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Methods of intra- and post-operative determination of the position of the tibial component during total knee replacement

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Abstract

Aim of the study

To identify the most reliable anatomical landmarks and imaging techniques for assessing the rotation of the tibial component in total knee arthroplasty (TKA).

Methods

An extensive literature review (from January 2016 to March 2019) was performed. We included studies about primary TKA with details concerning the anatomical landmarks used for implanting the tibial component and also imaging studies assessing tibial component rotation. The final selection comprises only thirty-five articles consistent with the inclusion criteria.

Results

Extra-articular landmarks are not always reliable (even though the tibial tubercle is one of the most popular extra-articular landmarks used to assess the rotation of the tibial component), mainly because they vary and can lead to malrotation of the tibial component. Akagi’s line (an intra-articular landmark) is considered to be the most reliable and easy to find during surgery and likewise is not affected by articular deformities. The anterior tibial cortex (intra-articular landmark) also proved to be accurate and reliable with the main advantage being that is palpable after tibial resection.

Radiography provides a good and inexpensive option for imaging, but it is insufficient. Magnetic resonance imaging (MRI) is used in some cases but not routinely for assessing TKA components or their orientation. Computed tomography (CT), used together with a well-defined protocol (Berger’s method being the preferred choice), remains the “gold standard” for evaluating the rotation of the tibial component after TKA.

Conclusion

Currently, the most accurate and reliable anatomical landmarks are represented by Akagi’s line and the anterior cortex of the tibia. Post-operatively, through CT and well-established protocols, the rotation of the tibial component can be accurately determined.

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Authors and Affiliations

  1. Carol Davila University of Medicine and Pharmacy, Rectorate - Dionisie Lupu Street, no. 37, District 1, 020021, Bucharest, Romania

    Roman Popescu, Emil G. Haritinian & Stefan Cristea

  2. Clinical Hospital of Orthopedics and Traumatology and Osteoarticular TB “Foișor”, Ferdinand Blvd, no. 35-37, District 2, 021382, Bucharest, Romania

    Emil G. Haritinian

  3. Department of Orthopaedics and Traumatology, Saint Pantelimon Emergency Hospital, Pantelimon Road, no. 340-342, District 2, 021659, Bucharest, Romania

    Stefan Cristea

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  1. Roman Popescu
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Correspondence to Emil G. Haritinian or Stefan Cristea.

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The authors have obtained permission from the Springer Nature and Copyright Clearance Centre to use Table 3 and Fig. 2 from this text, which are taken from the article written by Mo Saffarini, Luca Nover, Reha Tandogan et al., “The original Akagi line is the most reliable: a systematic review of landmarks for rotational alignment of the tibial component in TKA,” published in Knee Surgery, Sports Traumatology, Arthroscopy (2018). Permission attached.

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Popescu, R., Haritinian, E.G. & Cristea, S. Methods of intra- and post-operative determination of the position of the tibial component during total knee replacement. International Orthopaedics (SICOT) 44, 119–128 (2020). https://doi.org/10.1007/s00264-019-04424-9

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  • DOI: https://doi.org/10.1007/s00264-019-04424-9

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