Registration of Proximal Tibial Centre May Need to be Selectively Lateralized to Avoid Coronal Malalignment in Digitally-Assisted Knee Arthroplasty.

Abstract

Placement of prosthetic components and limb alignment can be adversely impacted by errors in identification of registration points in digitally assisted knee arthroplasty. The purpose of this study was to trigonometrically analyze the impact on the accuracy of coronal tibial component and limb alignment of discrepancy between the registered midpoint of the proximal bony tibia <i>vis-à-vis</i> the radiographic medio-lateral center of the lateralized final tibial implant in certain varus-deformed knees. We analyzed trigonometrically the angular difference <math xmlns="http://www.w3.org/1998/Math/MathML"><mi>θ</mi></math> in coronal alignment of tibial component and hip-knee-ankle angle resulting from lateral translation of the medio-lateral center of the final tibial implant, with respect to the initial registered midpoint of the proximal bony tibia. <math xmlns="http://www.w3.org/1998/Math/MathML"><mi>θ</mi></math> was calculated using the equation tan( <math xmlns="http://www.w3.org/1998/Math/MathML"><mi>θ</mi></math> ) = <i>d</i>/<i>t</i>, where <i>d</i> is the numerical distance between the registered point and the center of the final tibial tray position and t is the length of tibia distal to the resection. One degree of varus malpositioning of the tibial component and the limb can occur for every 6.3 mm of lateral translation of the tibial implant with respect to the midpoint of the proximal bony tibia of average reported length (372 mm). The magnitude of this error is inversely proportional to tibial length and the patient's height. Coronal malalignment of the tibial component and the limb is directly proportional to the amount of lateral translation of the tibial tray with respect to the registered midpoint of the proximal bony tibia and inversely proportional to the patient's height. This may occur in cases with tibial extra-articular deformity, those undergoing reduction osteotomy, downsizing of the tray, or inadvertently during tibial preparation. The error can be avoided by initial registration of the tibial midpoint more laterally by templating, re-registering the new center of the resected tibial surface or osteotomy for extra-articular deformity.