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J Knee Surg 2022; 35(12): 1370-1377
DOI: 10.1055/s-0041-1723970
Original Article

An Investigation of Medial Tibial Component Overhang in Unicompartmental and Total Knee Replacements Using Ultrasound in the Outpatient Department

Jacob F. Mortensen 
1   Department of Orthopaedic Surgery, Copenhagen University Hospital Herlev-Gentofte, Hellerup, Denmark
,
Julius T. Hald
2   Department of Orthopaedic Surgery, Gentofte Hospital, Hellerup, Denmark
,
Lasse E. Rasmussen
3   Department of Orthopaedic Surgery, Vejle Hospital, Vejle, Denmark
,
Svend E. Østgaard
4   Department of Orthopaedic Surgery, Aalborg Universitetshospital, Aalborg, Denmark
,
Anders Odgaard
2   Department of Orthopaedic Surgery, Gentofte Hospital, Hellerup, Denmark
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Abstract

Tibial component overhang is known to be a contributor to worse outcomes in knee arthroplasty. The aim of this study is to investigate the presence of tibial component overhang, and whether overhang correlates to a higher local tenderness in both medial unicompartmental and total knee replacements. Also, to determine if a rotational projection phenomenon is presented with radiographs when investigating tibial component overhang. A prospective study, including 64 participants, was performed, where ultrasound measurements were compared with postoperative radiographs. Local tenderness was measured as a pressure pain threshold, determined at 3 months postoperatively using algometry. Sixty-two of sixty-four patients had an underdiagnosed medial overhang on radiographs, with a mean difference of 2.4 mm between radiographs and ultrasound (p < 0.001), presenting a rotational projection phenomenon. When comparing sites with ultrasound measured overhang to sites without overhang measured by ultrasound, a higher local tenderness was observed (p < 0.001). A positive linear correlation was found between patients' overhang and local tenderness (r = 0.2; p = 0.045). Subgroup analysis of medial overhang showed significantly higher tenderness than all other locations. No significant differences were seen for lateral overhang. An apparent rotational projection phenomenon of overhang on radiographs was seen, and a linear association between overhang and local tenderness was demonstrated. This study warrants the use of ultrasound when a surgeon is presented with a patient with postoperative medial tenderness, but no overhang can be seen on radiographs. It should also raise awareness of implant selection and positioning during surgery, especially avoiding the overhang to be localized directly medially.

Keywords

knee - arthroplasty - ultrasound - overhang - radiography

Ethical Approval

The Danish Ethics committee did not deem this study necessary for ethics approval, as there was no radiation and intervention to the participants. Participants gave informed consent.




Publication History

Received: 21 July 2020

Accepted: 02 January 2021

Article published online:
22 February 2021

© 2021. Thieme. All rights reserved.

