Improving tibial component alignment in total knee arthroplasty

Purpose: Tibia torsion may influence the accuracy of extramedullary instrumentations in total knee arthroplasty (TKA). This study assessed whether the effect of tibial torsion may be overcome using a surgical technique in which the extramedullary rod is aligned to reference points at the proximal tibia only.

Methods: A consecutive series of 94 knees that underwent TKA were analyzed. In the first 47 knees (group 1), a standard procedure for tibial component alignment was performed while in the second group of 47 knees, a modified surgical technique was used including the alignment of the extramedullary rod to the reference points at the proximal tibia only (group 2). Lower limb, femoral, and tibial component alignment were measured on postoperative long-leg radiographs.

Results: Femorotibial mechanical axes angles were similar in the two groups. Femoral component alignment also did not differ between the groups. A neutral alignment of the tibial component was achieved in 17 and 34 % of the knees in group 1 and group 2, respectively (p = 0.04). A malalignment of the tibial component >3° was found in 34 % of knees in group 1 compared with 4 % of those in group 2 (p = 0.0001).

Conclusions: Coronal alignment of the tibial component may improve by setting the extramedullary rod in line with anatomical references in the proximal tibia only. This technique appears to bypass the influence of tibial torsion on the alignment of the extramedullary guide at the distal tibia. The clinical relevance of the study is that using this technique, the rate of malalignment of the tibial component may be reduced compared to a standard technique in which a fixed reference is used at the ankle joint.