- Surgical Technique:
-
extramedullary guides
-
proximal tibial resection:
-
posterior slope of the tibial component:
-
depth of tibial cut:
-
joint line position
-
bone grafts in TKR:
-
size and seating of the tibial tray
-
rotation of the tibial component:
-
tibial stem
- Biomechanical Considerations:
-
metal backed trays:
- metal tibial tray should be at least 3 mm thick for srength.
- metal-backed tibial plateau probably provides greater margin of safety in that it distributes stresses to 2 condyles of tibia
if surgeon is unable to obtain perfect alignment;
-
medial lateral translation:
- goal is to provide maximum coverage, and when possible have component extend to the cortical margins;
- this is generally achieved by removing extraneous osteophytes and selecting the largest possible component;
- note that laterally dislocated soft tissues tend to push the trial component medially, which is resolved by adequate retraction;
-
press fit coating:
- in the study by I. Onstem et al 1998, hydroxyapatite coating offered a significant clinical advantage over porous coated
tibial components and were comparable to cemented tibial components;
Avoiding neurologic and vascular injuries with screw fixation of the tibial component in total knee arthroplasty.
Mechanisms of failure of the femoral and tibial components in total knee arthroplasty.
Effect of knee component alignment on tibial load distribution with clinical correlation.
Review of the all-polyethylene tibial component in total knee arthroplasty. A minimum seven-year follow-up period.
Effect of the tibial cut on subsidence following total knee arthroplasty.
Analysis of surface damage in retrieved carbon fiber-reinforced and plain polyethylene tibial components from posterior stabilized total knee replacements.
Micromotion in knee arthroplasty. A roentgen stereophotogrammetric analysis of tibial component fixation.
An all-polyethylene cementless tibial component. A five- to nine-year follow-up study.
Four screws for fixation of the tibial component in cementless total knee arthroplasty.
Analysis of the bone surface area in resected tibia. Implications in tibial component subsidence and fixation.
Tibial plateau coverage in total knee arthroplasty.
The role of fixaion and bone quality on the mechanical stability of tibial knee components.
RW Lee et al.
CORR. Vol 273. 1991. p 177-183.
The anatomy of the tibial intramedullary canal.
Hydroxyapatite augmentation of the porous coating improves the fixation of tibial components.
A randomized RSA study in 116 patients.
I. Onsten et al. JBJS Vol 80-B. No 3. May 1998.
Factors Affecting the Severity of Backside Wear of Modular Tibial Inserts.
Mechanical Bond Strength of the Cement–Tibial Component Interface in Total Knee Arthroplasty.
