Risk Factors for Physiologic Radiolucent Lines Under the Tibial Base Plate After Osteoarthritis With Primary Computer-Assisted Navigation TKA—A Nested Case-Control Study

Abstract

Background: Osteoarthritis (OA) is the most prevalent joint disease in the elderly population, and primary computer-assisted navigation total knee arthroplasty (CA-TKA) remains a critical therapeutic intervention for OA. The presence of physiologic radiolucent lines (RLLs) beneath the tibial base plate following CA-TKA carries significant long-term clinical implications and is regarded as a potential indicator of prosthetic loosening. However, the specific risk factors for RLL development in CA-TKA, despite its theoretical precision advantages, remain poorly understood. This study aimed to characterize the clinical features of physiologic RLLs and identify associated risk factors.

Methods: A retrospective nested case-control study was conducted using a cohort of OA patients who underwent primary CA-TKA between January 2021 and September 2024. Physiologic RLLs were diagnosed according to the 1989 Knee Society Total Knee Arthroplasty Roentgenographic Evaluation and Scoring System. Patients with physiologic RLLs under the tibial base plate at follow-up were assigned to the RLLs group, while controls were matched 1:1 from the cohort based on follow-up time (±14 days). Covariates included age, gender, body mass index, smoking, alcohol consumption, hypertension, diabetes, surgical side, hospital stay duration, operative time, anesthesia type, continuous passive motion use, periprosthetic joint infection, total perioperative blood loss, preoperative/postoperative hip-knee-ankle angle (HKA), tibial cement mantle quality, cement penetration, and perioperative medial proximal tibial angle. Univariate and multivariate analyses were performed to identify risk factors.

Results: The cohort comprised 407 patients, of whom 113 developed physiologic RLLs under the tibial base plate. Univariate analysis identified age, preoperative HKA, tibial cement mantle defects, and cement penetration as statistically significant risk factors (all p < 0.05). Multivariate logistic regression analysis revealed that preoperative HKA (OR = 0.919, 95% CI = 0.876–0.963, p < 0.001), tibial cement mantle defects (OR = 2.638, 95% CI = 1.043–6.668, p = 0.040), and cement penetration (OR = 0.205, 95% CI = 0.126–0.332, p < 0.001) were independent risk factors for physiologic RLLs under the tibial base plate after primary CA-TKA in OA patients. Age was not an independent risk factor.

Conclusions: The overall incidence and clinical characteristics of physiologic RLLs under the tibial base plate after primary CA-TKA were comparable to those reported for conventional TKA techniques. This nested case-control study identified preoperative HKA, tibial cement mantle defects, and cement penetration as independent risk factors for physiologic RLLs, whereas age was not.

Keywords

computer-assisted navigation / osteoarthritis / radiolucent lines / risk factors / tibial implant / total knee arthroplasty

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