Abstract
Purpose
Although several anatomical landmarks have been proposed to obtain adequate femoral component alignment in total knee arthroplasty (TKA), there is still no consensus regarding the best way to correctly position the prosthetic component on the horizontal plane. A previous computed tomography (CT)-based study has demonstrated anatomical transepicondylar axis (aTEA) to be externally rotated relative to surgical transepicondylar axis (sTEA) of approximately 4.5°. In this study, it is described a new methodological approach to femoral component rotational positioning through the use of previously reported CT scan information and navigation.
Methods
Eight consecutive patients scheduled for navigated TKA were selected. Rotational placement of the femoral component was performed using navigation system. The femoral component was implanted setting 4.5° of internal rotation relative to the aTEA. Within 1 week from surgery, all patients underwent a CT scan, and the posterior condylar angle (PCA) was measured. A PCA of 0.0°, meaning component placement parallel to sTEA, was set as femoral rotational alignment target. Clinical evaluation was performed at a mean 14.3 months of follow-up with KOOS questionnaire.
Results
The mean PCA measured on post-operative CT images was 0.4° (SD 1.3°), meaning that the femoral component was averagely implanted with 0.4° of internal rotation relative to the sTEA. Seven out of eight cases (87.5 %) resulted to have within 1° deviation from the rotational alignment target. All patients but one reported good clinical results.
Conclusions
Relevant finding of the present study was that the use of navigation and aTEA as a reference demonstrated to be accurate to set up femoral component rotational positioning on the horizontal plane in TKA. Further study should be performed to confirm this conclusion.
Level of evidence
III.
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References
Aglietti P, Sensi L, Cuomo P, Ciardullo A (2008) Rotational position of femoral and tibial components in TKA using the femoral transepicondylar axis. Clin Orthop Relat Res 466(11):2751–2755
Akagi M, Matsusue Y, Mata T, Asada Y, Horiguchi M, Iida H, Nakamura T (1999) Effect of rotational alignment on patellar tracking in total knee arthroplasty. Clin Orthop Relat Res 366:155–163
Akagi M, Yamashita E, Nakagawa T, Asano T, Nakamura T (2001) Relationship between frontal knee alignment and reference axes in the distal femur. Clin Orthop Relat Res 388:147–156
Asano T, Akagi M, Nakamura T (2005) The functional flexion-extension axis of the knee corresponds to the surgical epicondylar axis: in vivo analysis using a biplanar image-matching technique. J Arthroplasty 20(8):1060–1067
Berger RA, Crossett LS, Jacobs JJ, Rubash HE (1998) Malrotation causing patellofemoral complications after total knee arthroplasty. Clin Orthop Relat Res 356:144–153
Berger RA, Rubash HE, Seel MJ, Thompson WH, Crossett LS (1993) Determining the rotational alignment of the femoral component in total knee arthroplasty using the epicondylar axis. Clin Orthop Relat Res 286:40–47
Chauhan SK, Scott RG, Breidahl W, Beaver RJ (2004) Computer-assisted knee arthroplasty versus a conventional jig-based technique. A randomised, prospective trial. J Bone Joint Surg Br 86(3):372–377
Cheng T, Zhang G, Zhang X (2011) Imageless navigation system does not improve component rotational alignment in total knee arthroplasty. J Surg Res 171(2):590–600
Cheng T, Zhao S, Peng X, Zhang X (2012) Does computer-assisted surgery improve postoperative leg alignment and implant positioning following total knee arthroplasty? A meta-analysis of randomized controlled trials? Knee Surg Sports Traumatol Arthrosc 20(7):1307–1322
