title: The dorsal pedis artery as a new distal landmark for extramedullary tibial alignment in total knee arthroplasty.
abstract: OBJECTIVE
  It is better to use multiple anatomical landmarks to reduce errors in component alignment in total knee arthroplasty. Therefore, it is worthwhile to find a new landmark that can be used as an addition to conventional ones. Herein, we assessed the dorsal pedis artery as a new distal landmark for extramedullary tibial alignment.
  
  
  METHODS
  Fifty-two ankles in patients undergoing total knee arthroplasty and 10 ankles in normal controls were included. Color Doppler ultrasonography was used to locate the dorsal pedis artery at the level of the ankle joint. Conventional landmarks, including the tibialis anterior tendon, the extensor hallucis longus tendon, the extensor digitorum longus tendon, and the malleolar centre, were also located on ultrasound images. The distances between the ankle centre and each landmark were measured and compared.
  
  
  RESULTS
  The dorsal pedis artery was absent in 2 patients and impalpable but visible with ultrasonography in other 2 patients. The dorsal pedis artery was located anatomically closest to the ankle centre in patients (0.4 ± 3.4 mm lateral). Statistical analysis showed that the dorsal pedis artery, the extensor hallucis longus tendon, and the malleolar centre were located significantly closer to the ankle centre comparing with the extensor digitorum longus tendon and the tibialis anterior tendon in both patients and controls (p < 0.001).
  
  
  CONCLUSIONS
  As long as the dorsal pedis artery exists, it can be used as an addition to the conventional landmarks in total knee arthroplasty. Using this new landmark will help reduce errors in coronal plane alignment of tibial component.
  
  
  METHODS
  II.
authors: Department of Orthopaedic Surgery, Kochi Medical School, Kochi University, Kohasu, Oko-cho, Nankoku, Kochi, 783-8505, Japan.
authors: Natsuki
authors: N
authors: Sugimura
authors: Masahiko
authors: M
authors: Ikeuchi
authors: Masashi
authors: M
authors: Izumi
authors: Koji
authors: K
authors: Aso
authors: Takahiro
authors: T
authors: Ushida
authors: Toshikazu
authors: T
authors: Tani
mesh_terms: D000328:Adult; D000842:Ankle / Q000098:blood supply / Q000601:surgery; D001158:Arteries / Q000000981:diagnostic imaging; D019645:Arthroplasty, Replacement, Knee / Q000379:methods*; D017760:Bone Malalignment / Q000517:prevention & control; D005260:Female; D006801:Humans; D008297:Male; D020370:Osteoarthritis, Knee / Q000601:surgery*; D013977:Tibia / Q000601:surgery*; D014463:Ultrasonography; D055815:Young Adult