Potential risk of medial cortex perforation due to peg position of morphometric tibial component in unicompartmental kne
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KNEE
Potential risk of medial cortex perforation due to peg position of morphometric tibial component in unicompartmental knee arthroplasty: a computer simulation study Keiji Tensho1 · Tomoya Iwaasa1 · Suguru Koyama1 · Hiroki Shimodaira1 · Hiroshi Horiuchi1 · Naoto Saito1 · Jun Takahashi1 Received: 29 May 2020 / Accepted: 14 August 2020 © European Society of Sports Traumatology, Knee Surgery, Arthroscopy (ESSKA) 2020
Abstract Purpose The purpose of this study is to evaluate the risk of medial tibial cortical perforation in unicompartmental knee arthroplasty (UKA) due to peg positions on the tibial tray of the Persona Partial Knee (PPK). Methods Preoperative CT images of 60 patients and 60 osteoarthritic knees (30 male and 30 female patients) were used. A tibial multiplanar reconstruction (MPR) image was reconstructed in preoperative planning software, and the implant was placed in a virtual osteotomy plane. In addition to PPK, Zimmer Unicompartmental Knee (ZUK) and TRIBRID (TBD) were used for evaluation. The horizontal distances from the medial tibial cortex to the anterior and posterior pegs (APCD/PPCD, respectively) were measured under neutral, 3-degree varus, 3-degree valgus and 2 mm distal positions. The differences between implants under the same positions and between positions using the same implants were compared. The percentage of total cases with APCD/PPCD of less than 3 mm and the perforation risk rate were calculated. Results The APCD of PPK was significantly shorter at all positions except for the varus position of TBD. The PPCD of PPK was significantly shorter at all positions compared to ZUK and TBD. There were no cases with an APCD of less than 3 mm. Except for varus positions, the perforation risk rate of PPCD was significantly higher for PPK than the other two implants. Conclusion The posterior pegs of the PPK are located more medially than the other two implants, which may result in perforation of the medial tibial cortex during implantation. Surgeons should consider the risk involved in the type of implant used. Keywords Unicompartmental knee arthroplasty · Tibial tray · Peg · Cortical perforation
Introduction * Keiji Tensho kten@shinshu‑u.ac.jp Tomoya Iwaasa tiwaasa@shinshu‑u.ac.jp Suguru Koyama koyamas@shinshu‑u.ac.jp Hiroki Shimodaira [email protected] Hiroshi Horiuchi horiuchih@shinshu‑u.ac.jp Naoto Saito saitoko@shinshu‑u.ac.jp Jun Takahashi jtaka@shinshu‑u.ac.jp 1
Department of Orthopedic Surgery, Shinshu University School of Medicine, Asahi 3‑1‑1, Matsumoto 390‑8621, Japan
Unicompartmental knee arthroplasty (UKA) is a viable option to treat patients with isolated single-compartment osteoarthritis of the knee. However, most articles report poor survival rates for UKA compared to TKA [6, 15, 19, 24]. Tibial component loosening has been cited as the most frequent cause of revision UKA [18]. To overcome this problem, implant designs have been improved to secure a better fixation of the tibial tray to the host bone. The Miller–Galante (M/G®) Unicompartmental Knee (Zimmer,
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