Improving Tibial Component Coronal Alignment During Total Knee Arthroplasty with the Use of a Double-Check Technique

Objective To compare the efficacy of the restoration of tibial component coronal alignment with a double-check technique and the conventional surgical technique during total knee arthroplasty (TKA) in knee osteoarthritis patients, and to investigate the distribution of the medial proximal tibial angle (MPTA) after TKA. Methods A retrospective review was performed of 151 patients (179 knees) with knee osteoarthritis undergoing primary TKA in Beijing Chaoyang Hospital, Capital Medical University from February 2013 to January 2015 to evaluate the differences in MPTA in patients undergoing the conventional TKA and those undergoing a modified TKA with a double-check technique after the surgery. All patients were evaluated by MPTA, range of motion (ROM), Knee Society Clinical Rating System (KSS) clinical scores, and KSS functional scores. An MPTA deviation of 3 degrees or greater was considered malalignment. Results A total of 130 TKA procedures in 119 patients were included in the study: 64 knees treated with conventional TKA and 66 knees treated with the double-check technique TKA. The mean postoperative MPTA was 88.6 degrees +/- 2.2 degrees in the conventional TKA group and 89.1 degrees +/- 1.5 degrees in the double-check TKA group. The mean postoperative MPTA between the two groups was not significantly different. In the conventional TKA group, 79.7% (51 knees) had a postoperative MPTA deviation within 3 degrees and 20.3% (13 knees) had a MPTA deviation greater than 3 degrees. In the double-check TKA group, 93.9% (62 knees) had a postoperative MPTA deviation within 3 degrees and 6.1% (4 knees) had a MPTA deviation greater than 3 degrees. The postoperative MPTA deviation within 3 degrees showed a statistically significant difference between the two groups. In the double-check TKA group, a 21.2% (14 knees) tibial malalignment was detected after the first check and a 9.1% (6 knees) tibial malalignment was detected after the second check. The mean postoperative ROM was 118.1 degrees +/- 9.2 degrees in the conventional TKA group and 115.7 degrees +/- 10.1 degrees in the double-check TKA group. The mean postoperative KSS clinical score was 89.3 +/- 3.5 in the conventional TKA group and 89.0 +/- 3.7 in the double-check TKA group. The mean postoperative KSS functional score was 84.8 +/- 10.0 in the conventional TKA group and 84.9 +/- 9.0 in the double-check TKA group. The mean postoperative ROM, KSS clinical scores, and KSS functional scores between the two groups were not statistically significantly different. Conclusion Malalignment of the tibial component can occur after conventional TKA, and the double-check technique is an effective method to improve tibial component coronal alignment.