Improving tibial component coronal alignment using clearly defined anatomical structures in total knee arthroplasty

Area of Science:

• Orthopedic Surgery
• Biomedical Engineering
• Radiology

Background:

• Accurate tibial component alignment is crucial for successful total knee replacement (TKR).
• Traditional extramedullary alignment often relies on the intermalleolar center, which can be imprecise.
• Novel anatomical landmarks are being explored to improve alignment accuracy.

Purpose of the Study:

• To evaluate the efficacy of using the dorsalis pedis artery and anterior tibial crest as distal landmarks for extramedullary tibial alignment in TKR.
• To compare the accuracy of this novel landmark technique against the traditional intermalleolar center method.

Main Methods:

• Retrospective analysis of postoperative radiographs from 195 total knee replacements.
• Comparison between a control group (intermalleolar center) and a landmark group (dorsalis pedis artery and anterior tibial crest).
• Radiographic assessment of coronal tibial component alignment and identification of outliers.

Main Results:

• No significant difference in mean coronal alignment between the groups (89.7° vs 90.0°).
• Significantly reduced proportion of radiological outliers (>2° and >3°) in the landmark group compared to the control group (p < 0.0001 and p = 0.01, respectively).
• The landmark group demonstrated superior accuracy in achieving desired tibial component alignment.

Conclusions:

• Utilizing the dorsalis pedis artery and anterior tibial crest as anatomical landmarks enhances the accuracy of extramedullary tibial alignment in TKR.
• This multi-landmark approach offers a more reliable method for achieving optimal coronal alignment compared to relying solely on the intermalleolar center.
• Adoption of these anatomical landmarks can lead to improved surgical precision and potentially better long-term outcomes in total knee replacement procedures.