Similar Midterm Outcomes of Total Knee Arthroplasties with Anterior and Posterior Tibial Slopes Performed on Paired Knees at a Minimum Follow-up of 5 Years

Sang Jun Song; Dae Kyung Bae; Sung Hyun Hwang; Hong Sik Park; Cheol Hee Park

doi:10.1055/a-2094-8728

The Journal of Knee Surgery, Table of Contents

J Knee Surg 2024; 37(04): 310-315
DOI: 10.1055/a-2094-8728

Original Article

Similar Midterm Outcomes of Total Knee Arthroplasties with Anterior and Posterior Tibial Slopes Performed on Paired Knees at a Minimum Follow-up of 5 Years

Sang Jun Song

¹Department of Orthopaedic Surgery, Kyung Hee University College of Medicine, Kyung Hee University Medical Center, Seoul, Republic of Korea

,

Dae Kyung Bae

²Department of Orthopaedic Surgery, Seoul Sacred Heart General Hospital, Seoul, Republic of Korea

,

Sung Hyun Hwang

¹Department of Orthopaedic Surgery, Kyung Hee University College of Medicine, Kyung Hee University Medical Center, Seoul, Republic of Korea

,

Hong Sik Park

¹Department of Orthopaedic Surgery, Kyung Hee University College of Medicine, Kyung Hee University Medical Center, Seoul, Republic of Korea

,

Cheol Hee Park

¹Department of Orthopaedic Surgery, Kyung Hee University College of Medicine, Kyung Hee University Medical Center, Seoul, Republic of Korea

› Author Affiliations

Abstract

A small posterior tibial slope (PTS) is generally recommended in posterior stabilized (PS) total knee arthroplasty (TKA). An unwanted anterior tibial slope (ATS), which can affect postoperative results, may be created in PS TKA because of the inaccuracy of surgical instruments and techniques, as well as high interpatient variability. We compared midterm clinical and radiographic results of PS TKAs with ATS and PTS performed on paired knees using the same prosthesis. One-hundred-twenty-four patients who underwent TKAs with ATS and PTS on paired knees using ATTUNE posterior-stabilized prostheses were retrospectively reviewed after a minimum follow-up period of 5 years. The mean follow-up period was 5.4 years. The Knee Society Knee and Function scores, Western Ontario and McMaster Universities Osteoarthritis Index, Feller and Kujalar scores, and range of motion (ROM) were evaluated. The preferred TKA out of ATS and PTS was also investigated. The hip-knee-ankle angle, component positions, tibial slope, posterior femoral offset, Insall–Salvati ratio, and knee sagittal angle were measured by radiography. There were no significant differences in the clinical results, including ROM, between TKAs with ATS and PTS preoperatively and at the last follow-up. Regarding patient preference, 58 patients (46.8%) were satisfied with bilateral knees, 30 (24.2%) preferred knees with ATS, and 36 (29%) preferred knees with PTS. There was no significant difference in the rate of preference between TKAs with ATS and PTS (p = 0.539). Except for the postoperative tibial slope (−1.8 vs. 2.5 degrees, p < 0.001), there were also no significant differences in the radiographic results, including the knee sagittal angle, preoperatively and at the last follow-up. The midterm outcomes were similar between PS TKAs with ATS and PTS performed on paired knees at a minimum of 5 years of follow-up. Nonsevere ATS did not affect midterm outcomes in PS TKA with proper soft tissue balancing and the current prosthesis of improved design. However, a long-term follow-up study is required to confirm the safety of nonsevere ATS in PS TKA.

