{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,18]],"date-time":"2026-09-18T19:56:57Z","timestamp":1789761417128,"version":"4.0.1"},"reference-count":35,"publisher":"Wiley","issue":"4","license":[{"start":{"date-parts":[[2021,4,7]],"date-time":"2021-04-07T00:00:00Z","timestamp":1617753600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2021,4,7]],"date-time":"2021-04-07T00:00:00Z","timestamp":1617753600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/www.springer.com\/tdm"},{"start":{"date-parts":[[2021,4,7]],"date-time":"2021-04-07T00:00:00Z","timestamp":1617753600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/www.springer.com\/tdm"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Knee surg. sports traumatol. arthrosc."],"published-print":{"date-parts":[[2022,4]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Purpose<\/jats:title><jats:p>Tibial plateau fractures are serious complications of Oxford mobile\u2010bearing unicompartmental knee arthroplasty (OUKA). This study examined where the fracture lines arises and evaluated the keel\u2013cortex distances (KCDs) using three\u2010dimensional computed tomography (3D\u2010CT) and the effects of technical error (assessed by tibial component positions) and proximal tibial morphology on the KCDs.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>This retrospective study included 217 OUKAs with cementless tibial components. Fifteen patients had tibial fractures after surgery. Anterior and posterior KCDs and fracture line origins were assessed using 3D\u2010CT postoperatively. Proximal tibial morphology was assessed using the medial eminence line (MEL), which runs parallel to the tibial axis and passes through the tip of the medial intercondylar eminence of the tibia on long\u2010leg anteroposterior radiograph. Knees had overhanging medial tibial condyle if the MEL passed medially to the medial tibial cortex. KCDs were compared between patients with\/without fractures. Tibial component positions were evaluated, considering effects of tibial morphologies and component positions on fracture prevalence and KCDs.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Fracture lines were found between the keel and posterior cortex in 12\/15 patients. Posterior KCDs were significantly shorter in patients with fractures than in patients without (2.7\u2009\u00b1\u20091.6\u00a0mm vs 5.2\u2009\u00b1\u20091.7\u00a0mm, <jats:italic>P<\/jats:italic>\u2009&lt;\u20090.001). Patients with medial overhanging condyles were more likely to have fracture (10\/51 vs 5\/166, <jats:italic>P<\/jats:italic>\u2009&lt;\u20090.001) and had significantly shorter posterior KCD than those without (3.6\u2009\u00b1\u20091.5\u00a0mm vs 5.5\u2009\u00b1\u20091.8\u00a0mm, <jats:italic>P<\/jats:italic>\u2009&lt;\u20090.001). Patients with tibial component that was set too medial, low, and valgus had higher rates of fracture than those without (7\/39 vs 8\/178, <jats:italic>P<\/jats:italic>\u2009=\u20090.008). Medial (<jats:italic>r<\/jats:italic>\u2009=\u20090.30, <jats:italic>P<\/jats:italic>\u2009&lt;\u20090.001), low (<jats:italic>r\u2009<\/jats:italic>=\u2009\u20100.33, <jats:italic>P<\/jats:italic>\u2009&lt;\u20090.001), and valgus implantations (<jats:italic>r<\/jats:italic>\u2009=\u20090.35, <jats:italic>P<\/jats:italic>\u2009&lt;\u20090.001) of tibial components were related to shorter posterior KCDs.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Short posterior KCD after OUKA is a risk factor for postoperative tibial fracture. Patients with either malposition of the tibial component (too medial, low, and valgus) and\/or a medial overhanging condyle exhibit a shorter distance of posterior KCD and higher rate of fracture.<\/jats:p><jats:p><jats:bold>Level of evidence:<\/jats:bold> Level III.<\/jats:p><\/jats:sec>","DOI":"10.1007\/s00167-021-06553-4","type":"journal-article","created":{"date-parts":[[2021,4,7]],"date-time":"2021-04-07T05:03:08Z","timestamp":1617771788000},"page":"1220-1230","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":19,"title":["Short distance from the keel to the posterior tibial cortex is associated with fracture after cementless Oxford UKA in Asian patients"],"prefix":"10.1002","volume":"30","author":[{"given":"Tomoyuki","family":"Kamenaga","sequence":"first","affiliation":[{"name":"<!