Ensini A, Catani F, Leardini A, Romagnoli M, Giannini S (2007) Alignments and clinical results in conventional and navigated total knee arthroplasty. Clin Orthop Relat Res 457:156–162
Fehring TK (2000) Rotational malalignment of the femoral component in total knee arthroplasty. Clin Orthop Relat Res 380:72–79
Fu Y, Wang M, Liu Y, Fu Q (2012) Alignment outcomes in navigated total knee arthroplasty: a meta-analysis. Knee Surg Sports Traumatol Arthrosc 20(6):1075–1082
Griffin FM, Math K, Scuderi GR, Insall JN, Poilvache PL (2000) Anatomy of the epicondyles of the distal femur: MRI analysis of normal knees. J Arthroplasty 15(3):354–359
Jenny JY, Boeri C (2004) Low reproducibility of the intra-operative measurement of the transepicondylar axis during total knee replacement. Acta Orthop Scand 75(1):74–77
LaPrade RF, Engebretsen AH, Ly TV, Johansen S, Wentorf FA, Engebretsen L (2007) The anatomy of the medial part of the knee. J Bone Joint Surg Am 89(9):2000–2010
Laskin RS (1995) Flexion space configuration in total knee arthroplasty. J Arthroplasty 10(5):657–660
Luyckx T, Zambianchi F, Catani F, Bellemans J, Victor J (2013) Coronal alignment is a predictor of the rotational geometry of the distal femur in the osteo-arthritic knee. Knee Surg Sports Traumatol Arthrosc 21(10):2331–2337
Matsuda S, Miura H, Nagamine R, Urabe K, Hirata G, Iwamoto Y (2001) Effect of femoral and tibial component position on patellar tracking following total knee arthroplasty: 10-year follow-up of Miller-Galante I knees. Am J Knee Surg 14(3):152–156
Matziolis G, Krocker D, Weiss U, Tohtz S, Perka C (2007) A prospective, randomized study of computer-assisted and conventional total knee arthroplasty. Three-dimensional evaluation of implant alignment and rotation. J Bone Joint Surg Am 89(2):236–243
Monticone M, Ferrante S, Salvaderi S, Rocca B, Totti V, Foti C, Roi GS (2012) Development of the Italian version of the knee injury and osteoarthritis outcome score for patients with knee injuries: cross-cultural adaptation, dimensionality, reliability, and validity. Osteoarthritis Cartilage 20(4):330–335
Nicoll D, Rowley DI (2010) Internal rotational error of the tibial component is a major cause of pain after total knee replacement. J Bone Joint Surg Br 92(9):1238–1244
Oberst M, Bertsch C, Würstlin S, Holz U (2003) CT analysis of leg alignment after conventional vs. navigated knee prosthesis implantation. Initial results of a controlled, prospective and randomized study. Unfallchirurg 106(11):941–948
Olcott CW, Scott RD (1999) The Ranawat Award. Femoral component rotation during total knee arthroplasty. Clin Orthop Relat Res 367:39–42
Stöckl B, Nogler M, Rosiek R, Fischer M, Krismer M, Kessler O (2004) Navigation improves accuracy of rotational alignment in total knee arthroplasty. Clin Orthop Relat Res 426:180–186
Stoeckl B, Nogler M, Krismer M, Beimel C, de la Barrera JL, Kessler O (2006) Reliability of the transepicondylar axis as an anatomical landmark in total knee arthroplasty. J Arthroplasty 21(6):878–882
Whiteside LA, Arima J (1995) The anteroposterior axis for femoral rotational alignment in valgus total knee arthroplasty. Clin Orthop Relat Res 321:168–172
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(4):493–497
Zimmermann F, Schwenninger C, Nolten U, Firmbach FP, Elfring R, Radermacher K (2012) A new approach to implant alignment and ligament balancing in total knee arthroplasty focussing on joint loads. Biomed Tech (Berl) 57(4):283–291
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Zambianchi, F., Luyckx, T., Victor, J. et al. How to improve femoral component rotational alignment in computer-assisted TKA. Knee Surg Sports Traumatol Arthrosc 22, 1805–1811 (2014). https://doi.org/10.1007/s00167-014-3045-y
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DOI: https://doi.org/10.1007/s00167-014-3045-y