ISSN 2380-2995 (Online)
ISSN 2380-2987 (Print)


Ronald W. Lindsey, MD
Zbigniew Gugala, MD, PhD


Tibial Resection and Coronal Alignment in Total Knee Arthroplasty

Joshua Choi, BS[1]; Carlos J. Meheux, MD[2]; Colin D. Canham, MD[2]; Shuyang Han, PhD[1]; Philip C. Noble, PhD[1]; Stephen J. Incavo MD[2]

[1] Institute of Orthopedic Research and Education; Houston, TX, USA
[2] Houston Methodist Orthopedics and Sports Medicine; Houston, TX, USA

Corresponding Author:
Stephen J. Incavo, MD
Houston Methodist Orthopedics & Sports Medicine
Outpatient Center, Suite 2500
6445 Main Street
Houston, TX 77030, USA



Introduction: Restoration of coronal plane knee alignment is considered one of the mainstays of a successful total knee arthroplasty (TKA) to achieve a desired mechanical axis (MA) of the lower extremity. In this study, we aimed to determine the effect of tibial resection performed at different rotational positions on coronal plane alignment in TKA.

Methods: Three-dimensional digital models of 15 cadaveric lower limbs were reconstructed using high definition computed tomography. Neutral and 3° varus proximal tibial osteotomies were made with respect to MA of the tibia with varying degrees of slope and rotation of the virtual cutting guide. Osteotomies with 0°, 5°, and 10° of slope were made in 0°, 10°, and 20° of internal and external rotation with respect to the selected tibial rotational axis. The resulting coronal alignment was measured for each scenario.

Results: At 0° tibial slope, the coronal plane alignment was unaffected by rotation of the cutting guide resulting in a neutral MA for a neutral proximal tibial osteotomy; and a 3° varus MA for a 3° varus proximal tibial osteotomy. Internal and external rotation of the cutting guide in proximal tibial resection altered coronal plane alignment up to 3.4° with a 5° tibial slope and 6.9° with a 10° tibial slope.

Discussion: Tibial resection with slope that is not rotationally aligned with the desired tibial implant position will result in altered coronal plane alignment. The tibial cutting jig should be aligned in the desired rotational position of the tibial implant.

Level of Evidence: Experimental cadaver study.

Keywords: Tibial resection in TKA; Coronal plane alignment in TKA; Rotational position in TKA.