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Ko DO, Lee S, Kim JH, Hwang IC, Jang SJ, Jung J. The Influence of Femoral Internal Rotation on Patellar Tracking in Total Knee Arthroplasty Using Gap Technique. Clin Orthop Surg 2021; 13:352-357. [PMID: 34484628 PMCID: PMC8380535 DOI: 10.4055/cios20168] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Revised: 09/19/2020] [Accepted: 09/28/2020] [Indexed: 12/15/2022] Open
Abstract
Backgroud Femoral internal rotation in total knee arthroplasty (TKA) is well known as one of the main causes of patellar maltracking. Although femoral internal rotation in TKA is considered unacceptable due to the risk of patellar maltracking, it is sometimes required for ligament balancing. We evaluated the influence of femoral internal rotation on patellar tracking in TKA performed using the gap technique. Methods From April 2008 to May 2018, 1,612 cases of TKA were done. Among them, 245 cases of TKA for osteoarthritis were followed up for at least 1 year and included in this study. We compared patellar tracking in two groups; group I consisted of 99 cases whose femoral rotation was less than 0° and group II consisted of 146 cases whose femoral rotation was 3°-5° external rotation. Preoperative femoral rotation was measured with the condylar twist angle (CTA) by using computed tomography. The patella was replaced in all cases. Patellar tracking was evaluated with patellar tilt angle (lateral tilt [+] and medial tilt [-]) in the merchant radiograph. Statistical analysis was done using Mann-Whitney U-test. Clinical assessment was performed using the Knee Society clinical rating system. Results The preoperative CTA was 5.3° ± 1.6° in group I and 5.4° ± 1.6° in group II, showing no statistically significant difference between groups (p = 0.455). Intraoperative femoral rotation was -0.5° ± 0.8° in group I and 3.9° ± 0.8° in group II when the gap technique was used (p < 0.001). The postoperative patellar tilt angle was -0.4° ± 3.6° in group I and 0.1° ± 4.1° in group II with no statistically significant difference (p = 0.251). Conclusions Compared with femoral external rotation, femoral internal rotation with ligament balance in TKA was not more associated with patellar maltracking. Therefore, patellar tracking might be related with ligament balance in flexion regardless of the anatomic femoral rotational alignment.
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Affiliation(s)
- Dong Oh Ko
- Department of Orthopedic Surgery, Seoul Sacred Heart General Hospital, Seoul, Korea
| | - Song Lee
- Department of Orthopedic Surgery, Seoul Sacred Heart General Hospital, Seoul, Korea
| | - Jin Hak Kim
- Department of Orthopedic Surgery, Seoul Sacred Heart General Hospital, Seoul, Korea
| | - Il Chan Hwang
- Department of Orthopedic Surgery, Seoul Sacred Heart General Hospital, Seoul, Korea
| | - Sung Jun Jang
- Department of Orthopedic Surgery, Seoul Sacred Heart General Hospital, Seoul, Korea
| | - Jin Jung
- Department of Orthopedic Surgery, Seoul Sacred Heart General Hospital, Seoul, Korea
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How coronal alignment affects distal femoral anatomy: an MRI-based comparison of varus and valgus knees. J Orthop Surg Res 2019; 14:92. [PMID: 30940179 PMCID: PMC6444419 DOI: 10.1186/s13018-019-1133-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2018] [Accepted: 03/15/2019] [Indexed: 11/10/2022] Open
Abstract
Purpose In contemporary total knee arthroplasty (TKA), most often, the goal is to align the femoral component to the epicondylar axis (EA). The posterior condylar axis (PCA) is easier to define than the EA, and thus the relationship of PCA to the EA is then used instead to align the femoral component to the EA. However, the relationship of PCA to EA is not constant and has been reported to differ between varus and valgus knees and with increasing deformity. The aim of this large MRI-based study was to evaluate the relationship between PCA and EA with varying coronal deformity especially with increasing valgus deformity. Methods EA, PCA, AP (Whiteside’s line) and the mechanical axis were obtained from 474 magnetic resonance imaging (MRI) scans used to create patient-specific instrumentation (PSI) for the Biomet Signature (Warsaw, NJ) system. Results The relationship of EA relative to the PCA showed considerable heterogeneity in both varus and valgus groups. In the valgus group, there was statistically greater external rotation (P < 0.05) of the EA from the PCA with a mean of 2.52° (range − 1.9° to 6°) compared to the varus group with a mean of 2.03° (range − 3.9° to 6.9°). This relationship did not significantly change with increasing severity of coronal malalignment. Externally rotating the femoral cutting guide by 3° from the PCA, 11% (42 of 382) of varus knees would lie outside of ± 3° from EA. In valgus knees, externally rotating the femoral cutting block by 3° or 5° from the PCA, 6.5% (6 of 92) and 33.7% (31 of 92) of knees, respectively, would lie outside of ± 3° from EA. Conclusion The relationship of PCA to EA is heterogeneous and is not altered significantly with increasing valgus coronal deformity. External rotation beyond 3° from PCA in valgus knees may lead to significant femoral component malrotation in a large proportion cases.
