Reference Axes for Tibial Component Rotation in Total Knee Arthroplasty: Computed Tomography-Based Study of 1,351 Tibiae.

Autor:	Jang ES; Department of Orthopaedic Surgery, Columbia University Medical Center, New York, NY., Davignon R; Stryker Orthopaedics, Mahwah, New Jersey., Geller JA; Department of Orthopaedic Surgery, Columbia University Medical Center, New York, NY., Cooper HJ; Department of Orthopaedic Surgery, Columbia University Medical Center, New York, NY., Shah RP; Department of Orthopaedic Surgery, Columbia University Medical Center, New York, NY.
Jazyk:	angličtina
Zdroj:	The Journal of bone and joint surgery. American volume [J Bone Joint Surg Am] 2023 Jan 04; Vol. 105 (1), pp. 1-8. Date of Electronic Publication: 2022 Oct 26.
DOI:	10.2106/JBJS.22.00520
Abstrakt:	Background: Many anatomic landmarks have been described for setting tibial component rotation intraoperatively. There is no consensus as to which axis is best for reducing outliers and preventing malrotation. Methods: The SOMA (Stryker Orthopaedic Modeling and Analytics) database (Stryker) was used to identify 1,351 computed tomography (CT) scans of the entire tibia. Several reference axes for the tibia (including the Mayo axis, Akagi line, Insall line, anterior condylar axis [ACA], posterior condylar axis [PCA], lateral tibial cortex [LTC], Cobb axis, tibial crest line [TCL], and transmalleolar axis [TMA]) were constructed according to published guidelines. The Berger method served as the reference standard. Results: The Mayo method (involving a line connecting the medial and middle one-thirds of the tibial tubercle and the geometric center of the tibia) and the Insall line (involving a line connecting the posterior cruciate ligament [PCL] insertion and the intersection of the middle and medial one-thirds of the tibial tubercle) both had low variability relative to the Berger method (7.8° ± 1.0° and 5.1° ± 2.2°, respectively) and a low likelihood of internal rotation errors (0.7% and 1.8%, respectively). No clinically significant gender-based differences were found (<0.7° for all). The same was true for ethnicity, with the exception of consistently greater tibial intorsion in Asian versus Caucasian individuals (mean difference in TCL position, +4.5° intorsion for Asian individuals; p < 0.001). Conclusions: This CT-based study of 1,351 tibiae (which we believe to be the largest study of its kind) showed that the Mayo and Insall methods (both of which reference the medial and middle one-thirds of the tibial tubercle) offer an ideal balance of accuracy, low variability, and a reduced likelihood of internal rotation errors. Setting rotation on the basis of distal landmarks (tibial shaft and beyond) may predispose surgeons to substantial malrotation errors, especially given the differences in tibial torsion found between ethnic groups in this study. Level of Evidence: Therapeutic Level IV . See Instructions for Authors for a complete description of levels of evidence. Competing Interests: Disclosure: The Disclosure of Potential Conflicts of Interest forms are provided with the online version of the article ( http://links.lww.com/JBJS/H289 ). (Copyright © 2022 by The Journal of Bone and Joint Surgery, Incorporated.)
Databáze:	MEDLINE
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