--<label>1<\/label>--> Department of Orthopaedic Surgery and Joint Surgery Center Takatsuki General Hospital 1\u20103\u201013, Kosobe\u2010cho 569\u20101192 Takatsuki Osaka Japan"},{"name":"<!--<label>2<\/label>--> Department of Orthopaedic Surgery Kobe University Graduate School of Medicine 7\u20105\u20101, Kusunoki\u2010cho, chuo\u2010ku 650\u20100017 Kobe Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4916-6071","authenticated-orcid":false,"given":"Takafumi","family":"Hiranaka","sequence":"additional","affiliation":[{"name":"<!--<label>1<\/label>--> Department of Orthopaedic Surgery and Joint Surgery Center Takatsuki General Hospital 1\u20103\u201013, Kosobe\u2010cho 569\u20101192 Takatsuki Osaka Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Naoki","family":"Nakano","sequence":"additional","affiliation":[{"name":"<!--<label>2<\/label>--> Department of Orthopaedic Surgery Kobe University Graduate School of Medicine 7\u20105\u20101, Kusunoki\u2010cho, chuo\u2010ku 650\u20100017 Kobe Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shinya","family":"Hayashi","sequence":"additional","affiliation":[{"name":"<!--<label>2<\/label>--> Department of Orthopaedic Surgery Kobe University Graduate School of Medicine 7\u20105\u20101, Kusunoki\u2010cho, chuo\u2010ku 650\u20100017 Kobe Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Takaaki","family":"Fujishiro","sequence":"additional","affiliation":[{"name":"<!--<label>1<\/label>--> Department of Orthopaedic Surgery and Joint Surgery Center Takatsuki General Hospital 1\u20103\u201013, Kosobe\u2010cho 569\u20101192 Takatsuki Osaka Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Koji","family":"Okamoto","sequence":"additional","affiliation":[{"name":"<!--<label>1<\/label>--> Department of Orthopaedic Surgery and Joint Surgery Center Takatsuki General Hospital 1\u20103\u201013, Kosobe\u2010cho 569\u20101192 Takatsuki Osaka Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ryosuke","family":"Kuroda","sequence":"additional","affiliation":[{"name":"<!--<label>2<\/label>--> Department of Orthopaedic Surgery Kobe University Graduate School of Medicine 7\u20105\u20101, Kusunoki\u2010cho, chuo\u2010ku 650\u20100017 Kobe Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tomoyuki","family":"Matsumoto","sequence":"additional","affiliation":[{"name":"<!--<label>2<\/label>--> Department of Orthopaedic Surgery Kobe University Graduate School of Medicine 7\u20105\u20101, Kusunoki\u2010cho, chuo\u2010ku 650\u20100017 Kobe Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2021,4,7]]},"reference":[{"key":"e_1_2_10_2_2","doi-asserted-by":"crossref","unstructured":"AkagiM OhM NonakaT TsujimotoH AsanoT HamanishiC(2004) An anteroposterior axis of the tibia for total knee arthroplasty.Clin Orthop Relat Res213\u2013219","DOI":"10.1097\/00003086-200403000-00030"},{"key":"e_1_2_10_3_2","doi-asserted-by":"publisher","DOI":"10.1155\/2013\/245915"},{"key":"e_1_2_10_4_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.knee.2018.12.013"},{"key":"e_1_2_10_5_2","doi-asserted-by":"publisher","DOI":"10.2106\/JBJS.C.00568"},{"key":"e_1_2_10_6_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.knee.2015.08.008"},{"key":"e_1_2_10_7_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.knee.2009.05.004"},{"key":"e_1_2_10_8_2","doi-asserted-by":"publisher","DOI":"10.1302\/0301\u2010620X.80B1.0800063"},{"key":"e_1_2_10_9_2","doi-asserted-by":"publisher","DOI":"10.1093\/jpepsy\/jsp004"},{"key":"e_1_2_10_10_2","doi-asserted-by":"publisher","DOI":"10.3758\/BRM.41.4.1149"},{"key":"e_1_2_10_11_2","doi-asserted-by":"publisher","DOI":"10.1177\/0363546503258880"},{"key":"e_1_2_10_12_2","doi-asserted-by":"publisher","DOI":"10.4055\/cios.2019.11.4.490"},{"key":"e_1_2_10_13_2","doi-asserted-by":"publisher","DOI":"10.1302\/0301-620X.102B7.BJJ-2019-1754.R1"},{"key":"e_1_2_10_14_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.arth.2014.10.015"},{"key":"e_1_2_10_15_2","doi-asserted-by":"publisher","DOI":"10.1177\/0363546514524164"},{"key":"e_1_2_10_16_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jos.2018.04.012"},{"key":"e_1_2_10_17_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