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Murgier J, Chantalat É, Li K, Chiron P, Telmon N, Huang W, Berard E, Cavaignac E. Distal femoral torsion: Differences between caucasians and asians. A multicentre computed tomography study of 515 distal femurs. Orthop Traumatol Surg Res 2018; 104:997-1001. [PMID: 30243675 DOI: 10.1016/j.otsr.2018.04.032] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2017] [Revised: 04/04/2018] [Accepted: 04/10/2018] [Indexed: 02/02/2023]
Abstract
BACKGROUND The posterior condylar angle (PCA) is formed by the posterior condylar line (PCL) and the clinical (or anatomic) transepicondylar line (TEL). The primary objective of this study was to compare the distribution of PCA values in Caucasians and Asians free of knee osteoarthritis. The secondary objectives were to assess PCA variability according to age, gender, and side. HYPOTHESIS PCA values differ between Caucasians and Asians. METHODS The study included the computed tomography scans of 515 healthy femurs, 259 from Asians in China and 256 from Caucasians in France. PCA values were determined based on four landmarks, namely, the two femoral epicondyles and the most prominent point of each condyle at the posterior aspect of the knee. The Mann-Whitney test was chosen to compare PCA values according to ethnic group, gender, and side and Spearman's correlation coefficient to assess correlations with age. Inter-observer and intra-observer variability of PCA measurements was assessed. RESULTS Mean PCA was 6.0°±2.5° (range, 0°-14°) overall, 6.4° (range, 0.31°-14.1°) in the Asians, and 5.5° (range, 0°-13.1°) in the Caucasians (p<0.0001). Chinese femurs are significantly more internally rotated. No differences in PCA values were found according to age (p=0.4307), gender (p=0.7113), or side (p=0.4304). Inter-observer and intra-observer variability was limited for each of the landmarks, indicating that PCA measurement was reliable. CONCLUSION PCA varies not only across individuals as reported previously, but also across ethnic groups. This finding further supports routine PCA measurement on imaging studies before total knee arthroplasty. LEVEL OF EVIDENCE III, comparative retrospective study.
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Affiliation(s)
- Jérôme Murgier
- CHU de Toulouse, hôpital Pierre-Paul Riquet, institut musculo squelettique, 31059 Toulouse, France
| | - Élodie Chantalat
- Laboratoire d'anatomie, faculté de médecine, 31000 Toulouse, France
| | - Ke Li
- Service de chirurgie orthopédique, Premier hôpital affilié de l'université de médecine de Chongqing, Chongqing, China
| | - Philippe Chiron
- CHU de Toulouse, hôpital Pierre-Paul Riquet, institut musculo squelettique, 31059 Toulouse, France
| | - Norbert Telmon
- UMR1027 Inserm, service d'épidémiologie, analyse en santé publique, université de Toulouse III, Centre Hospitalier Universitaire (CHU), Toulouse, France
| | - Wei Huang
- Service de chirurgie orthopédique, Premier hôpital affilié de l'université de médecine de Chongqing, Chongqing, China
| | - Emilie Berard
- UMR1027 Inserm, service d'épidémiologie, analyse en santé publique, université de Toulouse III, Centre Hospitalier Universitaire (CHU), Toulouse, France
| | - Etienne Cavaignac
- CHU de Toulouse, hôpital Pierre-Paul Riquet, institut musculo squelettique, 31059 Toulouse, France; Laboratoire AMIS, UMR 5288 CNRS, université Paul-Sabatier, 37, allée Jules-Guesdes, 31000 Toulouse, France.
