SpringerLink
Log in

Correlation of tibial component size and rotation with outcomes after total knee arthroplasty

  • Knee Arthroplasty
  • Published:
Archives of Orthopaedic and Trauma Surgery Aims and scope Submit manuscript

Abstract

Introduction

Tibial component design and positioning contribute more to patient satisfaction than previously realized. A surgeon needs to decide on the size and rotation, bearing in mind that coverage should be as high as possible, whilst malrotation and overhang should be avoided. No study investigates the impact of each of these components on clinical outcomes in a single cohort.

Materials and methods

This is a retrospective analysis of 1-year postoperative outcomes measured with the Knee Injury and Osteoarthritis Outcome (KOOS) Score, as well as a previously validated rotational CT protocol. Coverage, rotation from Insall’s axis, and overhang of an asymmetric tibial baseplate were measured, and positive and negative correlations to clinical outcomes were calculated.

Results

A total of 499 knees were analyzed. Patient average age was 68.4 years. Rotation within 7° internal and 5° external from Insall’s axis was a “safe zone”. Mean coverage was 76%. A total of 429 knees (94%) had a coverage of at least 70% and 102 knees (22%) greater than 80%. Overhang was detected in 23% of the cohort. Increased coverage was correlated to increased KOOS score and overhang correlated with a decreased KOOS score (p = 0.008).

Conclusions

This study demonstrates the individual role of three aspects of tibial component implantation properties in postoperative pain and short-term functional outcomes. Upsizing to the point of overhang with rotational tolerance of 7° internal and 3° external to Insall’s axis demonstrates best patient reported outcomes. Overhang decreases the clinical outcome by the same margin as loss of 16% of coverage.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Subscribe and save

Springer+ Basic
EUR 32.99 /Month
  • Get 10 units per month
  • Download Article/Chapter or Ebook
  • 1 Unit = 1 Article or 1 Chapter
  • Cancel anytime
Subscribe now

Buy Now

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. National Joint Registry for England, Wales, Northern Ireland and the Isle of Man (2019) The National Joint Registry Annual Report 2019. https://www.hqip.org.uk/wp-content/uploads/2018/11/NJR-15th-Annual-Report-2018.pdf

  2. Dunbar MJ, Richardson G, Robertsson O (2013) I can’t get no satisfaction after my total knee replacement: rhymes and reasons. Bone Jt J 95-B:148–152. https://doi.org/10.1302/0301-620X.95B11.32767

    Article  CAS  Google Scholar 

  3. Nicoll D, Rowley DI (2010) Internal rotational error of the tibial component is a major cause of pain after total knee replacement. J Bone Jt Surg Br 92:1238–1244. https://doi.org/10.1302/0301-620X.92B9.23516

    Article  CAS  Google Scholar 

  4. Bell SW, Young P, Drury C et al (2014) Component rotational alignment in unexplained painful primary total knee arthroplasty. Knee 21:272–277. https://doi.org/10.1016/j.knee.2012.09.011

    Article  PubMed  Google Scholar 

  5. Bonnin MP, Saffarini M, Mercier P-E et al (2011) Is the anterior tibial tuberosity a reliable rotational landmark for the tibial component in total knee arthroplasty? J Arthroplast 26(260–267):e1–2. https://doi.org/10.1016/j.arth.2010.03.015

    Article  Google Scholar 

  6. Mitsuhashi S, Akamatsu Y, Kobayashi H et al (2018) Combined CT-based and image-free navigation systems in TKA reduces postoperative outliers of rotational alignment of the tibial component. Arch Orthop Trauma Surg 138:259–266. https://doi.org/10.1007/s00402-017-2837-1

    Article  PubMed  Google Scholar 

  7. Panni AS, Ascione F, Rossini M et al (2018) Tibial internal rotation negatively affects clinical outcomes in total knee arthroplasty: a systematic review. Knee Surg Sports Traumatol Arthrosc 26:1636–1644. https://doi.org/10.1007/s00167-017-4823-0

