The tibial growth plate as a predictor of the original tibial plateau joint line as a reference for kinematically aligne
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RESEARCH ARTICLE
Open Access
The tibial growth plate as a predictor of the original tibial plateau joint line as a reference for kinematically aligned total knee arthroplasty Katsuya Nagai1, Yasuo Niki1*, Kengo Harato1, Shu Kobayashi1, Takeo Nagura1, Takayuki Nakamura2, Morio Matsumoto1 and Masaya Nakamura1
Abstract Background: Restoration of the natural joint line is a cornerstone for kinematically aligned total knee arthroplasty (TKA). The purpose of this study was to investigate the relative orientation of the tibial growth plate (GP) with respect to the tibial plateau (TP) for possible application in predicting natural joint line for knees with highly advanced osteoarthritis patient at the time of kinematically aligned TKA. Methods: Images from computed tomography (CT) of 27 normal knees (9 males, 18 females; mean age, 31.6 years) were studied. Geometry of the GP was extracted from CT images, and its moment-of-inertia axes were calculated for the whole GP and the medial and lateral halves. Angular orientations of each GP axis with respect to the TP plane were measured in anatomical coordinates. Results: The TP and GP planes were oriented in 2.3 ± 1.8° of varus and 1.1 ± 1.9° of valgus relative to the tibial mechanical axis, respectively. With respect to the TP plane, the whole GP plane was inclined in 3.4 ± 1.5° of valgus. Orientation of the GP plane differed drastically between medial and lateral halves. The medial GP was in 4.9 ± 2.9° of varus and 1.8 ± 2.5° of anterior inclination, and the lateral half was in 10.4 ± 2.4° of valgus and 18.6 ± 4.0° of anterior inclination relative to the TP. Conclusions: Angular orientation of the original TP plane can be predicted in reference to the GP plane and may provide reasonable guidance for the target bone resection angle of the tibia in kinematically aligned TKA. Keywords: Kinematically aligned total knee arthroplasty, Joint line, Growth plate, Tibial plateau
Background From the perspective of patient satisfaction after total knee arthroplasty (TKA), interest has been growing in surgical techniques that utilize modified implant alignments. Several investigators have demonstrated no significant correlation between neutral mechanical alignment and implant survivorship [1–3], and a slight under-correction of limb alignment yielded more satisfactory outcomes [4]. Kinematically aligned (KA)- or anatomically aligned (AA)-TKA techniques aim to reproduce a natural joint * Correspondence: [email protected] 1 Department of Orthopaedic Surgery, School of Medicine, Keio University, 35 Shinanomachi, Shinjuku, Tokyo 160-8582, Japan Full list of author information is available at the end of the article
line and the flexion-extension axis of the femur in a pre-osteoarthritis (OA) state presumed in each patient. Functional recovery after KA-TKA has recently been reported to be better than that after mechanically aligned TKA [5, 6]. Restoration of the natural joint line is a cornerstone philosophy for KA- or AA-TKA, but reliable methods have yet to be described for predicting the or
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