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Talbot S, Dimitriou P, Mullen M, Bartlett J. Referencing the sulcus line of the trochlear groove and removing intraoperative parallax errors improve femoral component rotation in total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 2017; 25:2743-2750. [PMID: 26049806 PMCID: PMC5570779 DOI: 10.1007/s00167-015-3668-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2014] [Accepted: 05/29/2015] [Indexed: 11/24/2022]
Abstract
PURPOSE Firstly, to assess and compare the accuracy and reproducibility of the sulcus line compared to Whiteside's line. Secondly, to assess the accuracy of intraoperative techniques for using the rotational alignment of the trochlear groove to set femoral rotation. Thirdly, to assess the reproducibility of a trochlear alignment guide which removes parallax errors that occur when projecting the sulcus line onto the surface of the femur. Finally, to measure the result of combining the geometrically accurate sulcus line and the posterior condylar axis. METHODS Three surgeons measured eight rotational angles on ten cadaveric femora. This included Whiteside's line, the sulcus line and the techniques in which they can be referenced during surgery. RESULTS Relative to the anatomical epicondylar axis, the sulcus line (mean -2.8°, SD 2.0°, range -5.4° to 0.8°) had significantly lower variance (F = 5.16, p = 0.036) than Whiteside's line (mean -2.0°, SD 3.7°, range -6.0° to 3.4°). The trochlear alignment guide produced the best results of the intraoperative techniques by maintaining the accuracy of the sulcus line and projecting it onto the distal cut surface of the femur without change in rotational angle. CONCLUSION The sulcus line is more accurate and reproducible than Whiteside's line. Removing parallax errors during surgery improves femoral component rotation. The trochlear alignment guide produced accurate results suggesting that it may be beneficial in a clinical setting. Averaging the sulcus line and posterior condylar axis on the cut surface of the femur improved accuracy over the individual landmarks. Femoral component malrotation is a common cause of patient dissatisfaction and revision surgery. By isolating the rotational alignment of the trochlear groove using the sulcus line, and maintaining its accuracy with an intraoperative guide, we can decrease the risk of femoral component malrotation and improve patient outcomes.
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Affiliation(s)
- Simon Talbot
- Western Health, Melbourne, VIC, 3011, Australia.
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Huang G, Xia J, Wang S, Wei Y, Wu J, Chen F, Chen J, Shi J. Total knee arthroplasty using trochlear groove as guide for position of femoral component in severe knee osteoarthritis. BMC Surg 2016; 16:33. [PMID: 27216144 PMCID: PMC4877803 DOI: 10.1186/s12893-016-0148-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2016] [Accepted: 04/30/2016] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND Apart from transepicondylar axis, the native femoral sulcus was also reported to be used as a guide for the femoral component position in total knee arthroplasty (TKA). However, it was not shown in patients with severe knee osteoarthritis. This study was conducted to compare the position of trochlear groove in patients with and without osteoarthritis, and to assess whether trochlear groove could be used as a guide for position of femoral component in TKA for severe knee osteoarthritis. METHODS Total 50 severe knee osteoarthritis patients (Kellgren Lawrence grade 3 or 4) who underwent TKA were included. Meanwhile, 50 patients who underwent arthroscopic surgery without osteoarthritis were included as control. The distance from trochlear groove to the midpoint of a virtual anterior condyle osteotomy line (parallel to the posterior condyle line) (a-b) was recorded by radiological and surgical measurements. Midpoint of transepicondylar axis and trochlear groove were used as guide for placing prosthesis model in TKA, respectively. No-thumb test was performed to assess the patellar tracking. The position of femoral component was finally performed using trochlear groove as guide in TKA. RESULTS Value of "a-b" was significantly different between osteoarthritic and control knees (P = 0.008). During the placement of prosthesis model, similar patellar tracking was detected between using midpoint of transepicondylar axis and trochlear groove as guide (P > 0.05). After placing femoral component using trochlear groove as guide, most patients obtained good patellofemoral congruence with pneumatic tourniquet inflated (n = 43) or deflated (n = 5), and good patellofemoral congruence was also obtained by lateral patellar retinaculum release in two patients. CONCLUSION Despite the shifting of trochlear groove caused by severe knee osteoarthritis, trochlear groove can be used as a guide for position of femoral component, with equivalent patellar tracking compared with transepicondylar axis.
