A new landmark for measuring tibial component rotation after total knee arthroplasty

Existing methods for assessment of total knee arthroplasty (TKA) component rotation on computed tomography (CT) scans are complex, especially in relation to the tibial component. Anecdotal evidence from our practice pointed towards a potential new landmark. The study aims were to check the prevalence of this landmark, define tibial component rotation in relation to it and demonstrate its reliability.

Two hundred and eleven CTs undertaken following TKA were reviewed for presence of the landmark. A protocol to measure tibial component rotation in relation to this landmark was developed and the rotation measured using this method and Berger's protocol. Thirty one of the 211 CT scans were measured twice by two observers. Reliability was calculated using the Intraclass Correlation Coefficient (ICC).

The new landmark of a flat area on the lateral cortex of the tibia inferior to the tibial component was identified on all scans. Median tibial component rotation measured using our protocol was 0.0° ± 5.4° and -9.2° ± 5.5° using Berger's protocol. Intra-observer reliability with the new method was excellent (ICCs of 0.899 and 0.871) and inter-observer reliability was good (ICCs of 0.734 and 0.836).

The new landmark had a very high prevalence and could be used to define tibial component rotation. This measurement of tibial component rotation had acceptable reliability. This landmark has potential for use in the radiological assessment of tibial component rotation following TKA. Further work is required to determine its relationship to anatomical structures and symptoms of tibial component mal-rotation.