title: Improving tibial component coronal alignment during total knee arthroplasty with use of a tibial planing device.
abstract: BACKGROUND
  The outcomes of knee arthroplasty have been shown to be affected by component alignment. Intramedullary and extramedullary alignment instrumentation are fairly effective for achieving the desired mean tibial component coronal alignment. However, there are outliers representing >3 degrees of varus or valgus alignment with respect to the anatomic tibial shaft axis. We measured the efficacy of a custom tibial planing device for reducing the outliers in tibial alignment.
  
  
  METHODS
  We designed a tibial planing tool in an effort to improve tibial alignment. In one cohort (100 knees), we used traditional intramedullary alignment instrumentation to make the tibial bone cut. In a second cohort (120 knees), we used intramedullary alignment instrumentation to make the cut and also used a custom tool to check the cut and to correct an inexact cut. Tibial tray alignment relative to the long axis of the tibial shaft was measured in the coronal and sagittal planes on postoperative radiographs. The target coronal alignment was 90 degrees with respect to the tibial shaft axis (with <90 degrees denoting varus alignment). A total of 100 anteroposterior radiographs and sixty-five lateral radiographs were analyzed for the group that was treated with traditional instrumentation alone, and a total of 120 anteroposterior radiographs and fifty-five lateral radiographs were analyzed for the group that was treated with use of the custom tibial planing device.
  
  
  RESULTS
  The mean coronal alignment of the tibial component was 89.5 degrees +/- 2.1 degrees in the group that was treated with traditional instrumentation alone and 89.6 degrees +/- 1.4 degrees in the group that was treated with use of the custom planing device. Although the mean coronal alignment was not significantly different, the number of outliers was substantially reduced when the custom planing device was used. All 120 components that had been aligned with use of the custom planing device were within 3 degrees of the target coronal alignment, compared with only eighty-seven of the 100 components that had been implanted with use of traditional intramedullary alignment alone (p = 0.05).
  
  
  CONCLUSIONS
  The use of a simple, inexpensive tibial planing device reduced the number of outliers due to tibial tray malalignment. Tibial varus has been associated with a higher risk of failure. Improving the accuracy of tibial component alignment may reduce the potential for poor clinical outcomes.
authors.affiliation: Shiley Center for Orthopaedic Research and Education at Scripps Clinic, 11025 North Torrey Pines Road, Suite 140, La Jolla, CA 92037, USA.
authors.forename: Shantanu
authors.initials: S
authors.lastname: Patil
authors.forename: Darryl D
authors.initials: DD
authors.lastname: D'Lima
authors.forename: James M
authors.initials: JM
authors.lastname: Fait
authors.forename: Clifford W
authors.initials: CW
authors.lastname: Colwell
mesh_terms: D019645:Arthroplasty, Replacement, Knee / Q000009:adverse effects / Q000295:instrumentation* / Q000379:methods; D017760:Bone Malalignment / Q000517:prevention & control*; D006801:Humans; D013977:Tibia / Q000601:surgery*; D016896:Treatment Outcome