Comparison of clinical outcomes associated with change of posterior tibial slope in posterior-stabilized total knee arthroplasty
Keywords:
Clinical outcomes of changing posterior tibial slope PS TKA, Posterior tibial slope (PTS), Posterior-stabilized TKA (PS-TKA)Abstract
Objective : One of the most important factors that affect outcomes of total knee arthroplasty (TKA) is alignment. Surgeons always keep post-operative alignment back to normal of each patient to restore their knee kinematic. However, there is lack of study about sagittal alignment especially posterior tibial slope (PTS). In present, proper of PTS still controversy. Many finite element and cadaveric studies confirm that knee kinematic also depend on changing of PTS in Posterior-stabilized TKA (PS-TKA). A purpose of this study was to evaluate effect of changing PTS to short-term clinical outcomes in PS-TKA.
Method : Retrospective cohort study in 30 knees (26 patients) who underwent PS-TKA. Divide into 2 groups, first for patient who changing of PTS 10 degree or higher and another group for patient who changing PTS less than 10 degree. Pre-operative and post-operative Knee ROM, VAS, Coronal alignment, PTS, WOMAC score and KSS score of each patient were collected the day before surgery and at 1 year follow up.
Result : All patients got better clinical outcomes post-operative. There is no significant correlation was found between both groups. Although patients who changing of PTS less than 10 degree got better improve in VAS {6.7 (4-10 SD 1.7) vs 5.5 (3-8 SD 2.1) P=0.10}, knee ROM {16.4 (0-35 SD 12.8) vs 10.7 (0-25 SD 8.3) P=0.17}, WOMAC score {46.8 (27-60 SD 8.5) vs 38.1 (22-61 SD 10.0) P=0.02} and KSS score {knee rating:64.2 (30-90 SD 19.9) vs 55.6 (28-85 SD 18.1) P=0.24 Knee function:52.1 (20-70 SD 18.3) vs 38.6 (10-70 SD 18.0) P=0.058} when compare between pre-operative and post-operative, there is only WOMAC score that statistical different. In addition, these difference of WOMAC score between 2 groups is less than MCID of WOMAC score.
Conclusion : Changing of PTS may be one of the factors that affect clinical outcomes of PS-TKA. The less changing of PTS may be a proper option for adjust PTS in PS-TKA.
References
Bourne RB, Chesworth BM, Davis AM, Mahomed NN, Charron KDJ. Patient satisfaction after total knee arthroplasty: who is satisfied and who is not? Clin Orthop Relat Res. 2010;468:57–63.
Anderson JG, Wixson RL, Tsai D, Stulberg SD, Chang RW. Functional outcome and patient satisfaction in total knee patients over the age of 75. J Arthroplasty. 1996;11:831–840.
Hawker G, Wright J, Coyte P, Paul J, Dittus R, Croxford R, Katz B, Bombardier C, Heck D, Freund D. Health-related quality of life after knee replacement. Results of the knee replacement patient outcomes research team study. J Bone Joint Surg Am. 1998;80:163–173.
Komistek RD, Dennis DA, Walker SA, Anderson DT (1998) A multicenter analysis of A/P translation in TKA.11th conference of the ESB, Toulouse
Komistek RD, Walker SA, Crossett LS,Running D, Dennis DA (1998) In vivo kinematics of PS implanted knees during gait. 11th Conference of the ESB,Toulouse
Lewandowski PJ, Askew MJ, Lin DF,Hurst FW, Melby A (1997) Kinematicsof posterior cruciate ligament-retainingand -sacrificing mobile bearing total knee arthroplasties. J Arthroplasty 12:777–784
Wang Y, Yan S, Zeng J, Zhang K. The biomechanical effect of different posterior tibial slopes on the tibiofemoral joint after posterior-stabilized total knee arthroplasty. J Orthop Surg Res. 2020 Aug 12;15(1):320.
Pritchett JW. Patients prefer a bicruciate-retaining or the medial pivot total knee prosthesis. J Arthroplast. 2011;26:224–8.
Victor J, Bellemans J. Physiologic kinematics as a concept for better flexion in TKA. Clin Orthop Relat Res. 2006;452:53–8.
Chambers AW, Wood AR, Kosmopoulos V, Sanchez HB, Wagner RA. Effect of posterior tibial slope on flexion and anterior-posterior tibial translation in posterior cruciate-retaining total knee arthroplasty. J Arthroplast. 2016;31:103–6.
Fujito T, Tomita T, Yamazaki T, Oda K, Yoshikawa H, Sugamoto K. Influence of posterior tibial slope on kinematics after cruciate-retaining total knee arthroplasty. J Arthroplast. 2018;33:3778–82.
Fujimoto E, Sasashige Y, Tomita T, Iwamoto K, Masuda Y, Hisatome T. Significant effect of the posterior tibial slope on the weight-bearing, midflexion in vivo kinematics after cruciate-retaining total knee arthroplasty. J Arthroplast. 2014;29:2324–30.
Okazaki K, Tashiro Y, Mizu-uchi H, Hamai S, Doi T, Iwamoto Y. Influence of the posterior tibial slope on the flexion gap in total knee arthroplasty. Knee. 2014;21:806–9.
