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Posterior condylar resections in total knee arthroplasty: current standard instruments do not restore femoral condylar anatomy

  • Knee Arthroplasty
  • Published:
Archives of Orthopaedic and Trauma Surgery Aims and scope Submit manuscript

Abstract

Introduction

Correct femoral rotational alignment in total knee arthroplasty (TKA) is important for femoropatellar knee kinematics as well as for the overall clinical success. The goal of the present study was to evaluate how accurately standard instruments of various manufacturers with specific rotational settings in posterior referencing restore the posterior femoral condylar anatomy and allow a rotational alignment which matches a particular anatomic rotational landmark on CT.

Methods

The anatomical transepicondylar axis (aTEA) and the posterior condylar line (PCL) were identified and the angle formed by these two axes was measured on 100 consecutive CT scans of knees. A virtual posterior condylar resection was performed relative to the aTEA for femoral sizers of various manufacturers in different external rotations ranging from 3° to 7°. The resections of medial and lateral posterior condyle were calculated as well as the condylar twist angle (CTA) between PCL and aTEA.

Results

The posterior condylar resection varied between 9 mm and 14 mm on the medial side and between 4 mm and 10.5 mm on the lateral side. The mean CTA was 5.5° of internal rotation (SD ± 1.9°). External femoral rotation resulted in increased resection of the medial posterior condyle and decreased resection of the lateral posterior condyle.

Conclusion

Femoral sizers using a posterior referencing technique increase, with rising external rotation, medial posterior condylar resection to an extent that may exceed the implant thickness in the majority of systems. Surgeons should be aware that current standard instruments do not restore the anatomy of the posterior medial and lateral condyle and do not align the femoral component parallel to the aTEA, which may result in internal rotation of a symmetric femoral component.

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References

  1. Akagi M, Matsusue Y, Mata T et al (1999) Effect of rotational alignment on patellar tracking in total knee arthroplasty. Clin Orthop Relat Res 366:155–163

    Article  Google Scholar 

  2. Barrack RL, Schrader T, Bertot AJ et al (2001) Component rotation and anterior knee pain after total knee arthroplasty. Clin Orthop Relat Res 392:46–55

    Article  Google Scholar 

  3. Bédard M, Vince KG, Redfern J, Collen SR (2011) Internal rotation of the tibial component is frequent in stiff total knee arthroplasty. Clin Orthop Relat Res 469:2346–2355. https://doi.org/10.1007/s11999-011-1889-8

    Article  PubMed  PubMed Central  Google Scholar 

  4. Bell SW, Young P, Drury C et al (2014) Component rotational alignment in unexplained painful primary total knee arthroplasty. Knee 21:272–277. https://doi.org/10.1016/j.knee.2012.09.011

    Article  PubMed  Google Scholar 

  5. Berger RA, Crossett LS, Jacobs JJ, Rubash HE (1998) Malrotation causing patellofemoral complications after total knee arthroplasty. Clin Orthop Relat Res 356:144–153

    Article  Google Scholar 

  6. Nicoll D, Rowley DI (2010) Internal rotational error of the tibial component is a major cause of pain after total knee replacement. J Bone Jt Surg Br 92:1238–1244. https://doi.org/10.1302/0301-620X.92B9.23516

    Article  CAS  Google Scholar 

  7. Laskin RS (1995) Flexion space configuration in total knee arthroplasty. J Arthroplasty 10:657–660

    Article  CAS  PubMed  Google Scholar 

  8. Sharkey PF, Hozack WJ, Rothman RH et al (2002) Insall Award paper Why are total knee arthroplasties failing today? Clin Orthop Relat Res 404:7–13

    Article  Google Scholar 

  9. Berger RA, Rubash HE, Seel MJ et al (1993) Determining the rotational alignment of the femoral component in total knee arthroplasty using the epicondylar axis. Clin Orthop Relat Res 286:40–47

    Google Scholar 

  10. Whiteside LA, Arima J (1995) The anteroposterior axis for femoral rotational alignment in valgus total knee arthroplasty. Clin Orthop Relat Res 321:168–172

    Google Scholar 

  11. Michaut M, Beaufils P, Galaud B et al (2008) Rotational alignment of femoral component with computed-assisted surgery (CAS) during total knee arthroplasty. Rev Chir Orthop Reparatrice Appar Mot 94:580–584. https://doi.org/10.1016/j.rco.2008.03.038

    Article  CAS  PubMed  Google Scholar 

  12. Victor J, Van Doninck D, Labey L et al (2009) How precise can bony landmarks be determined on a CT scan of the knee? Knee 16:358–365. https://doi.org/10.1016/j.knee.2009.01.001

    Article  CAS  PubMed  Google Scholar 

  13. Tokuhara Y, Kadoya Y, Nakagawa S et al (2004) The flexion gap in normal knees. An MRI study. J Bone Jt Surg Br 86:1133–1136

    Article  CAS  Google Scholar 

  14. Dennis DA, Mahfouz MR, Komistek RD, Hoff W (2005) In vivo determination of normal and anterior cruciate ligament-deficient knee kinematics. J Biomech 38:241–253. https://doi.org/10.1016/j.jbiomech.2004.02.042

    Article  PubMed  Google Scholar 

  15. Pinskerova V, Johal P, Nakagawa S et al (2004) Does the femur roll-back with flexion? J Bone Jt Surg Br 86:925–931

    Article  CAS  Google Scholar 

  16. Stiehl JB, Komistek RD, Dennis DA et al (1995) Fluoroscopic analysis of kinematics after posterior-cruciate-retaining knee arthroplasty. J Bone Jt Surg Br 77:884–889