Level of Evidence: III

Keywords

knee - arthroplasty - tibial slope - range of motion - knee sagittal angle

Full Text

References

References
1 Song SJ, Kim KI, Park CH. Comparison of risk for postoperative hyperextension between cruciate retaining and posterior stabilized total knee arthroplasties. Arch Orthop Trauma Surg 2021; 141 (10) 1779-1788
2 Song SJ, Park CH, Bae DK. What to know for selecting cruciate-retaining or posterior-stabilized total knee arthroplasty. Clin Orthop Surg 2019; 11 (02) 142-150
3 DePuy Synthes. ATTUNE ^® Knee System. 2017; Accessed 22 May, 2017 at: https://www.depuysynthes.com/hcp/knee/products/qs/ATTUNE-Knee-System
4 ZimmerBiomet. Persona ^® The Personalized Knee; the surgical technique 2018; Accessed 23 May, 2020 at: https://www.zimmerbiomet.com/content/dam/zimmer-biomet/medical-professionals/knee/persona-knee-system/persona-the-personalized-knee-surgical-technique.pdf
5 Kang KT, Koh YG, Son J, Kwon OR, Lee JS, Kwon SK. Influence of increased posterior tibial slope in total knee arthroplasty on knee joint biomechanics: a computational simulation study. J Arthroplasty 2018; 33 (02) 572-579
6 Howard N, Jakaraddi C, Jr F. et al. Effect of posterior tibial slope on postoperative flexion and functional outcome in total knee arthroplasty. a double blinded randomised controlled trial. Biomedical J Scientific Technical Research. 2021; 35 (03) 27771-27777
7 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; 26 (10) 3188-3195
8 Hofmann AA, Bachus KN, Wyatt RW. Effect of the tibial cut on subsidence following total knee arthroplasty. Clin Orthop Relat Res 1991; (269) 63-69
9 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
10 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
11 Takemura S, Ikawa T, Ohyama Y. et al. The posterior tibial slope does not influence the flexion angle in posterior-stabilized mobile-bearing total knee arthroplasty. Arthroplasty 2021; 3 (01) 28
12 Lee OS, Lee J, Lee MC, Han HS. Effect of posterior tibial slope change on postoperative range of motion and clinical outcomes after posterior cruciate-substituting total knee arthroplasty. J Knee Surg 2023; 36 (01) 87-94
13 Hees T, Zielke J, Petersen W. Effect of anterior tibial bowing on measurement of posterior tibial slope on conventional X-rays. Arch Orthop Trauma Surg 2023; 143 (06) 2959-2964
14 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
15 Piazza SJ, Delp SL, Stulberg SD, Stern SH. Posterior tilting of the tibial component decreases femoral rollback in posterior-substituting knee replacement: a computer simulation study. J Orthop Res 1998; 16 (02) 264-270
16 Kim HJ, Kim JW, Shin JY. et al. A sagittal reference line using the preoperative radiograph in total knee arthroplasty. J Orthop Surg (Hong Kong) 2020; 28 (02) 2309499020924143
17 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
18 Piovan G, Farinelli L, Screpis D. et al. Distal femoral osteotomy versus lateral unicompartmental arthroplasty for isolated lateral tibiofemoral osteoarthritis with intra-articular and extra-articular deformity: a propensity score-matched analysis. Knee Surg Relat Res 2022; 34 (01) 34
19 Song SJ, Lee HW, Kim KI, Park CH. Appropriate determination of the surgical transepicondylar axis can be achieved following distal femur resection in navigation-assisted total knee arthroplasty. Knee Surg Relat Res 2021; 33 (01) 41
20 Song SJ, Lee HW, Park CH. A current prosthesis with a 1-mm thickness increment for polyethylene insert could result in fewer adjustments of posterior tibial slope in cruciate-retaining total knee arthroplasty. J Arthroplasty 2020; 35 (11) 3172-3179
21 Clarke HD. Changes in posterior condylar offset after total knee arthroplasty cannot be determined by radiographic measurements alone. J Arthroplasty 2012; 27 (06) 1155-1158
22 Coleman JL, Widmyer MR, Leddy HA. et al. Diurnal variations in articular cartilage thickness and strain in the human knee. J Biomech 2013; 46 (03) 541-547
23 Healy WL, Della Valle CJ, Iorio R. et al. Complications of total knee arthroplasty: standardized list and definitions of the Knee Society. Clin Orthop Relat Res 2013; 471 (01) 215-220
24 Marra MA, Strzelczak M, Heesterbeek PJC. et al. Anterior referencing of tibial slope in total knee arthroplasty considerably influences knee kinematics: a musculoskeletal simulation study. Knee Surg Sports Traumatol Arthrosc 2018; 26 (05) 1540-1548
25 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 (01) 25-29
26 Waelchli B, Romero J. Dislocation of the polyethylene inlay due to anterior tibial slope in revision total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 2001; 9 (05) 296-298
27 Song SJ, Lee HW, Park CH. Intraoperative assessment of gap balancing in total knee arthroplasty using navigation with joint stability graphs. J Knee Surg 2023; 36 (05) 540-547
28 Mochizuki T, Tanifuji O, Koga Y. et al. Correlation between posterior tibial slope and sagittal alignment under weight-bearing conditions in osteoarthritic knees. PLoS One 2018; 13 (09) e0202488
29 Milanese S, Gordon S, Buettner P. et al. Reliability and concurrent validity of knee angle measurement: smart phone app versus universal goniometer used by experienced and novice clinicians. Man Ther 2014; 19 (06) 569-574