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The flexion space is more reliably balanced when using the transepicondylar axis as compared to the posterior condylar line

  • Knee
  • Published:
Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Purpose

The purpose of this study was to evaluate the differences in flexion space balance when the femoral component is implanted parallel to the surgical transepicondylar axis (TEA) or with 3° of external rotation from the posterior condylar line (PoCoLi). It was hypothesized that implantation parallel to the TEA will produce a more reliably balanced flexion space.

Methods

Forty-eight consecutive patients with a varus deformity were prospectively randomized to undergo total knee arthroplasty with a femoral component implanted parallel the TEA, or with 3° of external rotation from the PoCoLi. The posterior condylar angle (PCA) was measured. Intraoperative load measurements were taken at 10°, 45°, and 90° of flexion.

Results

The PCA was similar between groups (TEA group: 4.2° ± 1.5° and PoCoLi group: 4.0° ± 1.3°; n.s.). The mean difference in load values between the medial and lateral compartments was significantly lower in the TEA group than in the PoCoLi group at the 45 (0 ± 8 vs. 9 ± 13 lbs; respectively, p = 0.008) and 90° flexion angles (1 ± 9 vs. 10 ± 15 lbs; respectively, p = 0.01). The PoCoLi group had a linear increase in the difference of load values between the medial and lateral compartments with increasing magnitude of the posterior condylar angle (45°, p = 0.0013; 90°, p = 0.0006), but this was not observed in the TEA group.

Conclusion

Femoral component implantation parallel to the TEA resulted in a more balanced flexion gap as compared to implantation at 3° of external rotation from the PoCoLi. The intraoperative use of the TEA rather than the PoCoLi to set femoral component rotation may provide a more balanced flexion space and decrease the need for extensive soft tissue releases.

Level of evidence

II.

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Acknowledgements

This study was partially funded by the generous donation of Mr. Glenn Bergenfield and the Sidney Milton and Leoma Simon Foundation (Florida).

Funding

One author is a paid consultant for Orthosensor outside the work of this manuscript. No funding or company participation was received for this work.

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I attest to the fact that all authors have participated in the research, study design, manuscript preparation, attest to the validity and legitimacy of the data and its interpretation, and agree to its submission.

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Correspondence to Scott R. Nodzo.

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None of the other authors have a conflict of interest.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study.

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Nodzo, S.R., Franceschini, V., Cruz, D.S. et al. The flexion space is more reliably balanced when using the transepicondylar axis as compared to the posterior condylar line. Knee Surg Sports Traumatol Arthrosc 26, 3265–3271 (2018). https://doi.org/10.1007/s00167-018-4855-0

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  • DOI: https://doi.org/10.1007/s00167-018-4855-0

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