow-up of survivorship. J Arthroplasty, 2011, 26(4): 591-595.
2.	Qin YF, Li N, Shi YX, et al. Intramedullary versus extramedullary alignment guides on total knee arthroplasty: a meta-analysis. J Comp Eff Res, 2018, 7(12): 1181-1193.
3.	Feeley I, Hegarty A, Hickey A, et al. Impact of use of intramedullary and extramedullary guides on tibial component geometry in total knee replacements: A systematic review and meta-analysis. J Knee Surg, 2016, 29(6): 487-496.
4.	Fukagawa S, Matsuda S, Mitsuyasu H, et al. Anterior border of the tibia as a landmark for extramedullary alignment guide in total knee arthroplasty for varus knees. J Orthop Res, 2011, 29(6): 919-924.
5.	Sugimura N, Ikeuchi M, Izumi M, et al. The dorsal pedis artery as a new distal landmark for extramedullary tibial alignment in total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc, 2014, 22(11): 2618-2622.
6.	Bilgen O, Bilgen S, Ermutlu C, et al. The extensor hallucis longus tendon as the distal reference point in total knee arthroplasty and tibial alignment. Acta Orthop Traumatol Turc, 2014, 48(3): 271-275.
7.	Schneider M, Heisel C, Aldinger PR, et al. Use of palpable tendons for extramedullary tibial alignment in total knee arthroplasty. J Arthroplasty, 2007, 22(2): 219-226.
8.	Rajadhyaksha AD, Mehta H, Zelicof SB. Use of tibialis anterior tendon as distal landmark for extramedullary tibial alignment in total knee arthroplasty: an anatomical study. Am J Orthop (Belle Mead NJ), 2009, 38(3): E68-E70.
9.	Tsukeoka T, Lee TH, Tsuneizumi Y, et al. The tibial crest as a practical useful landmark in total knee arthroplasty. Knee, 2014, 21(1): 283-289.
10.	Nishikawa K, Mizu-uchi H, Okazaki K, et al. Accuracy of proximal tibial bone cut using anterior border of tibia as bony landmark in total knee arthroplasty. J Arthroplasty, 2015, 30(12): 2121-2124.
11.	Tsukeoka T, Tsuneizumi Y, Lee TH. Accuracy of the second metatarsal as a landmark for the extramedullary tibial cutting guide in total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc, 2014, 22(12): 2969-2974.
12.	賀強, 馬建兵, 孫相祥. 脛骨內翻畸形對全膝關節置換術脛骨假體對線影響的臨床研究. 實用骨科雜志, 2017, 23(7): 583-588.
13.	趙旻暐, 田華, 曾琳, 等. 中國人采用脛骨結節及脛前肌腱定位的髓外截骨法術后脛骨假體冠狀位力線的測量與分析. 北京大學學報 (醫學版), 2016, 48(2): 351-355.
14.	Yau WP, Chiu KY, Tang WM, et al. Coronal bowing of the femur and tibia in Chinese: its incidence and effects on total knee arthroplasty planning. J Orthop Surg (Hong Kong), 2007, 15(1): 32-36.
15.	Chiu KY, Yau WP, Ng TP, et al. The accuracy of extramedullary guides for tibial component placement in total knee arthroplasty. Int Orthop, 2008, 32(4): 467-471.
16.	Saibaba B, Dhillon MS, Chouhan DK, et al. Significant incidence of extra-articular tibia vara affects radiological outcome of total knee arthroplasty. Knee Surg Relat Res, 2015, 27(3): 173-180.
17.	吳偉, 郭萬首. 下肢全長X線檢查的臨床應用及其精準性的研究進展. 中華骨與關節外科雜志, 2017, 10(1): 83-87.
18.	Shao J, Vail TP, Qiao-Jie W, et al. Anatomical references for tibial sagittal alignment in total knee arthroplasty: A comparison of three anatomical axes based on 3D reconstructed CT images. Chin Med, 2013, 126(20): 3840-3844.
19.	劉恒, 李卓揚, 曹永平, 等. 脛骨側徒手截骨的膝關節置換術后力線測量及其影響因素分析. 北京大學學報 (醫學版), 2018, 50(5): 89-93.
20.	Dror P. Principles of deformity correction. Berlin: Springer Science & Business Media, 2002: 2-5.
21.	Palanisami D, George MJ, Hussain AM, et al. Tibial bowing and tibial component placement in primary total knee arthroplasty in valgus knees: Are we overlooking? J Orthop Surg (Hong Kong), 2019, 27(3): 2309499019867006. doi: 10.1177/2309499019867006.