Oka S, Matsumoto T, Muratsu H, Kubo S, Matsushita T, Ishida K, et al. The influence of the tibial slope on intra-operative soft tissue balance in cruciate-retaining and posterior-stabilized total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc. 2014;22:1812–8.
Ostermeier S, Hurschler C, Windhagen H, Stukenborg-Colsman C. In vitro investigation of the influence of tibial slope on quadriceps extension force after total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc. 2006;14:934–9.
Collier, M. B., Engh, C. A. J., McAuley, J. P., & Engh, G. A. Factors associated with the loss of thickness of polyethylene tibial bearings after knee arthroplasty. The Journal of Bone and Joint Surgery. American Volume, 89(6), 1306–1314.
Kang KT, Koh YG, Son J, Kwon OR, Lee JS, Kwon SK. Comparison of Kinematics in Cruciate Retaining and Posterior Stabilized for Fixed and Rotating Platform Mobile-Bearing Total Knee Arthroplasty with respect to Different Posterior Tibial Slope. Biomed Res Int. 2018 Jun11;2018:5139074.
Kyoung-Tak Kang, Yong-Gon Koh, Juhyun Son, Oh-Ryong Kwon, Jun-Sang Lee, Sae Kwang Kwon. Biomechanical Effects of Posterior Condylar Offset and Posterior Tibial Slope on Quadriceps Force and Joint Contact Forces in Posterior-Stabilized Total Knee Arthroplasty. BioMed Research International, vol. 2017, Article ID 4908639, 12 pages, 2017.
Kang KT, Kwon SK, Son J, Kwon OR, Lee JS, Koh YG. The increase in posterior tibial slope provides a positive biomechanical effect in posterior-stabilized total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc. 2018 Oct;26(10):3188-3195.
Ravishanker Baliga B, Raghuvir Pai B, Satish Shenoy, Atmananda Hegde K, Sharath Rao K, Shubham Swaroop & Abhijeet Shetkar (2018) Effect of posterior tibial slope and implant material on the bone-implant system following TKA: A finite element study, Cogent Engineering, 5:1, 1513771,
Tachibana, Muratsu, Kamimura, Ikuta, Oshima, Koga, Matsumoto, Maruo, Miya, Kuroda. Influence of posterior tibial slope on one-year postoperative patient satisfaction after posterior stabilized total knee arthroplasty. Orthopaedic ProceedingsVol. 101-B, No. SUPP_5
Vaidya, N., Aski, B., & Patil, R. (2016). Total knee arthroplasty and posterior tibial slope. International Surgery Journal, 2(1), 43-46.
Singh G, Tan JH, Sng BY, Awiszus F, Lohmann CH, Nathan SS. Restoring the anatomical tibial slope and limb axis may maximise post-operative flexion in posterior-stabilised total knee replacements. Bone Joint J. 2013 Oct;95-B(10):1354-8.
Seo SS, Kim CW, Kim JH, Min YK. Clinical results associated with changes of posterior tibial slope in total knee arthroplasty. Knee Surg Relat Res. 2013;25(1):25-29.
Shen, Y., Li, X., Fu, X., & Wang, W. (2015). A 3D finite element model to investigate prosthetic interface stresses of different posterior tibial slope. Knee Surgery, Sports Traumatology, Arthroscopy, 23(11), 3330–3336.
Vince, K. G.Why knees fail.The Journal of Arthroplasty, 18(3 Suppl 1), 39–44.
Lee, H.-Y., Kim, S.-J., Kang, K.-T., Kim, S.-H., & Park, -K.-K. The effect of tibial posterior slope on contact force and ligaments stresses in posterior-stabilized total knee arthroplasty-explicit finite element analysis. Knee Surgery & Related Research, 24(2), 91–98.
Schnurr, C., Eysel, P., & König, D. P. Is the effect of a posterior cruciate ligament resection in total knee arthroplasty predictable? International Orthopaedics. Berlin/Heidelberg.
Yoo, J. H., Chang, C. B., Shin, K. S., Seong, S. C., & Kim, T.K. Anatomical references to assess the posterior tibial slope in total knee arthroplasty: A comparison of 5 anatomical axes. The Journal of Arthroplasty, 23(4), 586–592.
Medda S, Kundu R, Sengupta S, Pal AK. Anatomical variation of posterior slope of tibial plateau in adult Eastern Indian population. Indian J Orthop 2017;51:69-74.
Brazier J, Migaud H, Gougeon F, Cotten A, Fontaine C, Duquennoy A. Evaluation of methods for radiographic measurement of the tibial slope. A study of 83 healthy knees. Rev Chir Orthop Reparatrice Appar Mot 1996;82:195-200.
Akagi M et al. An anteroposterior axis of the tibia for total knee arthroplasty. Clin Orthop Relat Res. 2004(420):213-9.
Kızılgöz V, Sivrioğlu AK, Ulusoy GR, Yıldız K, Aydın H, Çetin T. Posterior tibial slope measurement on lateral knee radiographs as a risk factor of anterior cruciate ligament injury: A cross-sectional study. Radiography (Lond). 2019 Feb;25(1):33-38.
Escobar A et al. Responsiveness and clinically important differences for the WOMAC and SF-36 after total knee replacement. Osteoarthritis and Cartilage, Volume 15, Issue 3, 273 - 280
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