dc.contributor.author
Zahn, Robert Karl
dc.contributor.author
Graef, Frank
dc.contributor.author
Conrad, J. L.
dc.contributor.author
Renner, L.
dc.contributor.author
Perka, C.
dc.contributor.author
Hommel, H.
dc.date.accessioned
2022-07-21T11:00:23Z
dc.date.available
2022-07-21T11:00:23Z
dc.identifier.uri
https://refubium.fu-berlin.de/handle/fub188/35619
dc.identifier.uri
http://dx.doi.org/10.17169/refubium-35333
dc.description.abstract
Background: Coronal alignment of the tibial component determines functional outcome and survival in total knee arthroplasty (TKA). Innovative techniques for tibial instrumentation have been developed to improve accuracy and reduce the rate of outliers.
Methods
In a prospective study, 300 patients were allocated to four different groups using a randomization process (two innovative and two conventional) techniques of tibial instrumentation (conventional: extramedullary, intramedullary; innovative: navigation and patient-specific instrumentation (PSI); n = 75 for each group). The aims were to reconstruct the medial proximal tibial angle (MPTA) to 90° and the mechanical tibio-femoral axis (mTFA) to 0°. Both angles were evaluated and compared between all groups three months after the surgery. Patients who presented with a postoperative mTFA > 3° were classified as outliers.
Results: The navigation and intramedullary technique both demonstrated that they were significantly more precise in reconstructing a neutral mTFA and MPTA compared to the other two techniques. The odd’s ratio (OR) for producing outliers was highest for the PSI method (PSI OR = 5.5, p < 0.05; extramedullary positioning OR = 3.7, p > 0.05; intramedullary positioning OR = 1.7, p > 0.05; navigation OR = 0.04, p < 0.05). We could only observe significant differences between pre- and postoperative MPTA in the navigation and intramedullary group. The MPTA showed a significant negative correlation with the mTFA in all groups preoperatively and in the extramedullary, intramedullary and PSI postoperatively.
Conclusion: The navigation and intramedullary instrumentation provided the precise positioning of the tibial component. Outliers were most common within the PSI and extramedullary technique. Optimal alignment is dependent on the technique of tibial instrumentation and tibial component positioning determines the accuracy in TKA since mTFA correlated with MPTA pre- and postoperatively.
en
dc.rights.uri
https://creativecommons.org/licenses/by/4.0/
dc.subject
Total knee arthroplasty
en
dc.subject
Tibial positioning
en
dc.subject
Mechanical axis
en
dc.subject
Extramedullary
en
dc.subject
Intramedullary
en
dc.subject.ddc
600 Technik, Medizin, angewandte Wissenschaften::610 Medizin und Gesundheit::610 Medizin und Gesundheit
dc.title
Accuracy of tibial positioning in the frontal plane: a prospective study comparing conventional and innovative techniques in total knee arthroplasty
dc.type
Wissenschaftlicher Artikel
dcterms.bibliographicCitation.doi
10.1007/s00402-020-03389-4
dcterms.bibliographicCitation.journaltitle
Archives of Orthopaedic and Trauma Surgery
dcterms.bibliographicCitation.originalpublishername
Springer Nature
dcterms.bibliographicCitation.pagestart
793
dcterms.bibliographicCitation.pageend
800
dcterms.bibliographicCitation.volume
140
refubium.affiliation
Charité - Universitätsmedizin Berlin
refubium.funding
Springer Nature DEAL
refubium.resourceType.isindependentpub
no
dcterms.accessRights.openaire
open access
dcterms.bibliographicCitation.pmid
32124032
dcterms.isPartOf.issn
0936-8051
dcterms.isPartOf.eissn
1434-3916