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Affiliation(s)
- Gangyong Huang
- Department of Orthopaedic Surgery, Huashan Hospital Fudan University, 12th Wulumuqi Middle Road, Shanghai, 200040, China
| | - Jun Xia
- Department of Orthopaedic Surgery, Huashan Hospital Fudan University, 12th Wulumuqi Middle Road, Shanghai, 200040, China.
| | - Siqun Wang
- Department of Orthopaedic Surgery, Huashan Hospital Fudan University, 12th Wulumuqi Middle Road, Shanghai, 200040, China
| | - Yibing Wei
- Department of Orthopaedic Surgery, Huashan Hospital Fudan University, 12th Wulumuqi Middle Road, Shanghai, 200040, China
| | - Jianguo Wu
- Department of Orthopaedic Surgery, Huashan Hospital Fudan University, 12th Wulumuqi Middle Road, Shanghai, 200040, China
| | - Feiyan Chen
- Department of Orthopaedic Surgery, Huashan Hospital Fudan University, 12th Wulumuqi Middle Road, Shanghai, 200040, China
| | - Jie Chen
- Department of Orthopaedic Surgery, Huashan Hospital Fudan University, 12th Wulumuqi Middle Road, Shanghai, 200040, China
| | - Jingsheng Shi
- Department of Orthopaedic Surgery, Huashan Hospital Fudan University, 12th Wulumuqi Middle Road, Shanghai, 200040, China
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Paternostre F, Schwab PE, Thienpont E. The combined Whiteside's and posterior condylar line as a reliable reference to describe axial distal femoral anatomy in patient-specific instrument planning. Knee Surg Sports Traumatol Arthrosc 2014; 22:3054-9. [PMID: 24441733 DOI: 10.1007/s00167-014-2836-5] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2013] [Accepted: 01/06/2014] [Indexed: 11/27/2022]
Abstract
PURPOSE Aligning the femoral component in the axial plane parallel to the surgical epicondylar axis (SEA) has been generally recommended. In this retrospective study on the axial anatomy of the distal femur, as determined by the patient-specific instruments (PSI) planning tool based on MRI and 3D reconstructions, the different rotational axes were compared. The purpose of this study was to compare the impact of posterior axial anatomy on anterior anatomy and to compare the different angles of rotation obtained by a PSI-planning engineer. METHODS The preoperative planning of 77 PSI patients with a mean (SD) age of 65.6 (9.6) years undergoing primary total knee replacement for osteoarthritis was analysed for rotational anatomy of the distal femur. The angles between the posterior condylar line (PCL) and the SEA called posterior condylar angle (PCA), between Whiteside's line and the SEA and finally between Whiteside's line and the PCL, were retrieved from the PSI axial rotation planning screen. RESULTS The mean (SD) PCA was 3.2° (1.4°). The mean (SD) angle between Whiteside's line and the SEA was 91.4° (2.2°), and the mean (SD) angle between Whiteside's line and the PCL was 94.5° (2.3°). No significant difference for this last rotational parameter was found in between varus and valgus knees. CONCLUSION Patient-specific instrument's preoperative planning found consistent angles to describe the distal femoral anatomy as previously published in the literature. The angle between Whiteside's line and the PCL as measured on PSI planning is a mean angle of 94.5° (2.3°) for both varus and valgus knees. Setting a fixed PCA of 5° of external rotation referenced of the PCL makes this planning repeatable during conventional surgery. LEVEL OF EVIDENCE Therapeutic study, Level III.