    Article  PubMed  Google Scholar 

  8. Wernecke GC, Harrris IA, Seeto BG et al (2016) Normal femorotibial rotational alignment and implications for total knee arthroplasty: an MRI analysis. HSS J 12:216–222. https://doi.org/10.1007/s11420-016-9491-y

    Article  PubMed  PubMed Central  Google Scholar 

  9. Cobb JP, Dixon H, Dandachli W, Iranpour F (2008) The anatomical tibial axis: reliable rotational orientation in knee replacement. J Bone Jt Surg Br 90:1032–1038. https://doi.org/10.1302/0301-620X.90B8.19905

    Article  CAS  Google Scholar 

  10. Scott RD (2013) Femoral and tibial component rotation in total knee arthroplasty: methods and consequences. Bone Jt J 95-B:140–143. https://doi.org/10.1302/0301-620X.95B11.32765

    Article  CAS  Google Scholar 

  11. Incavo SJ, Ronchetti PJ, Howe JG, Tranowski JP (1994) Tibial plateau coverage in total knee arthroplasty. Clin Orthop Relat Res 299:81–85

    Google Scholar 

  12. Berend ME, Ritter MA, Hyldahl HC et al (2008) Implant migration and failure in total knee arthroplasty is related to body mass index and tibial component size. J Arthroplast 23:104–109. https://doi.org/10.1016/j.arth.2008.05.020

    Article  Google Scholar 

  13. Hartel MJ, Loosli Y, Delfosse D et al (2014) The influence of tibial morphology on the design of an anatomical tibial baseplate for TKA. Knee 21:415–419. https://doi.org/10.1016/j.knee.2014.01.003

    Article  PubMed  Google Scholar 

  14. Martin S, Saurez A, Ismaily S et al (2014) Maximizing tibial coverage is detrimental to proper rotational alignment. Clin Orthop Relat Res 472:121–125. https://doi.org/10.1007/s11999-013-3047-y

    Article  PubMed  Google Scholar 

  15. Simsek ME, Akkaya M, Gursoy S et al (2018) Posterolateral overhang affects patient quality of life after total knee arthroplasty. Arch Orthop Trauma Surg 138:409–418. https://doi.org/10.1007/s00402-017-2850-4

    Article  PubMed  Google Scholar 

  16. Bonnin MP, Saffarini M, Shepherd D et al (2016) Oversizing the tibial component in TKAs: incidence, consequences and risk factors. Knee Surg Sports Traumatol Arthrosc 24:2532–2540. https://doi.org/10.1007/s00167-015-3512-0

    Article  PubMed  Google Scholar 

  17. Lemaire P, Pioletti DP, Meyer FM et al (1997) Tibial component positioning in total knee arthroplasty: bone coverage and extensor apparatus alignment. Knee Surg Sports Traumatol Arthrosc 5:251–257. https://doi.org/10.1007/s001670050059

    Article  CAS  PubMed  Google Scholar 

  18. Mori S, Akagi M, Asada S et al (2013) Tibia vara affects the aspect ratio of tibial resected surface in female Japanese patients undergoing TKA. Clin Orthop Relat Res 471:1465–1471. https://doi.org/10.1007/s11999-013-2800-6

    Article  PubMed  PubMed Central  Google Scholar 

  19. Wakelin EA, Tran L, Twiggs JG et al (2018) Accurate determination of post-operative 3D component positioning in total knee arthroplasty: the AURORA protocol. J Orthop Surg Res 13:275. https://doi.org/10.1186/s13018-018-0957-0

    Article  PubMed  PubMed Central  Google Scholar 

  20. Twiggs JG, Dickison DM, Kolos EC et al (2018) Patient variation limits use of fixed references for femoral rotation component alignment in total knee arthroplasty. J Arthroplasty 33:67–74. https://doi.org/10.1016/j.arth.2017.08.023

