title: Using fibula as a reference can be beneficial for the tibial component alignment after total knee arthroplasty, a retrospective study.
abstract: OBJECTIVE
  One of the important factors in a successful arthroplasty is component alignment. The primary objective of this study was to determine whether the fibular shaft reference technique is beneficial for the tibial component position on the postoperative plain radiograph after total knee arthroplasty.
  
  
  METHODS
  A total of 42 patients between 2009 and 2011 were analysed retrospectively. The surgeon prepared the tibia using an extramedullary cutting guide and set the posterior tibial slope with respect to the fibular reference rod. In the postoperative radiographic measurements, a true anteroposterior and lateral radiograph of the lower leg covering the whole length of the tibia was used.
  
  
  RESULTS
  Five patients were excluded as they did not meet the inclusion criteria, four patients were excluded due to improper radiographs and the study group was reduced to 33 patients and 35 knees. The mean preoperative tibiofibular angle was 2.1° ± 0.8°. The mean postoperative tibial sagittal angle measurements were 83.3° ± 1.4° (81°-86°). 33 (94 %) Knees gained the desired tibial sagittal angle within the desired alignment (5° ± 3°). The mean postoperative tibial coronal angle was 89.3° ± 1.5°. The tibial component coronal angle of two knees was more than 3 alignment from the neutral mechanical axis.
  
  
  CONCLUSIONS
  The major clinical relevance of the technique described in the present study is cost-effectiveness, and it does not require any extra time or surgical equipment. This method can be used as an alternative choice for bulky extremities which is a cause of malalignment of the components.
  
  
  METHODS
  Retrospective case series, Level IV.
authors.affiliation: Orthopaedic and Traumatology Department, Faculty of Medicine, Sakarya University, Sakarya, Turkey, drmehmeterdem@gmail.com.
authors.forename: Mehmet
authors.initials: M
authors.lastname: Erdem
authors.forename: Deniz
authors.initials: D
authors.lastname: Gulabi
authors.forename: Gultekin Sitki
authors.initials: GS
authors.lastname: Cecen
authors.forename: Cem Coskun
authors.initials: CC
authors.lastname: Avci
authors.forename: Murat
authors.initials: M
authors.lastname: Asci
authors.forename: Fevzi
authors.initials: F
authors.lastname: Saglam
mesh_terms: D000368:Aged; D019645:Arthroplasty, Replacement, Knee / Q000379:methods*; D005260:Female; D005360:Fibula / Q000000981:diagnostic imaging* / Q000601:surgery; D006801:Humans; D008297:Male; D008875:Middle Aged; D020370:Osteoarthritis, Knee / Q000000981:diagnostic imaging* / Q000601:surgery*; D011184:Postoperative Period; D011859:Radiography; D012189:Retrospective Studies; D013977:Tibia / Q000000981:diagnostic imaging / Q000601:surgery