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International Orthopaedics

, Volume 36, Issue 10, pp 2067–2072 | Cite as

The effect of femoral component rotation on the five-year outcome of cemented mobile bearing total knee arthroplasty

  • Anna RienmüllerEmail author
  • Thomas Guggi
  • Gerald Gruber
  • Stefan Preiss
  • Tomas Drobny
Original Paper

Abstract

Purpose

Performing total knee replacement, accurate alignment and neutral rotation of the femoral component are widely believed to be crucial for the ultimate success. Contrary to absolute bone referenced alignment, using a ligament balancing technique does not automatically rotate the femoral component parallel to the transepicondylar axis. In this context we established the hypothesis that rotational alignment of the femoral component parallel to the transepicondylar axis (0° ± 3°) results in better outcome than alignment outside of this range.

Methods

We analysed 204 primary cemented mobile bearing total knee replacements five years postoperatively. Femoral component rotation was measured on axial radiographs using the condylar twist angle (CTA). Knee society score, range of motion as well as subjective rating documented outcome.

Results

In 96 knees the femoral component rotation was within the range 0 ± 3° (neutral rotation group), and in 108 knees the five-year postoperative rotational alignment of the femoral component was outside of this range (outlier group). Postoperative CTA showed a mean of 2.8° (±3.4°) internal rotation (IR) with a range between 6° external rotation (ER) and 15° IR (CI 95). No difference with regard to subjective and objective outcome could be detected.

Conclusion

The present work shows that there is a large given natural variability in optimal rotational orientation, in this study between 6° ER and 15° IR, with numerous co-factors determining correct positioning of the femoral component. Further studies substantiating pre- and postoperative determinants are required to complete the understanding of resulting biomechanics in primary TKA.

Keywords

Total Knee Arthroplasty External Rotation Femoral Component Knee Society Score Rotational Alignment 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