    Article  PubMed  Google Scholar 

  21. Hutt J, Massé V, Lavigne M, Vendittoli P-A (2016) Functional joint line obliquity after kinematic total knee arthroplasty. Int Orthop 40:29–34. https://doi.org/10.1007/s00264-015-2733-7

    Article  PubMed  Google Scholar 

  22. Lakstein D, Zarrabian M, Kosashvili Y et al (2010) Revision total knee arthroplasty for component malrotation is highly beneficial: a case control study. J Arthroplast 25:1047–1052. https://doi.org/10.1016/j.arth.2009.07.004

    Article  Google Scholar 

  23. Kuriyama S, Ishikawa M, Furu M et al (2014) Malrotated tibial component increases medial collateral ligament tension in total knee arthroplasty. J Orthop Res 32:1658–1666. https://doi.org/10.1002/jor.22711

    Article  PubMed  Google Scholar 

  24. Howell SM, Chen J, Hull ML (2013) 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 21:2288–2295. https://doi.org/10.1007/s00167-012-1987-5

    Article  PubMed  Google Scholar 

  25. Graw BP, Harris AH, Tripuraneni KR, Giori NJ (2010) Rotational references for total knee arthroplasty tibial components change with level of resection. Clin Orthop Relat Res 468:2734–2738. https://doi.org/10.1007/s11999-010-1330-8

    Article  PubMed  PubMed Central  Google Scholar 

  26. Kim JI, Jang J, Lee KW et al (2017) Anterior tibial curved cortex is a reliable landmark for tibial rotational alignment in total knee arthroplasty. BMC Musculoskelet Disord. https://doi.org/10.1186/s12891-017-1609-y

    Article  PubMed  PubMed Central  Google Scholar 

  27. Baldini A, Indelli PF, Luca DEL et al (2013) Rotational alignment of the tibial component in total knee arthroplasty: the anterior tibial cortex is a reliable landmark. Joints 1:155–160

    Article  Google Scholar 

  28. Aglietti P, Sensi L, Cuomo P, Ciardullo A (2008) Rotational position of femoral and tibial components in TKA using the femoral transepicondylar axis. Clin Orthop Relat Res 466:2751–2755. https://doi.org/10.1007/s11999-008-0452-8

    Article  PubMed  PubMed Central  Google Scholar 

  29. Akagi M, Mori S, Nishimura S et al (2005) Variability of extraarticular tibial rotation references for total knee arthroplasty. Clin Orthop Relat Res 436:172–176

    Article  Google Scholar 

  30. Sahin N, Atıcı T, Öztürk A et al (2012) Accuracy of anatomical references used for rotational alignment of tibial component in total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 20:565–570. https://doi.org/10.1007/s00167-011-1606-x

    Article  PubMed  Google Scholar 

  31. Devji T, Guyatt GH, Lytvyn L et al (2017) Application of minimal important differences in degenerative knee disease outcomes: a systematic review and case study to inform BMJ rapid recommendations. BMJ Open 7:e015587. https://doi.org/10.1136/bmjopen-2016-015587

    Article  PubMed  PubMed Central  Google Scholar 

  32. Liau JJ, Cheng CK, Huang CH, Lo WH (2002) The effect of malalignment on stresses in polyethylene component of total knee prostheses–a finite element analysis. Clin Biomech (Bristol, Avon) 17:140–146

    Article  Google Scholar 

  33. Dai Y, Scuderi GR, Bischoff JE et al (2014) Anatomic tibial component design can increase tibial coverage and rotational alignment accuracy: a comparison of six contemporary designs. Knee Surg Sports Traumatol Arthrosc 22:2911–2923. https://doi.org/10.1007/s00167-014-3282-0

    Article  PubMed  PubMed Central  Google Scholar 

  34. Ma Y, Mizu-Uchi H, Okazaki K et al (2018) Effects of tibial baseplate shape on rotational alignment in total knee arthroplasty: three-dimensional surgical simulation using osteoarthritis knees. Arch Orthop Trauma Surg 138:105–114. https://doi.org/10.1007/s00402-017-2828-2