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Affiliation(s)
- Frederic Paternostre
- Department of Orthopedic Surgery, Cliniques Universitaires Saint Luc (UCL), Avenue Hippocrate 10, 1200, Brussels, Belgium
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Thienpont E, Schwab PE, Paternostre F, Koch P. Rotational alignment of the distal femur: anthropometric measurements with CT-based patient-specific instruments planning show high variability of the posterior condylar angle. Knee Surg Sports Traumatol Arthrosc 2014; 22:2995-3002. [PMID: 24888223 DOI: 10.1007/s00167-014-3086-2] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2013] [Accepted: 05/20/2014] [Indexed: 11/29/2022]
Abstract
PURPOSE Finding the anatomical landmarks used for correct femoral axial alignment can be difficult. The posterior condylar line (PCL) is probably the easiest to find during surgery. The aim of this study was to analyse whether a predetermined fixed angle referencing of the PCL could help find the surgical epicondylar axis (SEA) and this based on a large CT database with enough Caucasian diversity to be representable. METHODS A total of 2,637 CT scans and 3D reconstructions from patients on four continents, executed for preoperative planning and creation of patient-specific instrumentation, were used to perform anthropometric measurements and to measure the posterior condylar angle (PCA) between the surgical epicondylar angle and the PCL. RESULTS The mean (SD) PCA was 4° (1.4°) of external rotation. A significant correlation was found between more external rotation of the SEA and more proximal varus of the tibia or more distal valgus of the femur. For 59% of the study population, 4° external rotation from the PCL would be the right amount of axial rotation to align the femoral component in line with the SEA. Nine per cent needs less, and 32% needs more than 4° of axial rotation. On 105 (4%) CT-based 3D models, external rotation between 7° and 11° was measured and 77 (73%) of those cases were in varus or neutral alignment. In 132 patients, bilateral measurements were available and 94 (71%) had rotation within 1° of the opposite side. This last finding underlines that there is even an intra-individual difference in distal femoral anatomy that can range from 1° to 5°. CONCLUSIONS This study was performed on a very large anthropometric CT and 3D models database and showed that there is a 41% risk of malalignment if a fixed PCA referenced of the PCL is used in total knee arthroplasty. The clinical importance of this study is the observation that femoral axial anatomy is individual and also that it is determined by the tibial anatomy. A group of patients needs more than the average external rotation because they have more distal femoral valgus with dysplastic condyles or more proximal tibial varus with a bigger medial condyle. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Emmanuel Thienpont
- Department of Orthopaedic Surgery, University Hospital Saint Luc-UCL, Avenue Hippocrate 10, 1200, Brussels, Belgium,
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Lakstein D, Naser M, Adar E, Atoun E, Edelman A, Hendel D. Partial lateral patellar facetectomy as an alternative to lateral release in Total Knee Arthroplasty (TKA). J Arthroplasty 2014; 29:2146-9. [PMID: 25064018 DOI: 10.1016/j.arth.2014.06.013] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2014] [Revised: 06/18/2014] [Accepted: 06/24/2014] [Indexed: 02/01/2023] Open
Abstract
This study presents the selective use of partial patellar lateral facetectomy for maltracking during primary TKA, as an alternative to lateral release. Twenty three partial facetectomies were performed out of 191 TKAs (12%). Balanced tracking was achieved in 22 knees. At follow-up 2 patients had persistent anterior knee pain. Mean Knee Society score (KSS) was 94 and mean functional KSS was 86. Mean patellar score was 28. Patellar tilt angles were within 2 degrees in all but one knee. Patellar translation was within 2 mm in all cases. No complications were recorded. A control group of 46 matched patients had similar functional and radiographic results. If tracking is not satisfactory at the conclusion of TKA, our method of choice would be partial lateral facetectomy.
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Affiliation(s)
- Dror Lakstein
- Orthopaedic Department, E. Wolfson Medical Center, Holon, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Muhammad Naser
- Orthopaedic Department, E. Wolfson Medical Center, Holon, Israel
| | - Eliyahu Adar
- Orthopaedic Department, E. Wolfson Medical Center, Holon, Israel
| | - Ehud Atoun
- Orthopaedic Department, Barzilai Medical Center, Ashkelon, Israel; Faculty of Medicine, Ben-Gurion University, Beer-Sheva, Israel
| | | | - David Hendel
- Orthopaedic Department, E. Wolfson Medical Center, Holon, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Clark DA, Upadhyay N, Gillespie G, Wakeley C, Eldridge JD. The correct rotation of the femoral component in patellofemoral replacement. ACTA ACUST UNITED AC 2012. [DOI: 10.1302/0301-620x.94b12.29506] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Ensuring correct rotation of the femoral component is a challenging aspect of patellofemoral replacement surgery. Rotation equal to the epicondylar axis or marginally more external rotation is acceptable. Internal rotation is associated with poor outcomes. This paper comprises two studies evaluating the use of the medial malleolus as a landmark to guide rotation. We used 100 lower-leg anteroposterior radiographs to evaluate the reliability of the medial malleolus as a landmark. Assessment was made of the angle between the tibial shaft and a line from the intramedullary rod entry site to the medial malleolus. The femoral cut was made in ten cadaver knees using the inferior tip of the medial malleolus as a landmark for rotation. Rotation of the cut relative to the anatomical epicondylar axis was assessed using CT. The study of radiographs found the position of the medial malleolus relative to the tibial axis is consistent. Using the inferior tip of the medial malleolus in the cadaver study produced a mean external rotation of 1.6° (0.1° to 3.7°) from the anatomical epicondylar axis. Using the inferior tip of the medial malleolus to guide the femoral cutting jig avoids internal rotation and introduces an acceptable amount of external rotation of the femoral component.
