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Femoral matched tibia component rotation has little effect on the tibial torsion after total knee arthroplasty

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Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Purpose

Tibiofemoral synchronization technique matches the rotational alignment of the tibial component to the femoral component during the total knee arthroplasty (TKA). The rotational axis of the proximal tibia can be changed by this technique, which affects tibial torsion postoperatively. The purpose of this study was to investigate whether the tibiofemoral synchronization technique affect the tibial torsion, and the lower limb rotation after primary TKA. It was hypothesised that the tibial torsion would change after primary TKA.

Methods

Ninety-three posterior stabilised TKAs from 89 patients were included from January 2017 to December 2018. Mechanical hip–knee–ankle axis (mHKA), in plain radiographs, femoral anteversion, tibial torsion, femoral neck-malleolar angle (FNMA), and rotational alignment of the femoral and the tibial components in pre- and postoperative CT scans were measured by two blinded observers. The primary outcome was a postoperative change in femoral anteversion, tibial torsion and FNMA. Clinical outcomes were evaluated using the American Knee Society Knee Score (AKSKS)/Function Score (AKSFS), and Oxford Knee Score (OKS) preoperatively and at 1 year after TKA. Patients’ perception of changes in the foot progression angle after TKA was investigated. Statistical significance was set at p < 0.05.

Results

The mean rotational mismatch between the femoral and the tibial component was 0.6 ± 3.2°. There was a significant decrease in femoral anteversion (9.5 ± 6.7° vs. 5.2 ± 6.6°, p < 0.001), and a significant increase in the FNMA (17.6 ± 9.7° vs. 21.8 ± 10.5°, p = 0.005) after TKA, while no significant change in tibia torsion was observed (25.4 ± 8.8° vs. 24.9 ± 9.3°, p = 0.739). AKSS (37.8 ± 15.1 vs. 92.8 ± 8.8, p < 0.001), AKSFS (53.9 ± 18.1 vs. 89.9 ± 5.3, p < 0.001), and OKS (18.0 ± 7.3 vs. 39.9 ± 4.8, p < 0.001) were significantly improved at 1 year after TKA. Ten knees (11%) had changes in tibial torsion greater than ± 10° postoperatively. Four of five patients who had changes in FNMA greater than 15° perceived the external rotation of the foot progression angle after TKA. All four patients had an increase in tibial torsion larger than 10°.

Conclusion

Our study shows that the tibiofemoral synchronization technique less likely affects the tibial torsion after primary TKA.

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Acknowledgements

The authors thank Editage (www.editage.co.kr) for English-language editing.

Funding

We did not receive outside funding related to this study.

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Authors and Affiliations

  1. Department of Orthopedic Surgery, Korea University Guro Hospital, Korea University College of Medicine, 148 Gurodong-ro, Guro-gu, Seoul, 08308, Republic of Korea

    Ji Hoon Bae, Ja-Woon Lee, Young-Sik Jeon & Jeong Seok Choi

  2. Department of Orthopedic Surgery, Naval Maritime Medical Center, Jinju, 51640, Republic of Korea

    Soo-Hyun Kim

  3. Department of Orthopedic Surgery, Korea University Ansan Hospital, Korea University College of Medicine, Ansan, 15355, Republic of Korea

    Sang-Gyun Kim

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  1. Ji Hoon Bae
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Contributions

JHB: study concepts/design and manuscript drafting/revision, JWL: data acquisition/analysis, SHK: data acquisition/analysis, SGK: data acquisition/analysis and manuscript revision, YSJ: data acquisition/analysis and manuscript revision, and JSC: data acquisition/analysis and manuscript revision. All the authors read and approved the final manuscript.

Corresponding author

Correspondence to Ji Hoon Bae.

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Each author certifies that he has no commercial associations (e.g. consultancies, stock ownership, equity interest, and patent/licensing arrangements) that might pose a conflict of interest in connection with the submitted article.

Ethical approval

This study was approved by the institutional ethical review board (2016GR0311).

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The informed consent was obtained from each patient.

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Bae, J.H., Lee, JW., Kim, SH. et al. Femoral matched tibia component rotation has little effect on the tibial torsion after total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 30, 698–704 (2022). https://doi.org/10.1007/s00167-020-06429-z

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  • DOI: https://doi.org/10.1007/s00167-020-06429-z

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