title: Risk factors for tibial implant malpositioning in total knee arthrosplasty-consecutive series of one thousand, four hundred and seventeen cases.
abstract: Total knee arthroplasty (TKA) malalignment may result in pain and limited range of motion. The present study assessed the influence of different surgeon's and patient's related factors on the post-operative tibial tray coronal alignment.
  
  
  
  The charts and the x-rays of a continuous prospective series of 1417 TKAs operated upon between 1987 and 2015 were retrospectively reviewed. The long-leg AP views were performed at two months post-op and the tibial mechanical angle of the tibial tray was measured. Three groups were defined: varus (≤87° n = 167), valgus (≥93° n = 55) and well alignment (88° to 92° n = 1195). The influence of several pre-operative and peri-operative factors was investigated: surgeon handedness and experience (junior or senior), previous tibial osteotomies, Ahlbäck stage of osteoarthritits, pre-operative alignment, height and weight, age at surgery, approach (medial, lateral or tibial tubercle osteotomy), generation of implants, tray fixation, size of the tray and stem lenght. Univariate then multivariate analysis were performed to find out any correlation.
  
  
  
  Multivariate analysis showed a strong correlation between varus alignment of the tibial tray and pre-operative varus of the lower limb (p = 0.037), increased BMI (p = 0.016) and operated side opposite to the dominant surgeon's arm (p = 0.006). In a similar way a strong correlation was found between valgus alignment and pre-operative valgus of the limb (p = 0.026).
  
  
  
  Poor alignment of the tibial tray after TKA was associated with pre-operative malalignment of the lower limb, increased BMI and an index knee which was opposite to surgeon's dominant arm.
authors.affiliation: Centre Albert Trillat, Hôpital de la Croix Rousse, 103 grande rue de la Croix Rousse, 69004, Lyon, France. gaillard-romain@orange.fr.
authors.forename: Romain
authors.initials: R
authors.lastname: Gaillard
authors.affiliation: Casa Di Cura Villa Betania, Via Piccolomini 27, 00165, Rome, Italy.|Marrelli Hospital, via Gioacchino da fiore, 0962, Crotone, Italy.
authors.forename: Simone
authors.initials: S
authors.lastname: Cerciello
authors.affiliation: Centre Albert Trillat, Hôpital de la Croix Rousse, 103 grande rue de la Croix Rousse, 69004, Lyon, France.
authors.forename: Sebastien
authors.initials: S
authors.lastname: Lustig
authors.affiliation: Centre Albert Trillat, Hôpital de la Croix Rousse, 103 grande rue de la Croix Rousse, 69004, Lyon, France.
authors.forename: Elvire
authors.initials: E
authors.lastname: Servien
authors.affiliation: Centre Albert Trillat, Hôpital de la Croix Rousse, 103 grande rue de la Croix Rousse, 69004, Lyon, France.
authors.forename: Philippe
authors.initials: P
authors.lastname: Neyret
mesh_terms: D000328:Adult; D000368:Aged; D019645:Arthroplasty, Replacement, Knee / Q000009:adverse effects*; D005260:Female; D006801:Humans; D007719:Knee Joint / Q000000981:diagnostic imaging / Q000601:surgery*; D007720:Knee Prosthesis / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D020370:Osteoarthritis, Knee / Q000601:surgery; D011183:Postoperative Complications / Q000453:epidemiology / Q000209:etiology; D011446:Prospective Studies; D011475:Prosthesis Failure / Q000009:adverse effects / Q000209:etiology*; D012189:Retrospective Studies; D012307:Risk Factors; D013977:Tibia / Q000000981:diagnostic imaging / Q000601:surgery*
keywords: Obesity; Pre-operative malalignement; Surgeon handedness; Tibial implant malpositioning; Total knee arthroplasty