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A New Technique Determining Tibial Rotational Alignment in Total Knee Arthroplasty

Author: XiaoZuo
Tutor: ZuoShiLian
School: Tianjin Medical University
Course: Surgery
Keywords: Total knee arthroplasty Tibial prosthesis Rotational alignment
CLC: R687.4
Type: Master's thesis
Year: 2008
Downloads: 129
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Abstract

Objective: artificial total knee replacement technology has been widely used in clinical and achieved satisfactory results, patellofemoral complication rate high in recent years, and the consequent knee prosthesis early wear loose The problem is still very difficult. Rotation between the femoral and tibial prosthesis bad line relationship is one of the important reasons that led to this problem. The study found that the epicondyle axis in the femur surgical minimal impact due to anatomic variations and osteophytosis, the axis is considered to determine the credibility of the femoral prosthesis rotation angle markings. But determine the tibial prosthesis rotation positioning trusted flag line have not been able unified. Today more than 1/3 of the tibial tubercle line as the tibial rotational positioning of the prosthesis anatomy reference line, but after a long period of clinical observation, found that many patients with rotation of the tibiofemoral malalignment. Recently, some scholars have proposed, to the medial edge of the tibial tuberosity in 1/3 line rotary positioning the tibial anatomical reference intervals, specific positioning should be based on the patient's knee varus-valgus deformity degree. The author designed this prospective clinical trial, the clinical effect of surgical observation and measurement of the two positioning method aims to improve surgical outcome and reduce postoperative complications. Method: May 2006 to May 2007, 60 routine rotating platform total knee replacement knee varus patients were observed, the patients were randomly divided into two groups of 30 cases. Group A: 13 males and 17 females. Age 55 to 78 years, with an average age of 65. Etiology: 18 cases of osteoarthritis, rheumatoid arthritis, traumatic arthritis, 5 cases. The course of the disease: 2 to 12 years, an average of 6.8 years. Admission examination: 0 ~ 9 ° 15 cases, 10 to 19 ° 12 patients ≥ 20 ° varus. Group B: 14 males and 16 females. Age 57 to 75 years, an average of 62 years old. Etiology: 20 cases of osteoarthritis, rheumatoid arthritis, eight cases, two cases of traumatic arthritis. Course of the disease: 2 to 8 years, with an average of 5.7 years. Admission examination: 0 ~ 9 ° 10 cases, 10 to 19 ° 18 patients ≥ 20 ° varus. The clinical symptoms are manifested as knee pain, difficulty walking weight-bearing. X-ray examination showed joint space narrowing, subchondral bone plate rough, less smooth. The prosthesis selection German Link, the Gemini II rotating platform total knee prosthesis. Completion of the surgery by the same group of doctors, anterior cruciate median longitudinal incision rotational positioning of the femoral prosthesis in the condylar axis of the femur surgical. A group of patients with tibial prosthesis rotation positioning methods are used 1/3 of the tibial tubercle line as anatomic landmarks. Group B patients according to the knee turned a deformity select different reference line, 0 ~ 9 ° varus patients with tibial tubercle medial edge of the tibial prosthesis positioning anatomic landmarks; 10 to 19 ° in patients with tibial tubercle within The side edge to 1/3 of the tibial tubercle line interval midline prevail; 20 ° and above were managed with the 1/3 line of the tibial tubercle. Observation and measurement of the rotation angle after two groups of polyethylene meniscal gasket. Taken on all patients preoperative and postoperative orthostatic X-rays and measuring varus angle. All patients underwent preoperative and postoperative HSS score. The measurement data using SPSS11.5 statistical package for analysis. The data are expressed as mean ± standard deviation, the group within a single-factor analysis of variance was used to compare the groups were compared using t test, P value of <0.05 was considered statistically significant. Results: Postoperative polyethylene meniscal gasket rotation angle A group of knee varus 0 ~ 9 ° patients was 8.4 ± 3.8 ° to 19 ° were 3.5 ± 2.7 °, 20 ° and above patients was 0.0 ± 2.4 °; B group knee varus 0 ~ 9 ° were 0.0 ± 2.1 °, 10 to 19 ° were 0.0 ± 2.0 °, 20 ° and above patient was 0.0 ± 1.7 °. The difference between group A and group was statistically significant (P <0.05), the difference between the B group group was not statistically significant (P> 0.05). A group of patients with an average pronation 5.6 ± 2.8 °, the average B patients 0 ± 1.9 ° pronation the AB two groups was statistically significant (P <0.05) difference. All patients incisions are Ⅰ healing, deep venous thrombosis or pulmonary embolism, peroneal nerve palsy and other complications. The preoperative varus total angle of 13.8 ± 2.5 ° the postoperative knee varus total angle of 0.8 ° ± 1.5 °, compared with the preoperative difference was statistically significant (P <0.05). Preoperative HSS score of 36.5 ± 2.9, postoperative HSS score was 86.0 ± 3.5, the surgery good rate of 97.3%, compared with the preoperative difference was statistically significant (P <0.05). Conclusion: the tibial tubercle medial edge to the inner 1/3 line is considered to be the ideal tibial rotational positioning range, the linear positioning should be based on the patient's knee varus-valgus deformity extent. Patients mild knee varus tibial rotation positioning around medial edge of the tibial tuberosity prevail. The patients with moderate knee varus tibial rotational positioning about 1/3 of the tibial tuberosity line interval midline medial edge of the tibial tuberosity to prevail. Patients severe knee varus tibial rotational positioning about 1/3 of the tibial tuberosity line shall prevail.

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CLC: > Medicine, health > Surgery > Orthopaedic Surgery ( movement system diseases,orthopedic surgery ) > Orthopedic surgery and surgery > Joint Surgery
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