[Evaluation and analysis of the tibial coronal alignment after total knee replacement with the extramedullary tibial cutting guided by the tibial tubercle and anterior tibial tendon in Chinese patients]

Abstract

Objective: To evaluate the efficiency of the tibial coronal alignment after total knee arthroplasty with the extramedullary cutting system guided by the tibial tubercle and anterior tibial tendon, and to discuss the potential risk factors for the postoperative malalignment.

Methods: A retrospective study of 212 primary unilateral TKA surgeries (in 188 patients) in our hospital between June to December in 2014 had been analysed. All the cases were performed by one surgical group. An extramedullary tibial cutting guide system had been used, with a landmark of one third inner-medial tibial tubercle as a proximal anatomy reference, and anterior tibial tendon as a distal marker. The mechanical axis of lower extremity in full-length X-ray was measured before surgery, and the tibial prosthetic coronal alignment was checked two weeks postoperation, evaluating the accuracy of this extramedullary cutting system guided by our method.

Results: Since good alignment was defined as an angle within 3 degrees of the perpendicular to the mechanical axis, the tibial component positions were acceptable in 191 knees (90.1%), five knees were in valgus postoperative, and sixteen knees were in varus. There were seventeen(8.7%) in 179 knees with a preoperative varus presented malalignment after surgery, and four in 12 preoperative valgus kneess howed malalignment also, no statistical difference was found by Chi-square test(χ(2)=2.778,P=0.096), which cannot define the relationship between the varus or valgus deformity preoperation and the malalignmentposition in tibial prosthesis after surgery. Twenty-two knees suffered a severe preoperative deformity as a varus or valgus angle larger than 20 degrees with absolute value of mechanical axis before surgery and tibial prosthetic coronal alignment were 21.95 °(20.00°,26.90°)and 1.85°(0.10°, 7.10°), showed a significant difference (Z=2.11,P=0.035) compared with the data [10.65°(0.50°,19.80°)in preoperative mechanical axis and 1.10°(0.00°,4.60°)in the tibial prosthetic coronal alignment]of 190 knees who presented a mild deformity before surgery(less than 20 degrees), the result indicated the severe preoperative deformity might be a potential mal-alignment risk factor within this cutting system in TKA surgery.

Conclusion: The tibial coronal alignment after total knee arthroplasty could achieve good results with extramedullary cutting guide, by using one third inner-medial tibial tubercle and anterior tibial tendon as a proximal and distal anatomy marker. Postoperative varus might occur in this system, and tibial prosthetic malalignment appeared more often in the patients who suffered a severe deformity before surgery.