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KMID : 0361620070420030345
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Journal of the Korean Orthopaedic Association
2007 Volume.42 No. 3 p.345 ~ p.353
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Three Dimensional Analysis for the Intramedullary Canal Axis of the Proximal Tibia: Clinical Relevance to Total Knee Arthroplasty
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Song Sang-Joon
Choi Choong-Hyeok
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Abstract
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Purpose : To evaluate the appropriate entry point of an intramedullary tibial cutting guide in total knee arthroplasty in Koreans by measuring the "intramedullary canal axis" of the proximal tibia in three dimensions.
Materials and Methods : Computed tomography was performed on 116 lower extremities from the hip to the ankle on 58 Korean cadavers. A three dimensional image of the tibia was reconstructed using the program, Bionix version 3.3. The location of intramedullary canal axis of proximal tibia passing through tibial plateau, canal axis center 1 (CAC 1), was measured. The β’ angle was defined as the angle between the tibial anatomical axis and a line perpendicular to the knee joint line. The correlations between the β’ angle and the CAC 1 mediolateral coordinates were analyzed.
Results : The CAC 1 is located on 56.3% from the medial cortex and 27.8% from the anterior cortex on the average. On average, the CAC 1 was located 1.2 mm medially and 15.9 mm anteriorly from the lateral tibial spine 1. The β’ angles and medial-lateral coordinates of the CAC 1 showed a significant positive correlation (r=0.418, p=0.000).
Conclusion : When using an intramedullary guide for tibial cutting in total knee arthroplasty in Koreans, the entry point at the lateral and anterior positions from the surface center of the tibial plateau is appropriate. The lateralization of the entry point of intramedullary tibial cutting guide becomes necessary as the varus of the tibia becomes more severe. Because of the marked variability in the CAC 1, a preoperative evaluation of the CAC 1 needs to be carried out in order to properly locate the appropriate entry point of the intramedullary tibial cutting guide in total knee arthroplasty.
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KEYWORD
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Tibia, Intramedullary canal axis, 3D computed tomography, Total knee arthroplasty
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