    Article  CAS  Google Scholar 

  17. Fehring TK (2000) Rotational malalignment of the femoral component in total knee arthroplasty. Clin Orthop Relat Res 380:72–79

    Article  Google Scholar 

  18. Azukizawa M, Kuriyama S, Nakamura S et al (2018) Intraoperative medial joint laxity in flexion decreases patient satisfaction after total knee arthroplasty. Arch Orthop Trauma Surg 138:1143–1150. https://doi.org/10.1007/s00402-018-2965-2

    Article  PubMed  Google Scholar 

  19. Fitz W, Sodha S, Reichmann W, Minas T (2012) Does a modified gap-balancing technique result in medial-pivot knee kinematics in cruciate-retaining total knee arthroplasty? A pilot study. Clin Orthop Relat Res 470:91–98. https://doi.org/10.1007/s11999-011-2121-6

    Article  PubMed  Google Scholar 

  20. Matziolis G, Brodt S, Windisch C, Roehner E (2017) Changes of posterior condylar offset results in midflexion instability in single-radius total knee arthroplasty. Arch Orthop Trauma Surg 137:713–717. https://doi.org/10.1007/s00402-017-2671-5

    Article  PubMed  Google Scholar 

  21. Minoda Y, Mizokawa S, Ohta Y et al (2016) Posterior reference guides do not always maintain the size of posterior femoral condyles in TKA. Knee Surg Sports Traumatol Arthrosc 24:2489–2495. https://doi.org/10.1007/s00167-015-3706-5

    Article  PubMed  Google Scholar 

  22. Bonnin MP, Saffarini M, Nover L et al (2017) External rotation of the femoral component increases asymmetry of the posterior condyles. Bone Jt J 99:894–903. https://doi.org/10.1302/0301-620X.99B7.BJJ-2016-0717.R1

    Article  Google Scholar 

  23. Bellemans J, Banks S, Victor J et al (2002) Fluoroscopic analysis of the kinematics of deep flexion in total knee arthroplasty. Influence of posterior condylar offset. J Bone Jt Surg Br 84:50–53

    Article  CAS  Google Scholar 

  24. Dossett HG, Estrada NA, Swartz GJ et al (2014) A randomised controlled trial of kinematically and mechanically aligned total knee replacements: two-year clinical results. Bone Jt J 96:907–913. https://doi.org/10.1302/0301-620X.96B7.32812

    Article  Google Scholar 

  25. Woon JTK, Zeng ISL, Calliess T et al (2018) Outcome of kinematic alignment using patient-specific instrumentation versus mechanical alignment in TKA: a meta-analysis and subgroup analysis of randomised trials. Arch Orthop Trauma Surg 138:1293–1303. https://doi.org/10.1007/s00402-018-2988-8

    Article  CAS  PubMed  Google Scholar 

  26. Narkbunnam R, Electricwala AJ, Huddleston JI et al (2019) Suboptimal patellofemoral alignment is associated with poor clinical outcome scores after primary total knee arthroplasty. Arch Orthop Trauma Surg 139:249–254. https://doi.org/10.1007/s00402-018-3073-z

    Article  PubMed  Google Scholar 

  27. Kinzel V, Ledger M, Shakespeare D (2005) Can the epicondylar axis be defined accurately in total knee arthroplasty? Knee 12:293–296. https://doi.org/10.1016/j.knee.2004.09.003

    Article  PubMed  Google Scholar 

  28. Hirschmann MT, Konala P, Amsler F et al (2011) The position and orientation of total knee replacement components: a comparison of conventional radiographs, transverse 2D-CT slices and 3D-CT reconstruction. J Bone Jt Surg Br 93:629–633. https://doi.org/10.1302/0301-620X.93B5.25893

    Article  CAS  Google Scholar 

  29. Jazrawi LM, Birdzell L, Kummer FJ, Di Cesare PE (2000) The accuracy of computed tomography for determining femoral and tibial total knee arthroplasty component rotation. J Arthroplasty 15:761–766. https://doi.org/10.1054/arth.2000.8193

    Article  CAS  PubMed  Google Scholar 

  30. Clarke HD (2012) Changes in posterior condylar offset after total knee arthroplasty cannot be determined by radiographic measurements alone. J Arthroplasty 27:1155–1158. https://doi.org/10.1016/j.arth.2011.12.026

    Article  PubMed  Google Scholar 

  31. Yoshino N, Takai S, Ohtsuki Y, Hirasawa Y (2001) Computed tomography measurement of the surgical and clinical transepicondylar axis of the distal femur in osteoarthritic knees. J Arthroplasty 16:493–497. https://doi.org/10.1054/arth.2001.23621

    Article  CAS  PubMed  Google Scholar 

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Authors and Affiliations

  1. Klinikum Stuttgart-Olgahospital, Kriegsbergstr. 62, 70174, Stuttgart, Germany

    Nina Wuertele

  2. Sportklinik Stuttgart Taubenheimstr. 8, 70372, Stuttgart, Germany

    Johannes Beckmann, Malin Meier & Jochen Huth

  3. Harvard Medical School Brigham and Women’S Hospital, 75 Francis Street, Boston, MA, 02115, USA

    Wolfgang Fitz

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  1. Nina Wuertele
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  4. Jochen Huth
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  5. Wolfgang Fitz
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Correspondence to Johannes Beckmann.

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Wuertele, N., Beckmann, J., Meier, M. et al. Posterior condylar resections in total knee arthroplasty: current standard instruments do not restore femoral condylar anatomy. Arch Orthop Trauma Surg 139, 1141–1147 (2019). https://doi.org/10.1007/s00402-019-03221-8

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  • DOI: https://doi.org/10.1007/s00402-019-03221-8

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