The Position of Proximal Reference Point of Tibia Plateau for Correct Tibial Osteotomy in Total Knee Replacement: Prospective Randomized and 6 Years Follow-up Study
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Purpose: When there is a varus deformity in proximal tibia, the extension of a tibial shaft axis tends to pass through the lateral intercondylar eminence. A prospective randomized study was conducted to fi nd out whether the lateral eminence of tibia could serve as a reference point for proximal tibial osteotomy during total knee arthroplasty and results from 6-years follow up period were reported. Materials and Methods: Forty-six patients (50 knees) who received total knee replacement arthroplasty from April to December 2004, were randomly divided into two groups. For a proximal tibial osteotomy, the proximal tibial reference point was located at the center of intercondylar eminence for group I and at the lateral eminence for group II and subsequently, the results were evaluated. Radiologic indices were the angles between the axis of the prosthesis and the mechanical/shaft axes of tibia and angle of the prosthesis in sagittal plane. Clinical indices were pain and function score of American knee society, functional score of Hospital for Special Surgery and range of knee joint motion. Results: Th e angles between the axis of the prostheses and the mechanical/shaft axes of tibia were varus 1.64o/2.12o in group I and valgus 0.57o/0.38o in group II (p=0.589/p=0.558). Th ere were 6 cases of outliers (27.2%) in group 1 and 3 cases (15.0%) in group 2. Th ere was a signifi cant diff erence in the pain score between group I (82.9) and II (91.4) (p=0.032), respectively. Conclusions: By moving the reference point of proximal tibial osteotomy laterally, lower incidence of outlier and residual varus deformity could be achieved.
Abstract
Purpose: When there is a varus deformity in proximal tibia, the extension of a tibial shaft axis tends to pass through the lateral intercondylar eminence. A prospective randomized study was conducted to fi nd out whether the lateral eminence of tibia could serve as a reference point for proximal tibial osteotomy during total knee arthroplasty and results from 6-years follow up period were reported. Materials and Methods: Forty-six patients (50 knees) who received total knee replacement arthroplasty from April to December 2004, were randomly divided into two groups. For a proximal tibial osteotomy, the proximal tibial reference point was located at the center of intercondylar eminence for group I and at the lateral eminence for group II and subsequently, the results were evaluated. Radiologic indices were the angles between the axis of the prosthesis and the mechanical/shaft axes of tibia and angle of the prosthesis in sagittal plane. Clinical indices were pain and function score of American knee society, functional score of Hospital for Special Surgery and range of knee joint motion. Results: Th e angles between the axis of the prostheses and the mechanical/shaft axes of tibia were varus 1.64o/2.12o in group I and valgus 0.57o/0.38o in group II (p=0.589/p=0.558). Th ere were 6 cases of outliers (27.2%) in group 1 and 3 cases (15.0%) in group 2. Th ere was a signifi cant diff erence in the pain score between group I (82.9) and II (91.4) (p=0.032), respectively. Conclusions: By moving the reference point of proximal tibial osteotomy laterally, lower incidence of outlier and residual varus deformity could be achieved.
참고문헌 (23)
- Ritter MA, "Postoperative alignment of total knee replacement. Its effect on survival", Clin Orthop Relat Res, (299), pp.153~156 (1994)
- Windsor RE, "Mechanisms of failure of the femoral and tibial components in total knee arthroplasty", Clin Orthop Relat Res, (248), pp.15~19 (1989)
- Han HS, "Accuracy of intramedullary versus extramedullary tibial alignment guides: a randomized, prospective study in bilateral total knee arthroplasty", J Korean Knee Soc, 19, pp.181~186 (2007)
- Cho WS, "Arthroplasty of the knee joint", pp.266~315 (2004), Young Chang
- Nam WD, "change of proximal reference of tibial plateau in total knee replacement: the cadaveric study", J Korean Knee Soc, 17, pp.69~72 (2005)
- Hsu HP, "Eff ect of knee component alignment on tibial load distribution with clinical correlation", Clin Orthop Relat Res, (248), pp.135~144 (1989)
- Teter KE, "Accuracy of intramedullary versus extramedullary tibial alignment cutting systems in total knee arthroplasty", Clin Orthop Relat Res, (321), pp.106~110 (1995)
- Engh GA, "The diffi cult knee: severe varus and valgus", Clin Orthop Relat Res, (416), pp.58~63 (2003)
- Tew M, "Tibiofemoral alignment and the results of knee replacement", J Bone Joint Surg Br. 1985;67:551-6, 67, pp.551~556 (1985)
- Lotke PA, "Infl uence of positioning of prosthesis in total knee replacement", J Bone Joint Surg Am, 59, pp.77~79 (1977)
- Teeny SM, "Primary total knee arthroplasty in patients with severe varus deformity", A comparative study. Clin Orthop Relat Res, (273), pp.19~31 (1991)
- D’Lima DD, "Polyethylene contact stresses, articular congruity, and knee alignment", Clin Orthop Relat Res, (392), pp.232~238 (2001)
- Green GV, "The effects of varus tibial alignment on proximal tibial surface strain in total knee arthroplasty: Th e posteromedial hot spot", J Arthroplasty, 17, pp.1033~1039 (2002)
- Hofmann AA, "Eff ect of the tibial cut on subsidence following total knee arthroplasty", Clin Orthop Relat Res, (269), pp.63~69 (1991)
- Matsuda S, "Tibial shaft axis does not always serve as a correct coronal landmark in total knee arthroplasty for varus knees", J Arthroplasty, 18, pp.56~62 (2003)
- Matsuda S, "Evaluation of tibial component fixation in specimens retrieved at autopsy", Clin Orthop Relat Res, (363), pp.249~257 (1999)
- Brys DA, "A comparison of intramedullary and extramedullary alignment systems for tibial component placement in total knee arthroplasty", Clin Orthop Relat Res, (263), pp.175~179
- Laskin RS, "Instrumentation pitfalls: you just can’t go on autopilot!", J Arthroplasty, 18, pp.18~22 (2003)
- Plaskos C, "Bone cutting errors in total knee arthroplasty", J Arthroplasty, 17, pp.698~705 (2002)
- Bellemans J, "Robot-assisted total knee arthroplasty", Clin Orthop Relat Res, 464, pp.111~116 (2007)
- Mizu-Uchi H, "Three-dimensional analysis of computed tomography-based navigation system for total knee arthroplasty: the accuracy of computed tomography-based navigation system", J Arthroplasty, 24, pp.1103~1110 (2009)
- 원예연, "전자기장 네비게이션과 고식적 방법을 이용한 슬관절 전치환술의 방사선학적 결과와 비교", 대한정형외과학회지, 43(6), pp.760~765 (2008), 대한정형외과학회
- 배대경, "슬관절 전치환술에서 자동 항법 장치와 고식적인 수술법에 따른 삽입물의 방사선 계측치에 대한 비교 분석", 대한정형외과학회지, 40(4), pp.398~402 (2005), 대한정형외과학회