The Journal of Bone and Joint Surgery (American). 2006;88:2632-2636.
doi:10.2106/JBJS.E.01288
© 2006 The Journal of Bone and Joint Surgery, Inc.
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The Effect of Ankle Rotation on Cutting of the Tibia in Total Knee Arthroplasty

Hideki Mizu-uchi, MD1, Shuichi Matsuda, MD, PhD1, Hiromasa Miura, MD, PhD1, Hidehiko Higaki, PhD2, Ken Okazaki, MD, PhD1 and Yukihide Iwamoto, MD, PhD1

1 Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, 3-1-1, Maidashi, Higashi-ku, Fukuoka City, 812-8582, Japan. E-mail address for H. Mizu-uchi: himizu{at}ortho.med.kyushu-u.ac.jp. E-mail address for S. Matsuda: mazda{at}ortho.med.kyushu-u.ac.jp. E-mail address for H. Miura: miura{at}ortho.med.kyushu-u.ac.jp. E-mail address for K. Okazaki: okazaki{at}ortho.med.kyushu-u.ac.jp. E-mail address for Y. Iwamoto: yiwamoto{at}ortho.med.kyushu-u.ac.jp
2 Department of Mechanical Engineering, Kyushu Sangyo University, 2-3-1, Matsukadai, Higashi-ku, Fukuoka City, 813-8503, Japan. E-mail address: higaki{at}ip.kyusan-u.ac.jp

Investigation performed at the Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, Fukuoka City, Japan

The authors did not receive grants or outside funding in support of their research for or preparation of this manuscript. They did not receive payments or other benefits or a commitment or agreement to provide such benefits from a commercial entity. No commercial entity paid or directed, or agreed to pay or direct, any benefits to any research fund, foundation, educational institution, or other charitable or nonprofit organization with which the authors are affiliated or associated.

Background: Extramedullary alignment guides are commonly used to prepare the tibia during total knee arthroplasty. One disadvantage is that the guide is easily affected by the position of the ankle joint. The tibia may have a rotational mismatch between its proximal and distal ends. We hypothesized that a rotational mismatch might cause incorrect positioning of an extramedullary alignment guide and evaluated such a mismatch on the predicted postoperative coronal alignment of the tibia.

Methods: Fifty-three osteoarthritic knees with varus deformity in fifty-one patients were evaluated with use of computerized tomography scans before total knee arthroplasty. We defined one anteroposterior axis of the ankle joint and five different anteroposterior axes of the proximal aspect of the tibia using three-dimensional bone models from the computerized tomography data. We measured the rotational angle between the anteroposterior axis of the ankle joint and the proximal part of the tibia. The distal end of the extramedullary guide was placed in front of the center of the ankle joint (on the line of the extended anteroposterior axis of the ankle joint), and the proximal end was placed on the line of the extended anteroposterior axis of the proximal part of the tibia. We established spatial coordinates to evaluate the effect of the rotational angle on the predicted postoperative coronal alignment of the tibia and calculated the presumed tibial coronal alignment.

Results: The rotational angle was positive (3.6° to 19.7°) for all of the anteroposterior axes of the proximal aspect of the tibia, indicating that the ankle joint was externally rotated relative to the proximal part of the tibia. The predicted tibial coronal alignment was varus (0.5° to 5.1°) for all of the anteroposterior axes of the proximal part of the tibia.

Conclusions: When an extramedullary alignment guide is used to prepare the tibia in total knee arthroplasty, varus alignment of the tibial component can occur because of a rotational mismatch between the proximal part of the tibia and the ankle joint.

Clinical Relevance: To avoid tibial component malalignment, it is important to consider a rotational mismatch between the proximal part of the tibia and the ankle joint when an extramedullary alignment guide is used in total knee arthroplasty.


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