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Varus tibial alignment is associated with greater tibial baseplate migration at 10 years following total knee arthroplasty

  • Knee
  • Published:
Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Purpose

To examine implant migration and articular behavior of primary total knee arthroplasty (TKA) at 10 years after index surgery and correlate to implant alignment.

Methods

Thirty-five patients underwent a cemented posterior stabilized total knee arthroplasty with a surgical objective of neutral alignment and were enrolled in a long-term radiostereometric analysis (RSA) study. At 10 years after surgery, patients were analyzed for implant migration using RSA as well as radiographic assessment of articular behavior at four positions of knee flexion. Implant position and alignment was measured on full-length radiographs. Patient demographics and reported outcomes were also collected.

Results

No difference between patient demographics or patient-reported outcomes were found. When categorized into neutral and varus groupings, no difference in migration was present. If alignment was considered as a continuous variable, there was no correlation between overall leg alignment and migration, however, migration increased with an increasing varus tibial alignment. Although contact location did not differ between neutral and varus groups through a range of motion, condylar liftoff was much more common in the varus group, of which all were lateral liftoff.

Conclusions

Increased tibial varus results in increased implant migration. Overall varus limb alignment is correlated with isolated lateral compartment liftoff, and liftoff occurs more commonly than in neutral aligned knees. The increased migration and liftoff raise concerns about the longevity of malaligned total knee replacements. If a goal of overall varus limb alignment is desired for TKA, the tibia should remain neutral.

Level of evidence

Level III.

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Author information

Authors and Affiliations

  1. Division of Orthopaedic Surgery, Department of Surgery, Schulich School of Medicine and Dentistry, Western University and London Health Sciences Centre, 339 Windermere Road, London, ON, N6A 5A5, Canada

    Matthew G. Teeter, Douglas D. Naudie, Richard W. McCalden, David W. Holdsworth, Steven J. MacDonald & Brent A. Lanting

  2. Department of Medical Biophysics, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada

    Matthew G. Teeter & David W. Holdsworth

  3. Imaging Research Laboratories, Robarts Research Institute, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada

    Matthew G. Teeter, Xunhua Yuan & David W. Holdsworth

  4. Surgical Innovation Program, Lawson Health Research Institute, London, ON, Canada

    Matthew G. Teeter

Authors
  1. Matthew G. Teeter
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  2. Douglas D. Naudie
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  3. Richard W. McCalden
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  4. Xunhua Yuan
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  5. David W. Holdsworth
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  6. Steven J. MacDonald
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  7. Brent A. Lanting
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Contributions

MGT participated in the design of the study, conducted the statistical analysis, and co-wrote the initial manuscript draft. DDN, RWM, DWH, and SJM conceived of the initial migration study and collected the data. XY collected patient images and analyzed the data. BAL participated in the design of the study, collected the alignment data, and co-wrote the initial manuscript draft. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Matthew G. Teeter.

Ethics declarations

Conflict of interest

One of the authors (DDN) is a paid consultant to Microport, Smith & Nephew, and Zimmer Biomet, and receives royalties from Smith & Nephew. One of the authors (RWM) is a paid consultant to Smith & Nephew. One of the authors (SJM) is a paid consultant to DePuy. One of the authors (BAL) is a paid consultant to DePuy, Smith & Nephew, and Stryker.

Funding

Smith & Nephew provided research funds in support of the study, but were not involved in study design or data analysis.

Ethical approval

The study was approved by the ethics committee of the institution.

Informed consent

Patients were informed, and they contented to conduct the study.

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Cite this article

Teeter, M.G., Naudie, D.D., McCalden, R.W. et al. Varus tibial alignment is associated with greater tibial baseplate migration at 10 years following total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 26, 1610–1617 (2018). https://doi.org/10.1007/s00167-017-4765-6

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  • DOI: https://doi.org/10.1007/s00167-017-4765-6

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