Download PDF
J Knee Surg 2023; 36(01): 087-094
DOI: 10.1055/s-0041-1729967
Original Article

Effect of Posterior Tibial Slope Change on Postoperative Range of Motion and Clinical Outcomes after Posterior Cruciate-Substituting Total Knee Arthroplasty

O-Sung Lee 
1   Department of Orthopedic Surgery, Eulji University School of Medicine, Uijeongbu-si, Korea (the Republic of)
,
Jangyun Lee
2   Department of Orthopedic Surgery, National Medical Center, Seoul, Korea (the Republic of)
,
Myung Chul Lee
3   Department of Orthopedic Surgery, Seoul National University Hospital, Seoul, Korea (the Republic of)
,
Hyuk-Soo Han 
3   Department of Orthopedic Surgery, Seoul National University Hospital, Seoul, Korea (the Republic of)
› Author Affiliations
› Further Information
   Permissions and Reprints

Abstract

The posterior tibial slope (PTS) is usually adjusted by less than 5 degrees, without considering its individual difference, during posterior cruciate-substituting (PS) total knee arthroplasty (TKA). The effect of these individual changes of PTS would be important because clinical results depending on postoperative PTS were reported conflictingly. We investigated the effect of the change in PTS on the postoperative range of motion (ROM) and clinical scores after PS TKA. We retrospectively reviewed 164 knees from 107 patients who underwent PS TKA with a 2-year follow-up. We analyzed the preoperative and postoperative PTS, ROM, visual analog scale pain scale, Western Ontario and McMaster University Index (WOMAC), Hospital for Special Surgery Knee Score, Knee Society Score, and Forgotten Joint Score (FJS). The association of the absolute change in PTS with ROM and clinical scores was analyzed using correlation analysis and multiple regression analysis. As a result, the mean PTS and mean ROM changed from 9.6 ±  3.4 and 120.1 ±  15.4 degrees preoperatively to 2.0 ±  1.3 and 128.4 ±  9.3 degrees postoperatively, and the mean PTS change was 7.6 ±  3.5 degrees. The PTS change had no statistically significant association with the postoperative ROM and clinical scoring systems, although it did have a weak positive correlation with WOMAC function, No 10 (difficulty in rising from sitting) (correlation coefficient = 0.342, p = 0.041), and moderate positive correlation with the FJS, No. 6 (awareness when climbing stairs) (correlation coefficient = 0.470, p = 0.001). The authors concluded that the amount of change in PTS did not affect the postoperative ROM and clinical scores, although proximal tibial resection with a constant target of PTS resulted in individually different changes in the PTS after PS TKA,

Keywords

total knee arthroplasty - posterior tibial slope - range of motion - clinical outcome


Publication History

Received: 27 December 2020

Accepted: 01 April 2021

Article published online:
15 May 2021

© 2021. Thieme. All rights reserved.

Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA

 

