Wheeless' Textbook of Orthopaedics
Radius and Ulna
Tibia and Fibula
TKR: Tibial Component
TKR Surgical Technique
proximal tibial resection
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
- 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;
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:
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.
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. 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
Original Text by Clifford R. Wheeless, III, MD.
Last updated by Data Trace Staff on Wednesday, March 16, 2016 10:06 am
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