Skip to main content
SpringerLink
Log in

Tibial component rotation during the unicompartmental knee arthroplasty: is the anterior superior iliac spine an appropriate landmark?

  • Knee
  • Published:
Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Purpose

No “ideal” landmark for tibial component rotation in medial unicompartmental knee arthroplasty (UKA) has been suggested by a biomechanical and clinical study. The aim of this study was to investigate whether the anterior superior iliac spine (ASIS) could provide a consistent rotational landmark of the tibial component during mobile-bearing medial UKA using computed tomography (CT).

Methods

During sagittal tibial resection, we utilized the ASIS as a rotational landmark. In 47 knees that underwent postoperative CT scans after medial UKA, the tibial component position was assessed by drawing a line tangential to the lateral wall of the tibial component. Rotation of the tibial component was measured using two reference lines: a line perpendicular to the posterior cortical rim of the tibia (angle α) and Akagi’s line (angle β). Instant bearing position and posterior cruciate ligament (PCL) fossa involvement were also evaluated. External rotation of the tibial component relative to each reference line was considered positive values.

Results

The mean α and β angles were 8.0° ± 6.1° (range −4.0 to 24.3) and 8.7° ± 4.8° (range 1.9–25.2), respectively. Fourteen knees (29.8 %) showed PCL fossa involvement of the tibial resection margin. One bearing showed complete 180° rotation at 2 weeks postoperatively.

Conclusion

Due to the wide variation and inherent difficulty of identifying the ASIS during the operation, it is not recommended for guidance of sagittal tibial resection during medial UKA. In cases of inappropriate tibia component rotation, risk of PE bearing spinning and iatrogenic PCL injury should be reminded after medial UKA.

Level of evidence

IV.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6

Similar content being viewed by others

References

  1. Akagi M, Oh M, Nonaka T, Tsujimoto H, Asano T, Hamanishi C (2004) An anteroposterior axis of the tibia for total knee arthroplasty. Clin Orthop Relat Res 420:213–219

    Article  Google Scholar 

  2. Altman DG (1991) Practical statistics for medical research, 1st edn. Chapman and Hall, London, pp 403–405

    Google Scholar 

  3. Anderson CJ, Ziegler CG, Wijdicks CA, Engebretsen L, LaPrade RF (2012) Arthroscopically pertinent anatomy of the anterolateral and posteromedial bundles of the posterior cruciate ligament. J Bone Joint Surg Am 94(21):1936–1945

    Article  PubMed  Google Scholar 

  4. Barbadoro P, Ensini A, Leardini A, d’Amato M, Feliciangeli A, Timoncini A, Amadei F, Belvedere C, Giannini S (2014) Tibial component alignment and risk of loosening in unicompartmental knee arthroplasty: a radiographic and radiostereometric study. Knee Surg Sports Traumatol Arthrosc 22(12):3157–3162

    Article  CAS  PubMed  Google Scholar 

  5. Campbell DG, Johnson LJ, West SC (2006) Multiparameter quantitative computer-assisted tomography assessment of unicompartmental knee arthroplasties. ANZ J Surg 76(9):782–787

    Article  PubMed  Google Scholar 

  6. Edwards A, Bull AM, Amis AA (2007) The attachments of the fiber bundles of the posterior cruciate ligament: an anatomic study. Arthroscopy 23(3):284–290

    Article  PubMed  Google Scholar 

  7. Emerson RH Jr, Higgins LL (2008) Unicompartmental knee arthroplasty with the oxford prosthesis in patients with medial compartment arthritis. J Bone Joint Surg Am 90(1):118–122

    Article  PubMed  Google Scholar 

  8. Goodfellow J (2006) Unicompartmental arthroplasty with the Oxford knee. Oxford University Press, Oxford

    Google Scholar 

  9. Hatsushika D, Nimura A, Mochizuki T, Yamaguchi K, Muneta T, Akita K (2013) Attachments of separate small bundles of human posterior cruciate ligament: an anatomic study. Knee Surg Sports Traumatol Arthrosc 21(5):998–1004

    Article  PubMed  Google Scholar 

  10. Iriberri I, Aragon JF (2014) Alignment of the tibial component of the unicompartmental knee arthroplasty, assessed in the axial view by CT scan: does it influence the outcome? Knee 21(6):1269–1274

    Article  PubMed  Google Scholar 

  11. Kawahara S, Matsuda S, Okazaki K, Tashiro Y, Iwamoto Y (2012) Is the medial wall of the intercondylar notch useful for tibial rotational reference in unicompartmental knee arthroplasty? Clin Orthop Relat Res 470(4):1177–1184

    Article  PubMed  Google Scholar 

  12. Kawahara S, Okazaki K, Matsuda S, Mitsuyasu H, Nakahara H, Okamoto S, Iwamoto Y (2014) Medial sixth of the patellar tendon at the tibial attachment is useful for the anterior reference in rotational alignment of the tibial component. Knee Surg Sports Traumatol Arthrosc 22(5):1070–1075

    Article  PubMed  Google Scholar 

  13. Kendrick BJ, Simpson DJ, Kaptein BL, Valstar ER, Gill HS, Murray DW, Price AJ (2011) Polyethylene wear of mobile-bearing unicompartmental knee replacement at 20 years. J Bone Joint Surg Br 93(4):470–475