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Affiliation(s)
- D. A. Clark
- Bristol Royal Infirmary, Orthopaedic
Department, Queen’s Building, Marlborough Street, Bristol
BS2 8HY, UK
| | - N. Upadhyay
- Bristol Royal Infirmary, Orthopaedic
Department, Queen’s Building, Marlborough Street, Bristol
BS2 8HY, UK
| | - G. Gillespie
- Royal Gwent Hospital, Cardiff
Road, Newport, South Wales
NP20 2UB, UK
| | - C. Wakeley
- Bristol Royal Infirmary, Radiology
Department, Queen’s Building, Marlborough
Street, Bristol BS2 8HY, UK
| | - J. D. Eldridge
- Bristol Royal Infirmary, Orthopaedic
Department, Queen’s Building, Marlborough Street, Bristol
BS2 8HY, UK
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Combining different rotational alignment axes with navigation may reduce the need for lateral retinacular release in total knee arthroplasty. INTERNATIONAL ORTHOPAEDICS 2012; 36:1595-600. [PMID: 22588689 DOI: 10.1007/s00264-012-1523-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/28/2012] [Accepted: 02/28/2012] [Indexed: 10/28/2022]
Abstract
PURPOSE The aim of the study was to compare femoropatellar alignment and the incidence of lateral retinacular release (LRR) in total knee arthroplasty (TKA) in which the rotational alignment of the femoral component was determined using a combination of different rotational alignment axes and navigation or a single reference axis in the standard procedure. METHODS We assessed 66 patients undergoing TKA in whom the rotation of the femoral component was determined on the posterior condylar axis in standard procedures (group A) and 65 patients in whom it was determined by combining the posterior condylar axis, anteroposterior axis and epicondylar axis in navigated procedures (group B). The mean age was 68 and 69 years in groups A and B, respectively. Patellar tracking was assessed after deflation of the tourniquet and LRR performed in the presence of maltracking. Visual analogue scale (VAS), Knee Society Score (KSS), Lonner patellar score and patellar tilt were recorded. RESULTS LRR was carried out in 18 cases (27 %) in group A and in four (6 %) in group B (p = 0.003). The KSS and VAS were improved significantly compared to the preoperative status, but with no significant differences between the two groups. The patellar score showed a greater improvement in the navigated compared to the standard group at the four week follow-up. Patella tilt improved significantly in both groups. The complication rate was similar in the two groups. CONCLUSIONS Combining different rotational alignment axes with navigation significantly reduces patellar maltracking and the need for LRR compared to the standard procedure in which the posterior condylar axis is used as single anatomical reference.
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Berend M. Consequences of Malalignment in Total Knee Arthroplasty: Few if Any-Opposes. ACTA ACUST UNITED AC 2010. [DOI: 10.1053/j.sart.2009.12.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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12
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Wai Hung CL, Wai Pan Y, Kwong Yuen C, Hon Bong L, Lei Sha LW, Ho Man SW. Interobserver and intraobserver error in distal femur transepicondylar axis measurement with computed tomography. J Arthroplasty 2009; 24:96-100. [PMID: 18534429 DOI: 10.1016/j.arth.2007.11.014] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2007] [Accepted: 11/30/2007] [Indexed: 02/01/2023] Open
Abstract
On 2 separate occasions at least 1 week apart, 6 independent observers studied errors in identification of the transepicondylar axis (TEA) using computed tomography in 10 cadaveric knees. The reference surgical TEA was established by dissection of specimens. We found an average error of 2.6 degrees (external rotation) when the TEA was identified by computed tomography. The error was significantly smaller when the TEA was identified by using a conventional axial image than when a 3-dimensional reconstruction image was used (P < .001, paired t test). No significant intraobserver error (P = .814, Wilcoxon rank test) was found when the measurement was performed using conventional 2-dimensional computed tomography images. However, significant interobserver difference was evident (P < .001, Friedman test).