.knee.2018.06.016"},{"key":"e_1_2_10_18_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.arth.2019.07.006"},{"key":"e_1_2_10_19_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0140\u20106736(14)60419\u20100"},{"key":"e_1_2_10_20_2","doi-asserted-by":"publisher","DOI":"10.1302\/0301-620X.95B2.30411"},{"key":"e_1_2_10_21_2","doi-asserted-by":"publisher","DOI":"10.1054\/arth.2003.50002"},{"key":"e_1_2_10_22_2","doi-asserted-by":"publisher","DOI":"10.1080\/17453674.2019.1680924"},{"key":"e_1_2_10_23_2","doi-asserted-by":"publisher","DOI":"10.1007\/s11999\u2010013\u20102800\u20106"},{"key":"e_1_2_10_24_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00776\u2010004\u20100818\u2010z"},{"key":"e_1_2_10_25_2","doi-asserted-by":"crossref","unstructured":"NagamineR MiyanishiK MiuraH UrabeK MatsudaS IwamotoY(2003)Medial torsion of the tibia in Japanese patients with osteoarthritis of the knee.Clin Orthop Relat Res;https:\/\/doi.org\/10.1097\/00003086\u2010200303000\u201000028218\u2010224","DOI":"10.1097\/00003086-200303000-00028"},{"key":"e_1_2_10_26_2","doi-asserted-by":"publisher","DOI":"10.1302\/0301\u2010620X.88B1.17114"},{"key":"e_1_2_10_27_2","doi-asserted-by":"publisher","DOI":"10.2106\/JBJS.L.01005"},{"key":"e_1_2_10_28_2","first-page":"28","article-title":"Medial tibial plateau fracture and the Oxford unicompartmental knee","volume":"30","author":"Pandit H","year":"2007","journal-title":"Orthopedics"},{"key":"e_1_2_10_29_2","doi-asserted-by":"publisher","DOI":"10.1007\/s11999\u2010010\u20101506\u20102"},{"key":"e_1_2_10_30_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.arth.2006.01.005"},{"key":"e_1_2_10_31_2","doi-asserted-by":"publisher","DOI":"10.1302\/2046\u20103758.83.BJR\u20102018\u20100208.R2"},{"key":"e_1_2_10_32_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0968\u20100160(03)00003\u20106"},{"key":"e_1_2_10_33_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.arth.2009.07.012"},{"key":"e_1_2_10_34_2","doi-asserted-by":"publisher","DOI":"10.1302\/0301\u2010620X.73B4.2071640"},{"key":"e_1_2_10_35_2","first-page":"1","article-title":"Factors related to stress fracture after unicompartmental knee arthroplasty.","volume":"15","author":"Yokoyama M","year":"2019","journal-title":"Asia Pac J Sports Med Arthrosc Rehabil Technol"},{"key":"e_1_2_10_36_2","doi-asserted-by":"publisher","DOI":"10.4055\/cios19011"}],"container-title":["Knee Surgery, Sports Traumatology, Arthroscopy"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00167-021-06553-4.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1007\/s00167-021-06553-4\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00167-021-06553-4.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"},{"URL":"https:\/\/esskajournals.onlinelibrary.wiley.com\/doi\/pdf\/10.1007\/s00167-021-06553-4","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,19]],"date-time":"2025-10-19T09:28:52Z","timestamp":1760866132000},"score":1,"resource":{"primary":{"URL":"https:\/\/esskajournals.onlinelibrary.wiley.com\/doi\/10.1007\/s00167-021-06553-4"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,4,7]]},"references-count":35,"journal-issue":{"issue":"4","published-print":{"date-parts":[[2022,4]]}},"alternative-id":["10.1007\/s00167-021-06553-4"],"URL":"https:\/\/doi.org\/10.1007\/s00167-021-06553-4","archive":["Portico"],"relation":{},"ISSN":["0942-2056","1433-7347"],"issn-type":[{"value":"0942-2056","type":"print"},{"value":"1433-7347","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,4,7]]},"assertion":[{"value":"11 January 2021","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"25 March 2021","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"7 April 2021","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"The authors declare no conflicts of interest associated with this manuscript.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Conflict of interest"}},{"value":"This work was approved by the Institutional Review Board in Takatsuki General Hospital.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethical approval"}},{"value":"A written informed consent was obtained from each patient.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Informed consent"}}]}}