Abstract Background Kinematically aligned total knee arthroplasty strives to correct the arthritic deformity by restoring the native tibial joint line. However, the precision of such surgical correction needs to be quantified in order to reduce recuts of the resection and to design assisting instrumentation. This study describes a method for novel three-dimensional analysis of tibial resection parameters in total knee arthroplasty. Pre-operative versus post-operative differences in the slopes of the varus-valgus and flexion-extension planes and the proximal-distal level between the tibia resection and the arthritic tibial joint line can reliably be measured using the three-dimensional models of the tibia and fibula. This work uses the proposed comparison method to determine the parameters for resecting the tibia in kinematically aligned total knee arthroplasty. Methods Three-dimensional shape registration was performed between arthritic surface models segmented from pre-operative magnetic resonance imaging scans and resected surface models segmented from post-operative computed tomography scans. Mean, standard deviation and 95% confidence intervals were determined for all measurements. Results Results indicate that kinematically aligned total knee arthroplasty consistently corrects the varus deformity and restores the slope of the flexion-extension plane and the proximal-distal level of the arthritic tibial joint line. The slope of the varus-valgus plane is most precisely associated with the overall arthritic slope after approximately 3° of correction and the posterior slope is biased towards the overall arthritic plateau, though less precisely than the varus correlation. Conclusions Use of this analysis on a larger population can quantify the effectiveness of the tibial resection for correcting pathologies, potentially reduce imprecisions in the surgical technique, and enable development of instrumentation that reduces the risk of resection recuts. The kinematic alignment technique consistently corrects varus deformities
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