- 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;
- Analysis of the bone surface area in resected tibia. Implications in tibial component subsidence and fixation.
- Tibial plateau coverage in total knee arthroplasty.
- Posterolateral overhang affects patient quality of life after 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.
- 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.
Contemporary Cruciate-Retaining Total Knee Arthroplasty with a Pegged Tibial Baseplate. Results at a Minimum of Ten Years