  • References

  • 1 Matsuda S, Kawahara S, Okazaki K, Tashiro Y, Iwamoto Y. Postoperative alignment and ROM affect patient satisfaction after TKA. Clin Orthop Relat Res 2013; 471 (01) 127-133
    CrossrefPubMedGoogle Scholar
  • 2 Van Onsem S, Verstraete M, Dhont S, Zwaenepoel B, Van Der Straeten C, Victor J. Improved walking distance and range of motion predict patient satisfaction after TKA. Knee Surg Sports Traumatol Arthrosc 2018; 26 (11) 3272-3279
    CrossrefPubMedGoogle Scholar
  • 3 Bellemans J, Robijns F, Duerinckx J, Banks S, Vandenneucker H. The influence of tibial slope on maximal flexion after total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 2005; 13 (03) 193-196
    CrossrefPubMedGoogle Scholar
  • 4 Malviya A, Lingard EA, Weir DJ, Deehan DJ. Predicting range of movement after knee replacement: the importance of posterior condylar offset and tibial slope. Knee Surg Sports Traumatol Arthrosc 2009; 17 (05) 491-498
    CrossrefPubMedGoogle Scholar
  • 5 Shi X, Shen B, Kang P, Yang J, Zhou Z, Pei F. The effect of posterior tibial slope on knee flexion in posterior-stabilized total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 2013; 21 (12) 2696-2703
    CrossrefPubMedGoogle Scholar
  • 6 Walker PS, Garg A. Range of motion in total knee arthroplasty. A computer analysis. Clin Orthop Relat Res 1991; (262) 227-235
    PubMedGoogle Scholar
  • 7 Bai B, Baez J, Testa N, Kummer FJ. Effect of posterior cut angle on tibial component loading. J Arthroplasty 2000; 15 (07) 916-920
    CrossrefPubMedGoogle Scholar
  • 8 Cinotti G, Sessa P, Ragusa G. et al. Influence of cartilage and menisci on the sagittal slope of the tibial plateaus. Clin Anat 2013; 26 (07) 883-892
    CrossrefPubMedGoogle Scholar
  • 9 Dai Y, Angibaud LD, Jenny JY, Hamad C, Jung A, Cross MB. A soft-tissue preserving method for evaluating the impact of posterior tibial slope on kinematics during cruciate-retaining total knee arthroplasty: a validation study. Knee 2016; 23 (06) 1074-1082
    CrossrefPubMedGoogle Scholar
  • 10 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 Arthroplasty 2014; 29 (12) 2324-2330
    CrossrefPubMedGoogle Scholar
  • 11 Giffin JR, Vogrin TM, Zantop T, Woo SL, Harner CD. Effects of increasing tibial slope on the biomechanics of the knee. Am J Sports Med 2004; 32 (02) 376-382
    CrossrefPubMedGoogle Scholar
  • 12 Kansara D, Markel DC. The effect of posterior tibial slope on range of motion after total knee arthroplasty. J Arthroplasty 2006; 21 (06) 809-813
    CrossrefPubMedGoogle Scholar
  • 13 Oka S, Matsumoto T, Muratsu H. 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 (08) 1812-1818
    CrossrefPubMedGoogle Scholar
  • 14 Lee HY, Kim SJ, Kang KT, Kim SH, Park KK. The effect of tibial posterior slope on contact force and ligaments stresses in posterior-stabilized total knee arthroplasty-explicit finite element analysis. Knee Surg Relat Res 2012; 24 (02) 91-98
    CrossrefPubMedGoogle Scholar
  • 15 Okamoto S, Mizu-uchi H, Okazaki K, Hamai S, Nakahara H, Iwamoto Y. Effect of tibial posterior slope on knee kinematics, quadriceps force, and patellofemoral contact force after posterior-stabilized total knee arthroplasty. J Arthroplasty 2015; 30 (08) 1439-1443
    CrossrefPubMedGoogle Scholar
  • 16 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 (04) 806-809
    CrossrefPubMedGoogle Scholar
  • 17 de Boer JJ, Blankevoort L, Kingma I, Vorster W. In vitro study of inter-individual variation in posterior slope in the knee joint. Clin Biomech (Bristol, Avon) 2009; 24 (06) 488-492
    CrossrefPubMedGoogle Scholar
  • 18 Marouane H, Shirazi-Adl A, Adouni M, Hashemi J. Steeper posterior tibial slope markedly increases ACL force in both active gait and passive knee joint under compression. J Biomech 2014; 47 (06) 1353-1359
    CrossrefPubMedGoogle Scholar
  • 19 Asano H, Hoshino A, Wilton TJ. Soft-tissue tension total knee arthroplasty. J Arthroplasty 2004; 19 (05) 558-561
    CrossrefPubMedGoogle Scholar
  • 20 Kim JI, Chun SH, Han HS, Lee S, Lee MC. Femoral component rotations in different gap tensions in total knee arthroplasty: a prospective randomized controlled trial. Knee 2017; 24 (02) 439-446
    CrossrefPubMedGoogle Scholar
  • 21 Ahmad R, Patel A, Mandalia V, Toms A. Posterior tibial slope: effect on, and interaction with, knee kinematics. JBJS Rev 2016; 4 (04) e31-e36
