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The orientation of the surgical epicondylar axis varies in varus and non-varus knees in the coronal plane

Knee Surgery, Sports Traumatology, Arthroscopy volume 26, pages 2580–2586 (2018)Cite this article

Abstract

Purpose

To investigate the orientations of the surgical epicondylar axis (SEA) of varus and non-varus knees in the coronal plane.

Methods

One-hundred and sixty-two knees from 81 Chinese patients undergoing total knee arthroplasty (TKA) were retrospectively investigated. The angle between the medial side of the femoral mechanical axis and the SEA (MA-SEA), as well as the physiological valgus angle, was measured in the coronal plane using three-dimensional reconstruction. The joint line angle (JLA) and hip-knee-ankle angle (HKAA) were measured in long-leg weight-bearing radiographs. The mean of each parameter was compared between the varus (HKAA < 177.0°) and the non-varus knees (HKAA ≥ 177.0°) using an independent t test. Linear regression was used to assess the correlation between MA-SEA with JLA and HKAA.

Results

A total of 42 non-varus knees (6 valgus and 36 neutral knees) and 98 varus knees were measured, as 22 knees were abandoned due to unrecognizable bony landmarks. The mean MA-SEA and JLA were significantly larger in non-varus knees (both, p < 0.01). The mean physiological valgus angle was 5.9 ± 1.0° for Chinese TKA patients and was significantly larger in varus knees (p < 0.01). There was a strong positive correlation between the MA-SEA and JLA (R 2 = 0.35, p < 0.05).

Conclusions

There were significant differences in the orientation of the SEA between varus and non-varus knees, which was strongly correlated with the orientation of the femoral joint line. These findings will enhance the current knowledge of knee anatomy and should prove useful for coronal alignment in TKA.

Level of evidence

III.

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Acknowledgements

We would like to thank Meditool for extensive engineering consultancy.

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Author notes

    Affiliations

    1. Department of Orthopedic, Zhongshan Hospital, Fudan University, No. 180, Rd. Fenglin, Shanghai, China

      Yunjie Zhang, Xiaofeng Wang, Yunchao Shao & Qing Xia

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    1. Yunjie Zhang
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    2. Xiaofeng Wang
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    3. Yunchao Shao
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    4. Qing Xia
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    Corresponding authors

    Correspondence to Yunchao Shao or Qing Xia.

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    The authors have no conflicts of interest to report.

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    There is no funding source.

    Ethical approval

    The study protocol was approved by the institutional review board and ethical committee of Zhongshan Hospital, Fudan University (Shanghai, China) (approval no. 2011-214).

    Informed consent

    Informed consent was obtained from all study participants.

    Additional information

    Yunjie Zhang and Xiaofeng Wang contributed equally to this work.

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    Cite this article

    Zhang, Y., Wang, X., Shao, Y. et al. The orientation of the surgical epicondylar axis varies in varus and non-varus knees in the coronal plane. Knee Surg Sports Traumatol Arthrosc 26, 2580–2586 (2018). https://doi.org/10.1007/s00167-016-4386-5

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    • DOI: https://doi.org/10.1007/s00167-016-4386-5

    Keywords

    • Surgical epicondylar axis
    • Total knee arthroplasty
    • Femoral varus angle
    • Hip-knee-ankle angle
    • Kinematical alignment