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The anterior surface of the femur as a new landmark for femoral component rotation in total knee arthroplasty

Knee Surgery, Sports Traumatology, Arthroscopy volume 16, pages 258–262 (2008)Cite this article

Abstract

Femoral component rotation is very important in avoiding complications and maximizing knee function following total knee arthroplasty. There is continuing debate over the most accurate axis to select intraoperatively to obtain the best results. There is considerable doubt over the ability of commonly used bony landmarks to produce a line parallel to the flexion–extension axis of the femur, either due to anatomical variation or due to poor reproducibility of the axes. Computer navigation was used to accurately measure the relative rotation indicated intraoperatively between bony landmarks, including a previously uninvestigated axis on the anterior surface of the femur. Measurements were taken during 193 total knee arthroplasties. There was a significant association between the Whiteside’s Line and the axis on the anterior surface of the femur. The Posterior Condlylar Axis was extremely variable when compared with the other measurements, with a wide range centered on a mean value of 4.1° internally rotated to the perpendicular of Whiteside’s Line. There were significant differences in both the Posterior Condylar Axis and Anterior Femoral Axis when comparing varus and valgus knees. The Posterior Condylar Axis was shown to be an inconsistent measurement in comparison to other bony landmarks, particularly in valgus knees. The strong correlation between the Whiteside’s Line and the Anterior Femoral Axis raises the possibility that the Anterior Femoral Axis maybe a useful landmark in identifying correct femoral component rotation.

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References

  1. Ranawat CS (1986) The patellofemoral joint in total condylar knee arthroplasty. Pros and cons based on five- to ten-year follow-up observations. Clin Orthop Relat Res 205:93–99

    PubMed  Google Scholar 

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

    PubMed  Article  Google Scholar 

  3. Figgie HE 3rd, Goldberg VM, Figgie MP, Inglis AE, Kelly M, Sobel M (1989) The effect of alignment of the implant on fractures of the patella after condylar total knee arthroplasty. J Bone Joint Surg Am 71(7):1031–1039

    PubMed  Google Scholar 

  4. Aglietti P, Buzzi R, Gaudenzi A (1988) Patellofemoral functional results and complications with the posterior stabilized total condylar knee prosthesis. J Arthroplasty 3:17–25

    PubMed  Article  CAS  Google Scholar 

  5. Clayton ML, Thirupathi R (1982) Patellar complications after total condylar arthroplasty. Clin Orthop Relat Res 170:152–155

    PubMed  Google Scholar 

  6. Romero J, Stahelin T, Wyss T, Hofmann S (2003) [Significance of axial rotation alignment of components of knee prostheses]. Orthopade 32(6):461–468, German

    PubMed  CAS  Google Scholar 

  7. Barrack RL, Schrader T, Bertot AJ, Wolfe MW, Myers L (2001) Component rotation and anterior knee pain after total knee arthroplasty. Clin Orthop Relat Res 392:46–55

    PubMed  Article  Google Scholar 

  8. 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

    PubMed  Google Scholar 

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

    PubMed  Google Scholar 

  10. Churchill DL, Incavo SJ, Johnson CC, Beynnon BD (1998) The transepicondylar axis approximates the optimal flexion axis of the knee. Clin Orthop Relat Res 356:111–118

    PubMed  Article  Google Scholar 

  11. 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 287:170–177

    PubMed  Google Scholar 

  12. Olcott CW, Scott RD (1999) The Ranawat Award. Femoral component rotation during total knee arthroplasty. Clin Orthop Relat Res 367:39–42

    PubMed  Article  Google Scholar 

  13. Miller MC, Berger RA, Petrella AJ, Karmas A, Rubash HE (2001) Optimizing femoral component rotation in total knee arthroplasty. Clin Orthop Relat Res 392:38–45

    PubMed  Article  Google Scholar 

  14. 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(10):2276–2280

    PubMed  Article  Google Scholar 

  15. Jerosch J, Peuker E, Philipps B, Filler T (2002) Interindividual reproducibility in perioperative rotational alignment of femoral components in knee prosthetic surgery using the transepicondylar axis. Knee Surg Sports Traumatol Arthrosc 10:194–197

    PubMed  Article  CAS  Google Scholar 

  16. Jenny JY, Boeri C (2004) Low reproducibility of the intra-operative measurement of the transepicondylar axis during total knee replacement. Acta Orthop Scand 75:74–77

    PubMed  Article  Google Scholar 

  17. 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 77:13314

    Google Scholar 

  18. Matsuda S, Miura H, Nagamine R, Urabe K, Mawatari T, Iwamoto Y (2003) A comparison of rotational landmarks in the distal femur and the tibial shaft. Clin Orthop Relat Res 414:183–188

    PubMed  Article  Google Scholar 

  19. Tanavalee A, Yuktanandana P, Ngarmukos C (2001) Surgical epicondylar axis vs anatomical epicondylar axis for rotational alignment of the femoral component in total knee arthroplasty. J Med Assoc Thai 84 (Suppl 1):S401–S408

    PubMed  Google Scholar 

  20. Nagamine R, Miura H, Inoue Y, Urabe K, Matsuda S, Okamoto Y, Nishizawa M, Iwamoto Y (1998) Reliability of the anteroposterior axis and the posterior condylar axis for determining rotational alignment of the femoral component in total knee arthroplasty. J Orthop Sci 3(4):194–198

    PubMed  Article  CAS  Google Scholar 

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  1. Warringal Private Hospital, 216 Burgundy St., Melbourne, VIC, 3084, Australia

    Simon Talbot & John Bartlett

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  1. Simon Talbot
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  2. John Bartlett
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Correspondence to Simon Talbot.

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Talbot, S., Bartlett, J. The anterior surface of the femur as a new landmark for femoral component rotation in total knee arthroplasty. Knee Surg Sports Traumatol Arthr 16, 258–262 (2008). https://doi.org/10.1007/s00167-007-0421-x

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  • DOI: https://doi.org/10.1007/s00167-007-0421-x

Keywords

  • Total knee arthroplasty
  • Femoral rotation
  • Computer navigation
  • Anterior femoral axis
  • Whiteside’s line
  • Posterior condylar axis
  • Epicondylar axis
  • Arthroplasty