title: Rotational references for total knee arthroplasty tibial components change with level of resection.
abstract: BACKGROUND
  Various landmarks can guide tibial component rotational alignment in routine TKA, but with the deeper tibial resection levels common in complex primary and revision TKAs, it is unknown whether these landmarks remain reliable.
  
  
  OBJECTIVE
  We asked whether three techniques for determining tibial component rotation based on local anatomic landmarks are reliable deeper tibial resection levels.
  
  
  METHODS
  The femoral transepicondylar axis was identified by three independent reviewers on MR images of knees from 24 men and 24 women and transposed at a traditional tibial resection level and at the level of the proximal, middle, and distal parts of the proximal tibiofibular joint. Three axes were drawn on axial slices at these levels: the geometric center of the tibial plateau to the medial 1/3 of the tubercle, the posterior condylar line of the tibia, and the largest mediolateral dimension of the tibia. These lines were compared with the transposed femoral epicondylar axis line.
  
  
  RESULTS
  The posterior condylar line of the tibia is the least variable local landmark for tibial component positioning at deep resection levels.
  
  
  CONCLUSIONS
  Assuming the normal posterior condylar line of the tibia is visible at revision, setting the tibial component at 10° external rotation with respect to the posterior condylar axis of the tibia gets the tibial component within 10° of proper rotation in 86% to 98% of patients, even to the distal part of the proximal tibiofibular joint. The experienced surgeon then can adjust this position based on cues from an assortment of other axes.
authors.affiliation: Bone and Joint Rehabilitation Research and Development Center, VA Palo Alto Healthcare System, 3801 Miranda Avenue, Surgical Services-MC 112, Palo Alto, CA 94304, USA.
authors.forename: Bradley P
authors.initials: BP
authors.lastname: Graw
authors.forename: Alexander H
authors.initials: AH
authors.lastname: Harris
authors.forename: Krishna R
authors.initials: KR
authors.lastname: Tripuraneni
authors.forename: Nicholas J
authors.initials: NJ
authors.lastname: Giori
mesh_terms: D000328:Adult; D000368:Aged; D019645:Arthroplasty, Replacement, Knee / Q000295:instrumentation / Q000379:methods*; D005260:Female; D006801:Humans; D007719:Knee Joint / Q000473:pathology / Q000503:physiopathology / Q000601:surgery*; D007720:Knee Prosthesis; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D015588:Observer Variation; D010027:Osteotomy; D011237:Predictive Value of Tests; D016059:Range of Motion, Articular; D015203:Reproducibility of Results; D012399:Rotation; D013977:Tibia / Q000473:pathology / Q000601:surgery*; D016896:Treatment Outcome