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.