Article Abstract

Total knee replacement modifies the preoperative tibial torsion angle—similar results between computer-assisted and standard technique

Authors: Daniel Hernandez-Vaquero, Alfonso Noriega-Fernandez, Sergio Roncero-Gonzalez, Andres A. Sierra-Pereira, Manuel A. Sandoval-Garcia


Background: Malpositioning of the components in total knee replacement (TKR) can result in failure or deficient outcomes of the surgical procedure. In the tibial segment, the rotational position of the tray should reproduce the mechanical axis without modifying physiological tibial torsion.
Methods: A randomised, prospective study was made of 74 patients subjected TKR involving the standard technique (38 cases) and navigation surgery (36 cases). A computed tomography study of the knee and ankle was made before the operation and after arthroplasty implantation, in order to identify the position of the prosthetic tibial tray in the transverse axis and the tibial torsion angle.
Results: The rotation of the tibial tray changed from its preoperative to postoperative range, but no significant differences were found between the navigated and the standard groups. The presence of preoperative deformities in the frontal plane did not modify the changes in the rotation of the tibial component. The mean preoperative tibial torsion angle was 17.76º (SD =10.15) of external rotation, with no significant differences in relation to the previous frontal deformity. After TKR, the tibial torsion angle was 15.36º (SD =7.16) (P=0.021). There were no differences in final tibial torsion between the knees operated upon with the standard instruments and those subjected to computer-assisted surgery (CAS; P=0.157).
Conclusions: TKR surgery modifies preoperative tibial torsion. Neither mechanical instrumentation nor navigation surgery precisely reproduces the rotational axis of the leg.