Anatomic Rotational Relationship of Distal Femur in Indian Population and its Implication in Total Knee Arthroplasty: A Magnetic Resonance Imaging Based Study

2021 ◽  
Author(s):  
Balgovind S Raja ◽  
Kshitij Gupta ◽  
Sukhmin Singh ◽  
Abdusamad V ◽  
Hawaibam Nongdamba ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Magnetic Resonance ◽  
Indian Population ◽  
Distal Femur ◽  
External Rotation ◽  
Bony Landmarks ◽  
Clinical Epicondylar Axis ◽  
Posterior Condylar ◽  
Total Knee ◽  
Relationship Of

Abstract Background Bony landmarks for referencing distal femoral rotation may differ with ethnic populations. The study aims to find out the relationship of the bony landmarks of distal femur for rotational alignment of femoral component in total knee arthroplasty in Indian population and compare it with other ethnic groups. Methods Rotational relationship of distal femoral bony landmarks was studied using magnetic resonance images of 141 knees. The condylar twist angle (CTA), Whiteside's-posterior condylar axis angle (WL/PCL), Whiteside's-anatomical epicondylar angle (WL/A-EA) and difference between the two epicondylar axes (S-EA/A-EA) were measured. The effect of gender, side and age of these relationships was analyzed. Results The mean CTA, WL/A-EA/WL/PCL and A-EA/S-EA was found to be 5.59 ± 2°, 89.38 ± 2.66°, 5.44 ± 2.88°, 3.11 ± 0.54° respectively. A-EA/S-EA was found to be lower in younger population as compared to the older population. Rest none of the variables showed any significant difference when compared against age, sex or side. Conclusion The posterior condylar axis was 5.59˚ externally rotated in relation to clinical epicondylar axis. About 2.5° of added external rotation is required in jigs using the conventional 3° of inbuilt external rotation, if clinical epicondylar axis is taken as reference for apt placement of the femoral component.

Incidence of Femoral Component Malrotation Using Posterior Condylar Referencing in Total Knee Arthroplasty

2019 ◽  
Vol 33 (10) ◽  
pp. 971-977
Author(s):  
Diana K. Lee ◽  
Matthew J. Grosso ◽  
David P. Trofa ◽  
Julian J. Sonnenfeld ◽  
H. John Cooper ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Femoral Component ◽  
Knee Arthroplasty ◽  
External Rotation ◽  
Prognostic Impact ◽  
Posterior Condylar Axis ◽  
Femoral Component Rotation ◽  
Component Rotation ◽  
Posterior Condylar ◽  
Total Knee

AbstractProper femoral component rotation in total knee arthroplasty (TKA) is important, given the prognostic impact of a poorly positioned component. The purpose of this observational study was to determine the incidence of femoral component malrotation using posterior condylar axis (PCA) referencing. A total of 100 knees in 92 patients with varus gonarthritis of the knee undergoing primary TKA using a standard medial parapatellar approach were evaluated intraoperatively. After distal femoral resection, the standard femoral sizing guide referencing the posterior condylar axis was used to set femoral component rotation. This was then compared with both the transepicondylar (TEA) and trochlear anteroposterior axes (TRAx). Disparites were recorded and corrected in line with the epicondylar axis. Rotational adjustment for addition of further external rotation was made in 13 (13.0%) cases. In seven cases, the medial pin sites were raised between 1 and 3 mm, and in six cases, the lateral pin site was lowered between 1 and 3 mm (based on risk of notching the femoral cortex). It is critical to not rely exclusively on the PCA to confirm rotational positioning of the femoral component as predicted by posterior condylar referencing guides. Intraoperative adjustment and confirmation using the TEA and TRAx occurred in 13% of primary TKA cases, which might have, otherwise, had a significant effect on the clinical outcome.

scholarly journals Relationship of the posterior femoral axis of the “kinematically aligned” total knee arthroplasty to the posterior condylar, transepicondylar, and anteroposterior femoral axes

The Knee ◽  
2014 ◽  
Vol 21 (6) ◽  
pp. 1120-1123 ◽  
Author(s):  
Andrew Park ◽  
Stephen T. Duncan ◽  
Ryan M. Nunley ◽  
James A. Keeney ◽  
Robert L. Barrack ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Knee Arthroplasty ◽  
Posterior Condylar ◽  
Total Knee ◽  
Relationship Of

ROTATIONAL ALIGNMENT OF THE FEMORAL COMPONENT IN TOTAL KNEE ARTHROPLASTY FOR VARUS OSTEOARTHRITIS OF THE KNEE; A RETROSPECTIVE STUDY

2021 ◽  
pp. 46-48
Author(s):  
Pooyan Jalalpour ◽  
Mohammadreza Minator Sajadi ◽  
Seyed Amirali Matini ◽  
Kamyar Makvandi
Keyword(s):  
Total Knee Arthroplasty ◽  
Retrospective Study ◽  
Femoral Component ◽  
Knee Arthroplasty ◽  
External Rotation ◽  
Rotational Alignment ◽  
P Value ◽  
Osteoarthritis Of The Knee ◽  
Posterior Condylar ◽  
Total Knee

