Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2017 Sep 1;29(3):189-194.
doi: 10.5792/ksrr.16.023.

Extramedullary Tibial Bone Cutting Using Medial Cortical Line in Total Knee Arthroplasty

Ju-Hyung Yoo  1 , Chang-Dong Han  2 , Hyun-Cheol Oh  1 , Sang-Hoon Park  1 , Se-Han Jung  1 , Yun-Jae Lee  1
Affiliations

Extramedullary Tibial Bone Cutting Using Medial Cortical Line in Total Knee Arthroplasty

Ju-Hyung Yoo et al. Knee Surg Relat Res. .

Abstract

Purpose: This study aims to identify the effectiveness of the medial cortical line for attaining a more accurate tibial component alignment in proximal tibial resection using an extramedullary alignment rod.

Materials and methods: The study examined 100 cases of total knee arthroplasty performed from December 2013 to February 2014 in a retrospective manner. On a preoperative anteroposterior (AP) radiograph of the entire tibia, we identified the medial cortical line that runs parallel to the tibial anatomical axis and passes the medial tibial spine, and measured the point where the medial cortical line crosses between the medial malleolus and the lateral malleolus in the ankle joint.

Results: The preoperative AP radiograph of the tibia showed the medial cortical line passing the point 40.4%±0.8% medial to the distance from the medial malleolus to the lateral malleolus including the skin thickness in the ankle joint. When the proximal tibial resection was performed with the extramedullary tibial cutting guide aligned with the medial cortical line, the tibial component angle averaged 0.7°±0.3° varus and the alignment accuracy of the tibial component within 0°±3° varus amounted to 97.0%.

Conclusions: The use of the medial cortical line in proximal tibial resection with an extramedullary tibial cutting guide allowed for relatively accurate alignment of the tibial component.

Keywords: Arthroplasty; Knee; Tibial bone resection.

PubMed Disclaimer

Conflict of interest statement

Conflict of Interest

No potential conflict of interest relevant to this article was reported.

Figures

Fig. 1
Fig. 1
Anatomical axis and medial cortical line of the tibia. The ratios of the medial distance to the anatomical axis are calculated as b/a and e/d. The ratios of the medial distance to the medial cortical line are calculated as c/a and f/d. a: medial an lateral distance of tibial plateau, b: medial distance to the anatomical axis, c: medial distance to the medial cortical line, d: skin thickness in the ankle joint, e: skin thickness to the anatomical axis in the ankle joint, f: skin thickness to the medial cortical line in the ankle joint.
Fig. 2
Fig. 2
(A) Preoperative draping using Coban and Ioban. (B) Positioning of an extramedullary guide for tibial cutting. The extramedullary rod was fixed from the medial tibial spine proximally to the ankle joint distally regardless of the presence of tibial bowing and shape.
See this image and copyright information in PMC

Similar articles

See all similar articles

References

    1. Ritter MA, Faris PM, Keating EM, Meding JB. Postoperative alignment of total knee replacement. Its effect on survival. Clin Orthop Relat Res. 1994;(299):153–6. - PubMed
    1. Matsuda S, Miura H, Nagamine R, Urabe K, Hirata G, Iwamoto Y. Effect of femoral and tibial component position on patellar tracking following total knee arthroplasty: 10-year follow-up of Miller-Galante I knees. Am J Knee Surg. 2001;14:152–6. - PubMed
    1. Liau JJ, Cheng CK, Huang CH, Lo WH. The effect of malalignment on stresses in polyethylene component of total knee prostheses: a finite element analysis. Clin Biomech (Bristol, Avon) 2002;17:140–6. doi: 10.1016/S0268-0033(01)00109-7. - DOI - PubMed
    1. D’Lima DD, Chen PC, Colwell CW., Jr Polyethylene contact stresses, articular congruity, and knee alignment. Clin Orthop Relat Res. 2001;(392):232–8. doi: 10.1097/00003086-200111000-00029. - DOI - PubMed
    1. Werner FW, Ayers DC, Maletsky LP, Rullkoetter PJ. The effect of valgus/varus malalignment on load distribution in total knee replacements. J Biomech. 2005;38:349–55. doi: 10.1016/j.jbiomech.2004.02.024. - DOI - PubMed

LinkOut - more resources