References

  1. 1.
    Insall J, Scott WN, Ranawat CS (1979) The total condylar knee prosthesis. A report of two hundred and twenty cases. J Bone Joint Surg Am 61:173–180PubMedGoogle Scholar
  2. 2.
    Liau JJ, Cheng CK, Huang CH, Lo WH (2002) The effect of malalignment on stresses in polyethylene component of total knee prosthesis—a finite element analysis. Clin Biomech 140:149Google Scholar
  3. 3.
    Anouchi YS, Whiteside LA, Kaiser AD, Milliano MT (1993) The effects of axial rotational alignment of the femoral component on knee stability and patellar tracking in total knee arthroplasty demonstrated on autopsy specimens. Clin Orthop Relat Res 287:170–177PubMedGoogle Scholar
  4. 4.
    Ziehlmann MS, Stacoff A, Roméro J, Krames-de-Quervain I, Stüssi E (2005) Biomechanical background and clinical observations of rotational malalignment in TKA: literature review and consequences. Clin Biomech 20:661–668CrossRefGoogle Scholar
  5. 5.
    Boldt JG, Stiehl JB, Hodler J, Zanetti M, Munzinger U (2006) Femoral component rotation and arthrofibrosis following mobile-bearing total knee arthroplasty. Int Orthop 30:420–425PubMedCrossRefGoogle Scholar
  6. 6.
    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 366:155–163PubMedCrossRefGoogle Scholar
  7. 7.
    Hanada H, Whiteside LA, Steiger J, Dyer P, Naito M (2007) Bone landmarks are more reliable than tensioned gaps in TKA component alignment. Clin Orthop Relat Res 462:137–142PubMedCrossRefGoogle Scholar
  8. 8.
    Hungerford D, Krackow K (1985) Total joint arthroplasty of the knee. Clin Orthop Relat Res 192:23–33PubMedGoogle Scholar
  9. 9.
    Laskin R (1995) Flexion gap configuration in total knee arthroplasty. J Arthroplast 10:657–660CrossRefGoogle Scholar
  10. 10.
    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 40–47Google Scholar
  11. 11.
    Arima J, Whiteside LA, Mccarthy DS, White SE (1995) Femoral rotational alignment, based on the anteroposterior axis, in total knee arthroplasty in a valgus knee. A technical note. J Bone Joint Surg Am 77:1331–1334PubMedGoogle Scholar
  12. 12.
    Churchill D, Incavo SJ, Christopher J, Beynnon BD (1998) The transepicondylar axis approximates the optimal flexion axis of the knee. Clin Orthop Relat Res 256:111CrossRefGoogle Scholar
  13. 13.
    Miller MC, Berger R, Petrella AJ, Karmas A, Rubash HE (2001) Optimizing femoral component rotation in total knee arthroplasty. Clin Orthop Relat Res 392:38–45PubMedCrossRefGoogle Scholar
  14. 14.
    Büchel F (2002) Surgical technique of the LCS. In: Hamelynck KJ, Stiehl JB (eds) LCS-mobile bearing knee arthroplasty. Springer, New York, pp 121–135Google Scholar
  15. 15.
    Matziolis G, Boenicke H, Pfiel S, Wassilew G, Perka C (2011) The gap technique does not rotate the femur parallel to the epicondylar axis. Arch Orthop Trauma Surg 131:163–166PubMedCrossRefGoogle Scholar
  16. 16.
    Heesterbeek PJC, Jacobs WCH, Wymenga AB (2009) Effects of the balanced gap technique on femoral component rotation in TKA. Clin Orthop Relat Res 467:1015–1022PubMedCrossRefGoogle Scholar
  17. 17.
    Lee DS, Song EK, Seon JK, Park SJ (2011) Effect of balanced gap total knee arthroplasty on intraoperative laxities and femoral component rotation. J Arthroplast 26(5):699–704CrossRefGoogle Scholar
  18. 18.
    Kanekasu K, Kondo M, Kadoya Y (2005) Axial radiography of the distal femur to assess rotational alignment in total knee arthroplasty. Clin Orthop Relat Res 434:193–197Google Scholar
  19. 19.
    Edwald F (1989) The knee society total knee arthroplasty roentgenographic evaluation and scoring system. Clin Orthop Relat Res 248:9–12Google Scholar
  20. 20.
    Petrie A (2010) Statistical power in testing a hypothesis. J Bone Joint Surg Br 92:1192–1194PubMedCrossRefGoogle Scholar
  21. 21.
    Berger R, Crossett L, Jacobs J, Rubash H (1998) Malrotation causing patellofemoral complications after total knee arthroplasty. Clin Orthop Relat 11:144–153CrossRefGoogle Scholar
  22. 22.
    Boldt JG, Stiehl JB, Munzihger U, Beyerland D, Keblish PA (2006) Femoral component rotation in mobile-bearing total K arthroplasty. Knee 13:284–289PubMedCrossRefGoogle Scholar
  23. 23.
    Dennis D (2008) Measured resection: an outdated technique on total knee arthroplasty. Orthopedics 31:940–943PubMedCrossRefGoogle Scholar
  24. 24.
    Chiavetta J, Fehring T, Odum S, Griffin W, Bohannon Mason J (2006) Importance of balanced-gap technique in rotation platform knees. Orthopedics 29:45–48Google Scholar
  25. 25.
    Fehring T (2002) Rotational malalignment of the femoral component in total knee arthroplasty. Clin Orthop Relat Res 380:72–79CrossRefGoogle Scholar
  26. 26.
    Siston RA, Patel JJ, Goodman SB, Delp SL, Giori NJ (2005) The variability of femoral rotational alignment in total knee arthroplasty. J Bone Joint Surg Am 87:2276–2280PubMedCrossRefGoogle Scholar
  27. 27.
    Longstaff LM, Sloan K, Stamp N, Scaddan M, Beaver R (2009) Good alignment after total knee arthroplasty leads to faster rehabilitation and better function. J Arthroplast 24:570–578CrossRefGoogle Scholar
  28. 28.
    Dennis D, Komistek R, Mahfouz M (2005) Mobile-bearing total knee arthroplasty; do the polyethylene bearings rotate? Clin Orthop Relat Res 11:88–95CrossRefGoogle Scholar
  29. 29.
    Fehring T (2006) Ligamentous balancing in rotating-platform knees. Orthop Traum Surg Res 29:56–59Google Scholar
  30. 30.
    Colwell C Jr, Chen P, D’Lima D (2010) Extensor malalignment arising from femoral component malrotation in knee arthroplasty: effect of rotating-bearing. Clin Biomech 26:52–57CrossRefGoogle Scholar
  31. 31.
    Ball ST, Sanchez HB, Mahoney OM, Schmalried TP (2011) Fixed versus rotating platform total knee arthroplasty: a prospective, randomized, single-blind study. J Arthroplast 26(4):531–536CrossRefGoogle Scholar
  32. 32.
    Schache AG, Baker R, Lamoreux LW (2006) Defining the knee joint flexion-extension axis for purposes of quantitative gait analysis: an evaluation of methods. Gait Posture 24:100–109PubMedCrossRefGoogle Scholar
  33. 33.
    Lovejoy CO (2007) The natural history of human gait and posture. Part 3. The knee. Gait Posture 25:325–341PubMedCrossRefGoogle Scholar
  34. 34.
    Parratte S, Pagano MW, Trousdale RT, Berry DJ (2010) Effect of postoperative mechanical axis alignment on the fifteen-year survival of modern, cemented total knee replacements. J Bone Joint Surg 92:2143–2149PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag 2012

Authors and Affiliations

  • Anna Rienmüller
    • 1
    • 2
    Email author
  • Thomas Guggi
    • 2
  • Gerald Gruber
    • 3
  • Stefan Preiss
    • 2
  • Tomas Drobny
    • 2
  1. 1.DAL/Service d’Orthopédie et TraumatologieCHUV LausanneLausanneSwitzerland
  2. 2.Untere ExtremitätSchulthess Klinik ZürichZürichSwitzerland
  3. 3.Universitätsklinik für OrthopädieMedizinische Universität GrazGrazAustria

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