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. 2018 Apr;6(7):113.
doi: 10.21037/atm.2018.02.15.

Total knee replacement modifies the preoperative tibial torsion angle-similar results between computer-assisted and standard technique

Daniel Hernandez-Vaquero  1   2 , Alfonso Noriega-Fernandez  2 , Sergio Roncero-Gonzalez  2 , Andres A Sierra-Pereira  2 , Manuel A Sandoval-Garcia  2
Affiliations

Total knee replacement modifies the preoperative tibial torsion angle-similar results between computer-assisted and standard technique

Daniel Hernandez-Vaquero et al. Ann Transl Med. 2018 Apr.

Abstract

Background: Malpositioning of the components in total knee replacement (TKR) can result in failure or deficient outcomes of the surgical procedure. In the tibial segment, the rotational position of the tray should reproduce the mechanical axis without modifying physiological tibial torsion.

Methods: A randomised, prospective study was made of 74 patients subjected TKR involving the standard technique (38 cases) and navigation surgery (36 cases). A computed tomography study of the knee and ankle was made before the operation and after arthroplasty implantation, in order to identify the position of the prosthetic tibial tray in the transverse axis and the tibial torsion angle.

Results: The rotation of the tibial tray changed from its preoperative to postoperative range, but no significant differences were found between the navigated and the standard groups. The presence of preoperative deformities in the frontal plane did not modify the changes in the rotation of the tibial component. The mean preoperative tibial torsion angle was 17.76º (SD =10.15) of external rotation, with no significant differences in relation to the previous frontal deformity. After TKR, the tibial torsion angle was 15.36º (SD =7.16) (P=0.021). There were no differences in final tibial torsion between the knees operated upon with the standard instruments and those subjected to computer-assisted surgery (CAS; P=0.157).

Conclusions: TKR surgery modifies preoperative tibial torsion. Neither mechanical instrumentation nor navigation surgery precisely reproduces the rotational axis of the leg.

Keywords: Computer-assisted; tibial component; tibial torsion; total knee replacement (TKR).

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Conflict of interest statement

Conflicts of Interest: The authors have no conflicts of interest to declare.

Figures

Figure 1
Figure 1
Tibial proximal angle (line which connected the geometric centers of the plateaus and line tangent to the posterior tibial outline) and identification of the axis of the ankle.
Figure 2
Figure 2
Tibial torsion angle. Superimposition of the line joining the geometric centres of the tibial plateau and axis of the ankle. Preoperative and postoperative situation.
Figure 3
Figure 3
Preoperative varus, valgus and neutral alignment.
Figure 4
Figure 4
Correlation between the two preoperative measurements of the tibia (A, posterior tangent; B, plateau centre) and the axis of the ankle.
See this image and copyright information in PMC

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