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  • References

  • 1 Chau R, Gulati A, Pandit H. et al. Tibial component overhang following unicompartmental knee replacement–does it matter?. Knee 2009; 16 (05) 310-313
    CrossrefPubMedGoogle Scholar
  • 2 Bonnin MP, Saffarini M, Shepherd D, Bossard N, Dantony E. Oversizing the tibial component in TKAs: incidence, consequences and risk factors. Knee Surg Sports Traumatol Arthrosc 2016; 24 (08) 2532-2540
    CrossrefPubMedGoogle Scholar
  • 3 Seil R, Pape D. Causes of failure and etiology of painful primary total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 2011; 19 (09) 1418-1432
    CrossrefPubMedGoogle Scholar
  • 4 Dennis DA. Evaluation of painful total knee arthroplasty. J Arthroplasty 2004; 19 (04, Suppl 1): 35-40
    CrossrefPubMedGoogle Scholar
  • 5 Gudena R, Pilambaraei MA, Werle J, Shrive NG, Frank CB. A safe overhang limit for unicompartmental knee arthroplasties based on medial collateral ligament strains: an in vitro study. J Arthroplasty 2013; 28 (02) 227-233
    CrossrefPubMedGoogle Scholar
  • 6 Inui H, Taketomi S, Yamagami R, Tahara K, Tanaka S. Snapping Pes Syndrome after unicompartmental knee arthroplasty. Knee Surg Relat Res 2016; 28 (02) 172-175
    CrossrefPubMedGoogle Scholar
  • 7 Tensho K, Aoki T, Morioka S, Narita N, Kato H, Saito N. Snapping pes syndrome after total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 2014; 22 (01) 192-194
    CrossrefPubMedGoogle Scholar
  • 8 Kimura T, Tanikawa H, Hasegawa T. et al. Late onset of the fabella syndrome after total knee arthroplasty. Case Rep Orthop 2019; 2019: 5219237 DOI: 10.1155/2019/5219237.
    CrossrefPubMedGoogle Scholar
  • 9 Wang JW. Fabellar impingement after total knee replacement--a case report. Changge-ng Yi-xue Zazhi 1995; 18 (02) 185-189
    PubMedGoogle Scholar
  • 10 Nielsen CS, Nebergall A, Huddleston J, Kallemose T, Malchau H, Troelsen A. Medial overhang of the tibial component is associated with higher risk of inferior Knee Injury and Osteoarthritis Outcome Score pain after knee replacement. J Arthroplasty 2018; 33 (05) 1394-1398
    CrossrefPubMedGoogle Scholar
  • 11 Chau R, Gulati A, Pandit HG. et al. An acceptable limit of tibial component overhang in the Oxford unicompartmental knee arthroplasty. Orthop Proc 2018; 91 (III): 411-412
    PubMedGoogle Scholar
  • 12 Edmondson MC, Isaac D, Wijeratna M, Brink S, Gibb P, Skinner P. Oxford unicompartmental knee arthroplasty: medial pain and functional outcome in the medium term. J Orthop Surg Res 2011; 6: 52 DOI: 10.1186/1749-799x-6-52.
    CrossrefPubMedGoogle Scholar
  • 13 Biomet Z. Oxford Partial Knee, Microplasty Instrumentation, Surgical Technique. Accessed August 5, 2019 at: https://www.zimmerbiomet.com/content/dam/zimmer-biomet/medical-professionals/000-surgical-techniques/knee/oxford-partial-knee-microplasty-instrumentation-surgical-technique.pdf
    PubMedGoogle Scholar
  • 14 Abram SG, Marsh AG, Brydone AS, Nicol F, Mohammed A, Spencer SJ. The effect of tibial component sizing on patient reported outcome measures following uncemented total knee replacement. Knee 2014; 21 (05) 955-959
    CrossrefPubMedGoogle Scholar
  • 15 Bonnin MP, Schmidt A, Basiglini L, Bossard N, Dantony E. Mediolateral oversizing influences pain, function, and flexion after TKA. Knee Surg Sports Traumatol Arthrosc 2013; 21 (10) 2314-2324
    CrossrefPubMedGoogle Scholar
  • 16 Buckle CE, Udawatta V, Straus CM. Now you see it, now you don't: visual illusions in radiology. Radiographics 2013; 33 (07) 2087-2102
    CrossrefPubMedGoogle Scholar
  • 17 Pandey PU, Quader N, Guy P, Garbi R, Hodgson AJ. Ultrasound bone segmentation: a scoping review of techniques and validation practices. Ultrasound Med Biol 2020; 46 (04) 921-935
    CrossrefPubMedGoogle Scholar
  • 18 Guillin R, Botchu R, Bianchi S. Sonography of orthopedic hardware impingement of the extremities. J Ultrasound Med 2012; 31 (09) 1457-1463
    CrossrefPubMedGoogle Scholar
