Abstract

Several authors recently proposed to use clearly defined anatomical structures for extramedullary tibial alignment in total knee replacement, instead of using the intermalleolar center. The purpose of this study was to evaluate the benefits of using the dorsalis pedis artery and the anterior tibial crest as distal landmarks. Postoperative radiographs in 195 knees (98 in the control and 97 in the landmark group) were evaluated. The mean coronal alignment of the tibial component was 89.7° ± 2.1° in the control group and 90.0° ± 1.3° in the landmark group. Although there was no significant difference, the proportion of radiological outliers was significantly reduced in the landmark group compared to the control group (6.2% vs 27.6% in > 2° outliers ; p < 0.0001, 1.0% vs 10.2% in > 3° outliers ; p = 0.01). In order to achieve accurate coronal alignment of the tibial component, it appears better to use multiple clear anatomical landmarks such as the dorsal pedis artery and the anterior tibial crest rather than using only the intermalleolar center.