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Open Access Highly Accessed Research article

Rotational alignment of the tibial component in total knee arthroplasty is better at the medial third of tibial tuberosity than at the medial border

Jörg Lützner1*, Frank Krummenauer2, Klaus-Peter Günther1 and Stephan Kirschner1

Author Affiliations

1 Department of Orthopaedic Surgery, University Hospital Carl Gustav Carus, Medical Faculty of the Technical University of Dresden, Dresden, Germany

2 Clinical Epidemiology and Health Economy Unit, Department of Orthopaedic Surgery, University Hospital Carl Gustav Carus, Medical Faculty of the Technical University of Dresden, Dresden, Germany

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BMC Musculoskeletal Disorders 2010, 11:57  doi:10.1186/1471-2474-11-57

Published: 25 March 2010

Abstract

Background

Correct rotational alignment of the femoral and tibial component is an important factor for successful TKA. The transepicondylar axis is widely accepted as a reference for the femoral component. There is not a standard reference for the tibial component. CT scans were used in this study to measure which of 2 tibial landmarks most reliably reproduces a correct femoro-tibial rotational alignment in TKA.

Methods

80 patients received a cemented, unconstrained, cruciate-retaining TKA with a rotating platform. CT scans were performed 5-7 days postoperatively but before discharge. The rotational mismatch between the femoral and tibial components was measured. Furthermore, the rotational variance between the transepicondylar line, as a reference for the orientation of the femoral component and different tibial landmarks, was measured.

Results

There was notable rotational mismatch between the femoral and tibial components. The median mismatch was 0° (range: 16.2 degrees relative external to 14.4 degrees relative internal rotation of the femoral component).

Using the transepicondylar line as a reference for femoral rotational alignment and the medial third of the tuberosity as a reference for tibial rotational alignment, 67.5% of all TKA had a femoro-tibial variance within ± 5 degrees, 85% within ± 10 degrees and 97.5% within ± 20 degrees. Using the medial border of the tibial tubercle as a reference this variance was greater, only 3.8% had a femoro-tibial variance within ± 5 degrees, 15% within ± 10 degrees and 68.8% within ± 20 degrees.

Conclusion

Using fixed bone landmarks for rotational alignment leads to a notable variance between femoral and tibial components. Referencing the tibial rotation on a line from the medial third of the tibial tubercle to the center of the tibial tray resulted in a better femoro-tibial rotational alignment than using the medial border of tibial tubercle as a landmark. Surgeons using fixed bearings with a high rotational constraint between the inlay and the femoral component should be aware of this effect to avoid premature polyethylene wear.

Trial Registration

Clinical trials registry NCT01022099