Functional References for Tibial Axial Rotation in Total Knee Arthroplasty

4 pages•Published: March 8, 2024

Andrew Shimmin, David Liu, Brett Fritsch, David Parker, Ishaan Jagota, Joshua Twiggs and Brad Miles

Abstract

Excessive post-operative tibiofemoral rotational mismatch can result in inferior patient outcomes. This highlights the importance considering the femoral axial alignment during tibial axial alignment. This study investigates different tibial rotational references including Insall’s axis, Cobb’s axis, and the projection of the TEA on the proximal tibial plateau in the CT, weightbearing and extension distracted positions.
All patients obtained a pre-operative long-leg supine CT scan, weightbearing antero-posterior radiograph and an extension distracted radiograph. Each CT scan was segmented and landmarked, and the resulting 3D bone models were registered to the two radiographs. The position of Insall’s axis was determined relative to Cobb’s axis and the projection of the surgical TEA on the proximal tibia in the supine CT, weightbearing and extension distracted positions.
From the 325 joints analysed, the mean external rotation of Insall’s axis relative to Cobb’s axis and the projection of the TEA in the CT, weightbearing and extension distracted positions was 4.84°±3.37°, 9.67°±4.71°, 9.65°±6.59° and 8.31°±6.44°, respectively.
Although numerous tibial rotational reference axes exist, there is a lack of consensus amongst surgeons on which is most appropriate during TKA. Since tibial and femoral axial rotation mismatch is associated with post-operative knee pain, it is important to consider references for axial rotation which can be used to align both femoral and tibial components. A better understanding of the different tibial rotational reference axes including functional axes may assist the industry in reaching a consensus on a single or few reference axes for reporting purposes.

Keyphrases: component alignment, functional axial rotation, tea projection, tibial rotation, tibiofemoral rotation, tibiofemoral rotational mismatch, tka, total knee arthroplasty

In: Joshua W Giles (editor). Proceedings of The 22nd Annual Meeting of the International Society for Computer Assisted Orthopaedic Surgery, vol 6, pages 86-89.

Links:	https://easychair.org/publications/paper/s5GV
	https://doi.org/10.29007/7xh6

BibTeX entry

@inproceedings{CAOS2023:Functional_References_Tibial_Axial,
  author    = {Andrew Shimmin and David Liu and Brett Fritsch and David Parker and Ishaan Jagota and Joshua Twiggs and Brad Miles},
  title     = {Functional References for Tibial Axial Rotation in Total Knee Arthroplasty},
  booktitle = {Proceedings of The 22nd Annual Meeting of the International Society for Computer Assisted Orthopaedic Surgery},
  editor    = {Joshua W Giles},
  series    = {EPiC Series in Health Sciences},
  volume    = {6},
  publisher = {EasyChair},
  bibsource = {EasyChair, https://easychair.org},
  issn      = {2398-5305},
  url       = {/publications/paper/s5GV},
  doi       = {10.29007/7xh6},
  pages     = {86-89},
  year      = {2024}}

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