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Affiliation(s)
- Chester Lie Wai Hung
- Department of Orthopaedic and Traumatology, Queen Mary Hospital, The University of Hong Kong, Hong Kong
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Schnurr C, Nessler J, König DP. Is referencing the posterior condyles sufficient to achieve a rectangular flexion gap in total knee arthroplasty? INTERNATIONAL ORTHOPAEDICS 2008; 33:1561-5. [PMID: 18956189 DOI: 10.1007/s00264-008-0656-2] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/11/2008] [Revised: 08/08/2008] [Accepted: 08/09/2008] [Indexed: 11/26/2022]
Abstract
Femoral malrotation in total knee arthroplasty causes flexion gap instability. Conventional instruments mostly reference the posterior condylar angle (PCA). The aim of this study was to verify whether the computer-navigated flexion gap (GAP) method produces a rectangular flexion gap and if a balanced flexion gap could also be achieved by referencing the PCA. A total of 100 knee prostheses were analysed using the navigated GAP method, and flexion gap symmetry along with femoral rotation were recorded. The GAP technique resulted in a rectangular flexion gap with adequate femoral rotational alignment. If the PCA technique had been used, only 51% of the femoral components would have been implanted in correct femoral rotation; the remaining 49% would have implanted with flexion gap instability. The GAP technique produces a rectangular flexion gap. The referencing of the PCA was shown to be less reliable. Thus, modern knee prosthesis instrumentation should not base femoral rotation solely on the PCA.
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Affiliation(s)
- Christoph Schnurr
- Rheinische Klinik für Orthopädie Viersen, Horionstrasse 2, 41749, Viersen, Germany.
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Cobb JP, Dixon H, Dandachli W, Iranpour F. The anatomical tibial axis: reliable rotational orientation in knee replacement. ACTA ACUST UNITED AC 2008; 90:1032-8. [PMID: 18669958 DOI: 10.1302/0301-620x.90b8.19905] [Citation(s) in RCA: 115] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
The rotational alignment of the tibia is an unresolved issue in knee replacement. A poor functional outcome may be due to malrotation of the tibial component. Our aim was to find a reliable method for positioning the tibial component in knee replacement. CT scans of 19 knees were reconstructed in three dimensions and orientated vertically. An axial plane was identified 20 mm below the tibial spines. The centre of each tibial condyle was calculated from ten points taken round the condylar cortex. The tibial tubercle centre was also generated as the centre of the circle which best fitted eight points on the outside of the tubercle in an axial plane at the level of its most prominent point. The derived points were identified by three observers with errors of 0.6 mm to 1 mm. The medial and lateral tibial centres were constant features (radius 24 mm (SD 3), and 22 mm (SD 3), respectively). An anatomical axis was created perpendicular to the line joining these two points. The tubercle centre was found to be 20 mm (SD 7) lateral to the centre of the medial tibial condyle. Compared with this axis, an axis perpendicular to the posterior condylar axis was internally rotated by 6 degrees (SD 3). An axis based on the tibial tubercle and the tibial spines was also internally rotated by 5 degrees (sd 10). Alignment of the knee when based on this anatomical axis was more reliable than either the posterior surfaces or any axis involving the tubercle which was the least reliable landmark in the region.
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Affiliation(s)
- J P Cobb
- Department of Orthopaedic Surgery, Charing Cross Hospital, Fulham Palace Road, London W6 8RF, UK.
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Pickering TR, Berend ME. Patella Resurfacing in Total Knee Arthroplasty: The Sum of All Parts. ACTA ACUST UNITED AC 2008. [DOI: 10.1053/j.sart.2007.12.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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