1. Meding JB, Berend ME, Ritter MA, et al. Intramedullary vs extramedullary femoral alignment guides: a 15-year follow-up of survivorship. J Arthroplasty, 2011, 26(4): 591-595.
2. Qin YF, Li N, Shi YX, et al. Intramedullary versus extramedullary alignment guides on total knee arthroplasty: a meta-analysis. J Comp Eff Res, 2018, 7(12): 1181-1193.
3. Feeley I, Hegarty A, Hickey A, et al. Impact of use of intramedullary and extramedullary guides on tibial component geometry in total knee replacements: A systematic review and meta-analysis. J Knee Surg, 2016, 29(6): 487-496.
4. Fukagawa S, Matsuda S, Mitsuyasu H, et al. Anterior border of the tibia as a landmark for extramedullary alignment guide in total knee arthroplasty for varus knees. J Orthop Res, 2011, 29(6): 919-924.
5. Sugimura N, Ikeuchi M, Izumi M, et al. The dorsal pedis artery as a new distal landmark for extramedullary tibial alignment in total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc, 2014, 22(11): 2618-2622.
6. Bilgen O, Bilgen S, Ermutlu C, et al. The extensor hallucis longus tendon as the distal reference point in total knee arthroplasty and tibial alignment. Acta Orthop Traumatol Turc, 2014, 48(3): 271-275.
7. Schneider M, Heisel C, Aldinger PR, et al. Use of palpable tendons for extramedullary tibial alignment in total knee arthroplasty. J Arthroplasty, 2007, 22(2): 219-226.
8. Rajadhyaksha AD, Mehta H, Zelicof SB. Use of tibialis anterior tendon as distal landmark for extramedullary tibial alignment in total knee arthroplasty: an anatomical study. Am J Orthop (Belle Mead NJ), 2009, 38(3): E68-E70.
9. Tsukeoka T, Lee TH, Tsuneizumi Y, et al. The tibial crest as a practical useful landmark in total knee arthroplasty. Knee, 2014, 21(1): 283-289.
10. Nishikawa K, Mizu-uchi H, Okazaki K, et al. Accuracy of proximal tibial bone cut using anterior border of tibia as bony landmark in total knee arthroplasty. J Arthroplasty, 2015, 30(12): 2121-2124.
11. Tsukeoka T, Tsuneizumi Y, Lee TH. Accuracy of the second metatarsal as a landmark for the extramedullary tibial cutting guide in total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc, 2014, 22(12): 2969-2974.
12. 賀強, 馬建兵, 孫相祥. 脛骨內翻畸形對全膝關節置換術脛骨假體對線影響的臨床研究. 實用骨科雜志, 2017, 23(7): 583-588.
13. 趙旻暐, 田華, 曾琳, 等. 中國人采用脛骨結節及脛前肌腱定位的髓外截骨法術后脛骨假體冠狀位力線的測量與分析. 北京大學學報 (醫學版), 2016, 48(2): 351-355.
14. Yau WP, Chiu KY, Tang WM, et al. Coronal bowing of the femur and tibia in Chinese: its incidence and effects on total knee arthroplasty planning. J Orthop Surg (Hong Kong), 2007, 15(1): 32-36.
15. Chiu KY, Yau WP, Ng TP, et al. The accuracy of extramedullary guides for tibial component placement in total knee arthroplasty. Int Orthop, 2008, 32(4): 467-471.
16. Saibaba B, Dhillon MS, Chouhan DK, et al. Significant incidence of extra-articular tibia vara affects radiological outcome of total knee arthroplasty. Knee Surg Relat Res, 2015, 27(3): 173-180.
17. 吳偉, 郭萬首. 下肢全長X線檢查的臨床應用及其精準性的研究進展. 中華骨與關節外科雜志, 2017, 10(1): 83-87.
18. Shao J, Vail TP, Qiao-Jie W, et al. Anatomical references for tibial sagittal alignment in total knee arthroplasty: A comparison of three anatomical axes based on 3D reconstructed CT images. Chin Med, 2013, 126(20): 3840-3844.
19. 劉恒, 李卓揚, 曹永平, 等. 脛骨側徒手截骨的膝關節置換術后力線測量及其影響因素分析. 北京大學學報 (醫學版), 2018, 50(5): 89-93.
20. Dror P. Principles of deformity correction. Berlin: Springer Science & Business Media, 2002: 2-5.
21. Palanisami D, George MJ, Hussain AM, et al. Tibial bowing and tibial component placement in primary total knee arthroplasty in valgus knees: Are we overlooking? J Orthop Surg (Hong Kong), 2019, 27(3): 2309499019867006. doi: 10.1177/2309499019867006.

Chinese Journal of Reparative and Reconstructive Surgery

Value of personalized extramedullary positioning technique on tibia side for coronal alignment of tibial prosthesis in total knee arthroplasty

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