    CrossrefPubMedGoogle Scholar
  • 22 Yoo JH, Chang CB, Shin KS, Seong SC, Kim TK. Anatomical references to assess the posterior tibial slope in total knee arthroplasty: a comparison of 5 anatomical axes. J Arthroplasty 2008; 23 (04) 586-592
    CrossrefPubMedGoogle Scholar
  • 23 Blackburne JS, Peel TE. A new method of measuring patellar height. J Bone Joint Surg Br 1977; 59 (02) 241-242
    CrossrefPubMedGoogle Scholar
  • 24 Rogers BA, Thornton-Bott P, Cannon SR, Briggs TWR. Interobserver variation in the measurement of patellar height after total knee arthroplasty. J Bone Joint Surg Br 2006; 88 (04) 484-488
    CrossrefPubMedGoogle Scholar
  • 25 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; 95-B (10) 1354-1358
    CrossrefPubMedGoogle Scholar
  • 26 Bauer T, Biau D, Colmar M, Poux X, Hardy P, Lortat-Jacob A. Influence of posterior condylar offset on knee flexion after cruciate-sacrificing mobile-bearing total knee replacement: a prospective analysis of 410 consecutive cases. Knee 2010; 17 (06) 375-380
    CrossrefPubMedGoogle Scholar
  • 27 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 Arthroplasty 2016; 31 (01) 103-106
    CrossrefPubMedGoogle Scholar
  • 28 Hamai S, Okazaki K, Shimoto T, Nakahara H, Higaki H, Iwamoto Y. Continuous sagittal radiological evaluation of stair-climbing in cruciate-retaining and posterior-stabilized total knee arthroplasties using image-matching techniques. J Arthroplasty 2015; 30 (05) 864-869
    CrossrefPubMedGoogle Scholar
  • 29 Kim JH. Effect of posterior femoral condylar offset and posterior tibial slope on maximal flexion angle of the knee in posterior cruciate ligament sacrificing total knee arthroplasty. Knee Surg Relat Res 2013; 25 (02) 54-59
    CrossrefPubMedGoogle Scholar
  • 30 Callaghan JJ, Rourke MR, Goetz DD. et al. Tibial post impingement in posterior-stabilized total knee arthroplasty. Clin Orthop Relat Res 2002; 404: 83-88
    CrossrefPubMedGoogle Scholar
  • 31 Haas BD. Tibial post impingement in posterior-stabilized total knee arthroplasty. Orthopedics 2006; 29 (9, Suppl): S83-S85
    PubMedGoogle Scholar
  • 32 Kadoya Y, Kobayashi A, Komatsu T, Nakagawa S, Yamano Y. Effects of posterior cruciate ligament resection on the tibiofemoral joint gap. Clin Orthop Relat Res 2001; (391) 210-217
    CrossrefPubMedGoogle Scholar
  • 33 Park SJ, Seon JK, Park JK, Song EK. Effect of PCL on flexion-extension gaps and femoral component decision in TKA. Orthopedics 2009; 32 (10, Suppl): 22-25
    CrossrefPubMedGoogle Scholar
  • 34 Matziolis G, Loos M, Böhle S, Schwerdt C, Roehner E, Heinecke M. Effect of additional distal femoral resection on flexion deformity in posterior-stabilized total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 2019
    PubMedGoogle Scholar
  • 35 Catani F, Fantozzi S, Ensini A, Leardini A, Moschella D, Giannini S. Influence of tibial component posterior slope on in vivo knee kinematics in fixed-bearing total knee arthroplasty. J Orthop Res 2006; 24 (04) 581-587
    CrossrefPubMedGoogle Scholar
  • 36 Grelsamer RP. Patella baja after total knee arthroplasty: is it really patella baja?. J Arthroplasty 2002; 17 (01) 66-69
    CrossrefPubMedGoogle Scholar
  • 37 Prudhon JL, Caton JH, Aslanian T, Verdier R. How is patella height modified after total knee arthroplasty?. Int Orthop 2018; 42 (02) 311-316
    CrossrefPubMedGoogle Scholar
  • 38 Phillips CL, Silver DAT, Schranz PJ, Mandalia V. The measurement of patellar height: a review of the methods of imaging. J Bone Joint Surg Br 2010; 92 (08) 1045-1053
    CrossrefPubMedGoogle Scholar
  • 39 Cabral F, Sousa-Pinto B, Pinto R, Torres J. Patellar height after total knee arthroplasty: comparison of 3 methods. J Arthroplasty 2017; 32 (02) 552-557.e2
    CrossrefPubMedGoogle Scholar
  • 40 Aguirre-Pastor A, Ortolá DJ, Lizaur-Utrilla A, Rosa MA, Lopez-Prats FA. Is pseudo-patella baja really a serious complication of total knee arthroplasty?. J Arthroplasty 2020; 35 (02) 557-562
    CrossrefPubMedGoogle Scholar
  • 41 Bugelli G, Ascione F, Cazzella N. et al. Pseudo-patella baja: a minor yet frequent complication of total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 2018; 26 (06) 1831-1837
    CrossrefPubMedGoogle Scholar