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Does the tibia component design affect the need for offset stems in revision total knee arthroplasty?

Authors
  • Foruria, X.1, 2
  • Schmidt-Braekling, T.2
  • Nabarte, D. Arana1, 2
  • Faschingbauer, M.2, 3
  • Kasparek, M.2
  • Boettner, F.2
  • 1 Hospital Galdakao Usansolo, Barrio Labeaga s/n 48960, Galdakao, Spain , Galdakao (Spain)
  • 2 Hospital for Special Surgery, 535 East 70th Street, New York, NY, 10021, USA , New York (United States)
  • 3 University of Ulm, Department of Orthopedic Surgery, Ulm, 89081, Germany , Ulm (Germany)
Type
Published Article
Journal
Archives of Orthopaedic and Trauma Surgery
Publisher
Springer Berlin Heidelberg
Publication Date
Mar 22, 2017
Volume
137
Issue
6
Pages
853–860
Identifiers
DOI: 10.1007/s00402-017-2677-z
Source
Springer Nature
Keywords
License
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Abstract

IntroductionThe stem/keel location varies between anatomic and symmetric revision tibial baseplates. The current study investigates the impact of an anatomic versus symmetric stem location on the need for offset couplers in revision total knee arthroplasty.Materials and methodsHip to ankle standing radiographs and lateral radiographs of 75 patients were analyzed using digital templating software. The offset in the anterior–posterior as well as medial–lateral plane between the center of the tibial diaphysis and the stem of the tibial baseplate were determined for an anatomic and symmetric tibial baseplate, respectively. Measurements were repeated for 4 resection levels: tip of fibular head (0), 10 mm (1), 15 mm (2) and 20 mm (3) below the tip of the fibula head.ResultsAnatomic tibial baseplates require less offset for resection levels up to the tip of the fibula: total offset 2.28 versus 5.44 mm (p < 0.001). However, for defects that result in resection levels below the tip of the fibula symmetric tibial baseplates require less offset: resection level 1: 3.18 versus 2.4 mm (p = 0.008), 2: 4.81 versus 1.67 mm (p < 0.001) and resection level 3: 5.66 versus 1.52 mm (P < 0.001).ConclusionThe current study suggests that while asymmetric anatomic tibial baseplates have benefits for revisions with minimal bone loss, symmetric tibial baseplates require less offset when larger bone defects are encountered.

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