    Article  CAS  PubMed  Google Scholar 

  14. Khanna G, Levy BA (2007) Oxford unicompartmental knee replacement: literature review. Orthopedics 30(5 Suppl):11–14

    PubMed  Google Scholar 

  15. Kristensen PW, Holm HA, Varnum C (2013) Up to 10-year follow-up of the Oxford medial partial knee arthroplasty—695 cases from a single institution. J Arthroplasty 28(9 Suppl):195–198

    Article  PubMed  Google Scholar 

  16. Lewold S, Goodman S, Knutson K, Robertsson O, Lidgren L (1995) Oxford meniscal bearing knee versus the Marmor knee in unicompartmental arthroplasty for arthrosis. A Swedish multicenter survival study. J Arthroplasty 10(6):722–731

    Article  CAS  PubMed  Google Scholar 

  17. Muller PE, Pellengahr C, Witt M, Kircher J, Refior HJ, Jansson V (2004) Influence of minimally invasive surgery on implant positioning and the functional outcome for medial unicompartmental knee arthroplasty. J Arthroplasty 19(3):296–301

    Article  PubMed  Google Scholar 

  18. Pandit H, Murray DW, Dodd CA, Deo S, Waite J, Goodfellow J, Gibbons CL (2007) Medial tibial plateau fracture and the Oxford unicompartmental knee. Orthopedics 30(5 Suppl):28–31

    PubMed  Google Scholar 

  19. Paternostre F, Schwab PE, Thienpont E (2014) The combined Whiteside’s and posterior condylar line as a reliable reference to describe axial distal femoral anatomy in patient-specific instrument planning. Knee Surg Sports Traumatol Arthrosc 22(12):3054–3059

    Article  PubMed  Google Scholar 

  20. Peersman G, Stuyts B, Vandenlangenbergh T, Cartier P, Fennema P (2015) Fixed- versus mobile-bearing UKA: a systematic review and meta-analysis. Knee Surg Sports Traumatol Arthrosc 23(11):3296–3305

    Article  PubMed  Google Scholar 

  21. Rudol G, Jackson MP, James SE (2007) Medial tibial plateau fracture complicating unicompartmental knee arthroplasty. J Arthroplasty 22(1):148–150

    Article  PubMed  Google Scholar 

  22. Scott RD (2010) Mobile- versus fixed-bearing unicompartmental knee arthroplasty. Instr Course Lect 59:57–60

    PubMed  Google Scholar 

  23. Servien E, Fary C, Lustig S, Demey G, Saffarini M, Chomel S, Neyret P (2011) Tibial component rotation assessment using CT scan in medial and lateral unicompartmental knee arthroplasty. Orthop Traumatol Surg Res 97(3):272–275

    Article  CAS  PubMed  Google Scholar 

  24. Shakespeare D, Ledger M, Kinzel V (2005) The influence of the tibial sagittal cut on component position in the Oxford knee. Knee 12(3):169–176

    Article  PubMed  Google Scholar 

  25. Smith TO, Hing CB, Davies L, Donell ST (2009) Fixed versus mobile bearing unicompartmental knee replacement: a meta-analysis. Orthop Traumatol Surg Res 95(8):599–605

    Article  CAS  PubMed  Google Scholar 

  26. Song MH, Kim BH, Ahn SJ, Yoo SH, Lee MS (2009) Early complications after minimally invasive mobile-bearing medial unicompartmental knee arthroplasty. J Arthroplasty 24(8):1281–1284

    Article  PubMed  Google Scholar 

  27. Tajima G, Nozaki M, Iriuchishima T, Ingham SJ, Shen W, Smolinski P, Fu FH (2009) Morphology of the tibial insertion of the posterior cruciate ligament. J Bone Joint Surg Am 91(4):859–866

    Article  PubMed  Google Scholar 

  28. Yoshida K, Tada M, Yoshida H, Takei S, Fukuoka S, Nakamura H (2013) Oxford phase 3 unicompartmental knee arthroplasty in Japan—clinical results in greater than one thousand cases over ten years. J Arthroplasty 28(9 Suppl):168–171

    Article  PubMed  Google Scholar 

  29. Yoshioka Y, Siu DW, Scudamore RA, Cooke TD (1989) Tibial anatomy and functional axes. J Orthop Res 7(1):132–137

    Article  CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Orthopaedic Surgery, Seoul Barunsesang Hospital, 421 Siheung-daero, Geumcheon-gu, Seoul, 08523, Republic of Korea

    Seung-Yup Lee & Hong-Chul Lim

  2. Department of Orthopaedic Surgery, Korea University Medical College, Guro Hospital, 148, Gurodong-ro, Guro-gu, Seoul, 152-703, Republic of Korea

    Suhwoo Chay & Ji-Hoon Bae

Authors
  1. Seung-Yup Lee
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Suhwoo Chay
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Hong-Chul Lim
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Ji-Hoon Bae
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Ji-Hoon Bae.

Ethics declarations

Conflict of interest

The authors of this manuscript have no financial conflicts of interest to report regarding this work.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Lee, SY., Chay, S., Lim, HC. et al. Tibial component rotation during the unicompartmental knee arthroplasty: is the anterior superior iliac spine an appropriate landmark?. Knee Surg Sports Traumatol Arthrosc 25, 3723–3732 (2017). https://doi.org/10.1007/s00167-016-4192-0

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00167-016-4192-0

Keywords

Search

Navigation