    Article  PubMed  Google Scholar 

  35. Nielsen CS, Nebergall A, Huddleston J et al (2018) Medial overhang of the tibial component is associated with higher risk of inferior knee injury and osteoarthritis outcome score pain after knee replacement. J Arthroplast 33:1394–1398. https://doi.org/10.1016/j.arth.2017.12.027

    Article  Google Scholar 

  36. Abram SGF, Marsh AG, Brydone AS et al (2014) The effect of tibial component sizing on patient reported outcome measures following uncemented total knee replacement. Knee 21:955–959. https://doi.org/10.1016/j.knee.2014.05.010

    Article  PubMed  Google Scholar 

  37. Heyse TJ, Tibesku CO (2014) Improved femoral component rotation in TKA using patient-specific instrumentation. Knee 21:268–271. https://doi.org/10.1016/j.knee.2012.10.009

    Article  PubMed  Google Scholar 

  38. Heyse TJ, El-Zayat BF, De Corte R et al (2018) Internal femoral component malrotation in TKA significantly alters tibiofemoral kinematics. Knee Surg Sports Traumatol Arthrosc 26:1767–1775. https://doi.org/10.1007/s00167-017-4778-1

    Article  PubMed  Google Scholar 

  39. Nedopil AJ, Howell SM, Hull ML (2017) What mechanisms are associated with tibial component failure after kinematically-aligned total knee arthroplasty? Int Orthop 41:1561–1569. https://doi.org/10.1007/s00264-017-3490-6

    Article  PubMed  Google Scholar 

  40. National Joint Replacement Registry AOA (2019) 2019 Hip, knee and shoulder arthroplasty annual report. https://aoanjrr.sahmri.com/documents/10180/668596/Hip%2C+Knee+%26+Shoulder+Arthroplasty/c287d2a3-22df-a3bb-37a2-91e6c00bfcf0

Download references

Author information

Authors and Affiliations

  1. Sydney Orthopaedic Research Institute, Level 1, The Gallery, 445 Victoria Ave, Chatswood, NSW, 2067, Australia

    Antonio Klasan, Brett A. Fritsch & David A. Parker

  2. 360 Knee Systems, Sydney, NSW, Australia

    Joshua G. Twiggs & Brad P. Miles

  3. Red Cross Hospital, Frankfurt, Germany

    Thomas J. Heyse

  4. Sydney Orthopaedic Specialists, Randwick, NSW, Australia

    Michael Solomon

Authors
  1. Antonio Klasan
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Joshua G. Twiggs
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Brett A. Fritsch
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Brad P. Miles
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Thomas J. Heyse
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Michael Solomon
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. David A. Parker
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Antonio Klasan.

Ethics declarations

Conflict of interest

Antonio Klasan has received research support from Implantcast. Joshua Twiggs is an employee of 360 Knee Systems. Brett Fritsch has been paid for presentations by and is a consultant for Arthrex and Omni. He has stock options in 360 Knee Systems, he has received research support from Arthrex, Smith & Nephew and Zimmer. Brad Miles has Stock Options in 360 Knee Systems. Thomas Heyse has been paid for presentations by Smith & Nephew, Zimmer Biomet and Implantcast, he has received research support from Smith & Nephew, Zimmer Biomet and Implantcast and he is a consultant to Smith & Nephew. Michael Solomon receives royalties from Corin and Medacta, has been paid for presentations and received research support from Corin. David Parker has been paid for presentations by Arthrex and Smith & Nephew, he is a consultant for Arthrex and Global, has stock options in 360 Knee Systems and Trium.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Klasan, A., Twiggs, J.G., Fritsch, B.A. et al. Correlation of tibial component size and rotation with outcomes after total knee arthroplasty. Arch Orthop Trauma Surg 140, 1819–1824 (2020). https://doi.org/10.1007/s00402-020-03550-z

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00402-020-03550-z

Keywords

Search

Navigation