The Knee: Reconstruction, Replacement  and Revision Tracking Pixel
Duke Orthopaedics
presents
Wheeless' Textbook of Orthopaedics

TKR: Tibial Component


- TKR Surgical Technique:
    - extramedullary guides
    - proximal tibial resection:
            - posterior slope of the tibial component:
            - depth of tibial cut
                   - Effect of the tibial cut on subsidence following total knee arthroplasty
            - 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; 
            - references:
                   - Analysis of the bone surface area in resected tibia. Implications in tibial component subsidence and fixation.
                   - Tibial plateau coverage in total knee arthroplasty
   - anterior - posterior translation:
            -
ref: Anteroposterior positioning of the tibial component and its effect on the mechanics of patellofemoral contact.

   - cementing considerations:
            - Mechanical Bond Strength of the Cement–Tibial Component Interface in Total Knee Arthroplasty. 

- Misc:
      - 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; 
              - Hydroxyapatite augmentation augmentation of the porous coating improves fixation of tibial components.  A randomized RSA study in 116 patients.  
       - all poly inserts:
              - Review of the all-polyethylene tibial component in total knee arthroplasty. A minimum seven-year follow-up period
              - An all-polyethylene cementless tibial component. A five- to nine-year follow-up study




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.

Micromotion in knee arthroplasty. A roentgen stereophotogrammetric analysis of tibial component fixation.

The role of fixation and bone quality on the mechanical stability of tibial knee components

The anatomy of the tibial intramedullary canal.

Factors Affecting the Severity of Backside Wear of Modular Tibial Inserts.

Contemporary Cruciate-Retaining Total Knee Arthroplasty with a Pegged Tibial Baseplate. Results at a Minimum of Ten Years

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Original Text by Clifford R. Wheeless, III, MD.

Last updated by Data Trace Staff on Friday, May 24, 2013 12:17 pm