Background and Aims: Achieving proper axial rotational alignment of the femoral component for varus knees is a critical step in total knee arthroplasty (TKA). Trans epicondylar axis (TEA) is the most reliable reference for alignment of femoral component. Yet, nding the exact location is sometimes difcult and time consuming. The aim of this study was to determine the correlation between the TEA and posterior condylar line reference (PCL) in varus knees. Besides, the other aim of this study was to nd the relationship between lateral distal femoral angle (LDFA) and femoral component external rotation (ER) measured intraoperatively. Material and Methods: This retrospective study was conducted on patients who were candidates for total knee arthroplasty from May 2016 to December 2019. LDFA, VA were calculated based on hip-to-ankle (HTA) radiographs before the surgery. All patients underwent TKA through an anterior midline incision. ER was calculated by determining TEA intraoperatively. All data were entered into SPSS software for data analysis. Results: One hundred and four patients were included in the nal analysis. Nineteen patients (18.3%) were male and 85 out of 104 (81.7%) were female. (P value = 0.001). No signicant relationship between the amount of ER measured during surgery and the amount of varus angle in varus knees was observed. Furthermore, there were no correlations between ER and LDFA in varus knees. Conclusion: Adjusting femoral component in 3 degrees external rotation relative to posterior condylar line reference achieves proper rotational alignment of the femoral component in the axial plane in varus knees. Also, the lateral distal femoral angle measured preoperatively from knee radiographs is not a predictor of ER in varus knees

scholarly journals Consistency Between Posterior Condylar Axis (+3˚ external rotation) Line and Clinical Transepicondylar Axis Line in Primary Total Knee Arthroplasty

2017 ◽  
Vol 5 (2_suppl2) ◽  
pp. 2325967117S0010
Author(s):  
Zeki Taşdemir ◽  
Hüseyin Bilgehan Çevik ◽  
Nurzat Elmalı ◽  
Özgür Baysal
Keyword(s):  
Total Knee Arthroplasty ◽  
Knee Arthroplasty ◽  
External Rotation ◽  
Primary Total Knee Arthroplasty ◽  
Transepicondylar Axis ◽  
Posterior Condylar Axis ◽  
Rotation Line ◽  
Posterior Condylar ◽  
Total Knee ◽  
Primary Total Knee

Objectives: Purpose of this study is to as certain consistency between posterior condylar axis (PCA) + 3˚ external rotation line and clinical transepicondylar axis (cTEA) line in primary total knee arthroplasty cases. Materials-Methods: During surgery, following distal femoral cut PCA +3 degree external rotation line and cTEA line drawn on the distal femoral cutting surface by ruler and pencil. The both lines on distal femur were recorded by digital camera and relationship between lines was ascertained in reference to PCA +3 degree external rotation [parallel (P), Internal rotation (IR) and External Rotation (ER)]. Results: 9 knees of 9 patients [1 men, 8 women; average age 67 (59-80 age)] were constituted the study group. Evaluation results of the photographs revealed that clinical TEA line in comparison PCA +3 degrees external rotation line was ER in 9 knees (100%) whose mean angles 2.7˚ (1-6) and detected external roation with mean angle 4.7˚ (2-7) in 9 knees. Conclusion:: For determination of FC rotation in surgery setting, different results between cTEA and PCA + 3 degrees techniques possibly may due to disadvantages of techniques and anatomic variation of distal femur. Thus, using both techniques for check each other’s results seems unsafe. In custom made prosthesis, which can be done in the future it will be measured by CT. Keywords: Total knee arthroplasty, femoral component, rotational alignment, femoral transepicondylar axis, posterior condylar axis

scholarly journals Accuracy of total knee arthroplasty using the modified gap technique based on the bone gap: an evaluation of the bone gap with a distal femoral trial component

Arthroplasty ◽  
2021 ◽  
Vol 3 (1) ◽  
Author(s):  
Goki Kamei ◽  
Shigeki Ishibashi ◽  
Koki Yoshioka ◽  
Satoru Sakurai ◽  
Hiroyuki Inoue ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Soft Tissue ◽  
Knee Arthroplasty ◽  
Distal Femur ◽  
Gap Size ◽  
Flexion Gap ◽  
Gap Technique ◽  
Joint Gap ◽  
Total Knee ◽  
The Mean

Abstract Background In total knee arthroplasty (TKA) using the modified gap technique, the soft-tissue balance is measured after osteotomy of the distal femur and proximal tibia (conventional bone gap). However, after osteotomy, the flexion gap size during 90° knee flexion may be larger than that observed after implantation. The tension of the lateral compartment during 90° flexion may also be reduced after osteotomy of the distal femur. We manufactured a distal femoral trial component to reproduce the condition after implantation and prior to posterior condyle osteotomy. This study aimed to evaluate the effect of the trial component on the flexion gap. Methods This prospective study included 21 consecutive patients aged 78 years with medial osteoarthritis who underwent cruciate-retaining TKA between February 2017 and March 2018. The postoperative flexion gap size and inclination during 90° flexion were compared between cases with and without the trial component. Results The mean joint gap size with the trial component (13.4 ± 0.80 mm) was significantly smaller than that without the trial component (14.7 ± 0.84 mm). The mean gap inclination angle with the trial component (3.7° ± 0.62°) was significantly smaller than that without the trial component (5.5° ± 0.78°). Conclusions In the present study, the joint gap size and medial tension were significantly reduced after the trial component had been set. Accurate measurement of the soft-tissue balance is an important factor in the modified gap technique, and this method using a distal femoral trial component can offer better outcomes than those achieved with conventional methods.

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