title: Improving tibial component coronal alignment using clearly defined anatomical structures in total knee arthroplasty.
abstract: Several authors recently proposed to use clearly defined anatomical structures for extramedullary tibial alignment in total knee replacement, instead of using the intermalleolar center. The purpose of this study was to evaluate the benefits of using the dorsalis pedis artery and the anterior tibial crest as distal landmarks. Postoperative radiographs in 195 knees (98 in the control and 97 in the landmark group) were evaluated. The mean coronal alignment of the tibial component was 89.7 degrees +/- 2.1 degrees in the control group and 90.0 degrees +/- 1.3 degrees in the landmark group. Although there was no significant difference, the proportion of radiological outliers was significantly reduced in the landmark group compared to the control group (6.2% vs 27.6% in > 2 degrees outliers; p < 0.0001, 1.0% vs 10.2% in > 3 degrees outliers; p = 0.01). In order to achieve accurate coronal alignment of the tibial component, it appears better to use multiple clear anatomical landmarks such as the dorsal pedis artery and the anterior tibial crest rather than using only the intermalleolar center.
authors.affiliation: Department of Orthopaedic Surgery, Kochi Medical School, Kochi University, Nankoku, Kochi 783-8505, Japan. ikeuchim@kochi-u.ac.jp
authors.forename: Masahiko
authors.initials: M
authors.lastname: Ikeuchi
authors.affiliation: Department of Orthopaedic Surgery, Kochi Medical School, Kochi University, Nankoku, Kochi 783-8505, Japan.
authors.forename: Masashi
authors.initials: M
authors.lastname: Izumi
authors.affiliation: Department of Orthopaedic Surgery, Kochi Medical School, Kochi University, Nankoku, Kochi 783-8505, Japan.
authors.forename: Koji
authors.initials: K
authors.lastname: Aso
authors.affiliation: Department of Orthopaedic Surgery, Kochi Medical School, Kochi University, Nankoku, Kochi 783-8505, Japan.
authors.forename: Natsuki
authors.initials: N
authors.lastname: Sugimura
authors.affiliation: Department of Orthopaedic Surgery, Kochi Medical School, Kochi University, Nankoku, Kochi 783-8505, Japan.
authors.forename: Toshikazu
authors.initials: T
authors.lastname: Tani
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D019645:Arthroplasty, Replacement, Knee / Q000379:methods* / Q000592:standards; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies