Effects of tibial baseplate shape on rotational alignment in total knee arthroplasty: three-dimensional surgical simulation using osteoarthritis knees

Placement of tibial component is expected to fulfill both maximum surface coverage and recommended anterior-posterior (AP) alignment in total knee arthroplasty (TKA). The purpose of this study is to evaluate the effect of the tibial baseplate shape on AP axis. Virtual surgery of TKA was performed with three-dimensional bone models reconstructed from 77 osteoarthritis varus knees. Two differently designed tibial baseplates, symmetrically and anatomically, were set to the cut surface under posterior slopes of 0A degrees, 3A degrees, and 7A degrees. The AP axes were defined by connecting the geometrical center of the cut surface with the medial edge (axis MED) and medial 1/3 (axis 1/3MED) of patella tendon attachment. We evaluated the overhang rates as well as the most fitting AP axis which passes through the geometric center. Overhang rates when aligned to axis MED were 12-25% for the symmetrical-type group and 13-22% for the anatomical-type group. Overhang rates when aligned to axis 1/3MED were 42-48% for the symmetrical-type group and 3-7% for the anatomical-type group. The most fitting AP axis of tibial baseplate was located 2.5A degrees external to axis MED for the symmetrical-type group and around 3.3A degrees internal to axis 1/3MED for the anatomical-type group. Symmetrically or anatomically designed tibial baseplates have their own favored AP axis and specific performance on coverage. When aligned to axis 1/3MED, anatomically designed tibial baseplates will effectively lower the mismatch rates compared to a symmetrically designed tibial baseplate. Orthopaedic surgeons are expected to place the tibial components to the cut surface during TKA with full understanding of the features between different baseplate designs, AP axes, and posterior slopes for an ideal tibial rotational position.