  • 19 Mutlu EK, Ozdincler AR. Reliability and responsiveness of algometry for measuring pressure pain threshold in patients with knee osteoarthritis. J Phys Ther Sci 2015; 27 (06) 1961-1965
    CrossrefPubMedGoogle Scholar
  • 20 Dua AB, Neogi T, Mikolaitis RA, Block JA, Shakoor N. Somatosensation in OA: exploring the relationships of pain sensitization, vibratory perception and spontaneous pain. BMC Musculoskelet Disord 2018; 19 (01) 307
    CrossrefPubMedGoogle Scholar
  • 21 Hooten WM, Rosenberg CJ, Eldrige JS, Qu W. Knee extensor strength is associated with pressure pain thresholds in adults with fibromyalgia. PLoS One 2013; 8 (04) e59930 DOI: 10.1371/journal.pone.0059930.
    CrossrefPubMedGoogle Scholar
  • 22 Pelfort X, Torres-Claramunt R, Sanchez-Soler JF. et al. Pressure algometry is a useful tool to quantify pain in the medial part of the knee: an intra- and inter-reliability study in healthy subjects. Orthopaedics Traumatology Surgery Research 2015; 101 (05) 559-563
    CrossrefPubMedGoogle Scholar
  • 23 Johnson TW, Watson PJ. An inexpensive, self-assembly pressure algometer. Anaesthesia 1997; 52 (11) 1070-1072
    CrossrefPubMedGoogle Scholar
  • 24 Ferri FF. Ferri's Clinical Advisor 2019 E-Book: 5 Books in 1. Amsterdam, The Netherlands: Elsevier Health Sciences; 2018
    Google Scholar
  • 25 Free, Online, Easy-to-Use Power and Sample Size Calculators. Accessed January 22, 2021 at: http://www.powerandsamplesize.com
    PubMedGoogle Scholar
  • 26 Koo TK, Li MY. A guideline of selecting and reporting intraclass correlation coefficients for reliability research. J Chiropr Med 2016; 15 (02) 155-163
    CrossrefPubMedGoogle Scholar
  • 27 Tibrewal SB, Grant KA, Goodfellow JW. The radiolucent line beneath the tibial components of the Oxford meniscal knee. J Bone Joint Surg Br 1984; 66 (04) 523-528
    CrossrefPubMedGoogle Scholar
  • 28 Weale AE, Murray DW, Crawford R. et al. Does arthritis progress in the retained compartments after ‘Oxford’ medial unicompartmental arthroplasty? A clinical and radiological study with a minimum ten-year follow-up. J Bone Joint Surg Br 1999; 81 (05) 783-789
    CrossrefPubMedGoogle Scholar
  • 29 Martin BR, Pegg EC, van Duren BH. et al. Posterior bearing overhang following medial and lateral mobile bearing unicompartmental knee replacements. J Orthop Res 2019; 37 (09) 1938-1945
    CrossrefPubMedGoogle Scholar
  • 30 Minoda Y, Ikebuchi M, Mizokawa S, Ohta Y, Nakamura H. Asymmetric tibial component improved the coverage and rotation of the tibial component in a medial pivot total knee prosthesis. J Knee Surg 2018; 31 (05) 416-421
    Article in Thieme ConnectPubMedGoogle Scholar
  • 31 Padmanabha A, Li MT, Tybor DJ, Smith EL. Risk factors for tibial component oversizing in total knee arthroplasty among African Americans. J Knee Surg 2020; 33 (03) 301-305
    Article in Thieme ConnectPubMedGoogle Scholar
  • 32 Shao L, Wang T, Liao J, Xu W, Liang X, Huang W. Effect of tibial component alignment and posterior slope on tibial coverage in a Chinese population: a three-dimensional anthropometric study. J Knee Surg 2020; 33 (01) 53-61
    Article in Thieme ConnectPubMedGoogle Scholar
  • 33 Simsek ME, Akkaya M, Gursoy S. et al. Posterolateral overhang affects patient quality of life after total knee arthroplasty. journal article. Arch Orthop Trauma Surg 2018; 138 (03) 409-418
    CrossrefPubMedGoogle Scholar
  • 34 Dodd CAF, Kennedy J, Palan J, Mellon SJ, Pandit H, Murray DW. Radiological evaluation of revised unicompartmental knee arthroplasties in the UK National Joint Registry. Orthop Proc 2018; 100B (12) 2-2
    PubMedGoogle Scholar
  • 35 Mukaka MM. Statistics corner: a guide to appropriate use of correlation coefficient in medical research. Malawi Med J 2012; 24 (03) 69-71
    PubMedGoogle Scholar
  • 36 Klasan A, Twiggs JG, Fritsch BA. et al. Correlation of tibial component size and rotation with outcomes after total knee arthroplasty. Arch Orthop Trauma Surg 2020; 140 (11) 1819-1824
    CrossrefPubMedGoogle Scholar