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Variable rotation of the femur does not affect outcome with patient specific alignment navigated balanced TKA

Knee Surgery, Sports Traumatology, Arthroscopy volume 30, pages 517–526 (2022)Cite this article

Abstract

Purpose

Excessive internal and external rotation of the femoral component has been associated with poor outcome with a measured-resection neutral mechanical alignment TKA. This technique assumes that every tibia is in 3° of varus so the femoral component is placed in 3° of external rotation relative to the posterior condylar axis to enable a balanced flexion gap. This is not the case as there is wide variability in the bony anatomy and soft tissue envelope of the knee so flexion imbalance may occur. A patient-specific alignment navigated balanced TKA technique was performed whereby the tibia is cut anatomically up to 3° of varus, then a ligament tensor is used to determine the optimal femoral component position for a balanced TKA. This results in variable femoral rotation. The hypothesis is that matching the femoral component rotation to the patient’s anatomic tibial cut and soft tissue envelope will not affect clinical outcome

Methods

In a single surgeon series 287 consecutive varus aligned TKA’s were performed using this technique with an Attune cruciate retaining fixed bearing TKA with an anatomic patella resurfacing. The angle between the posterior femoral cuts and the posterior condylar axis was collected using Brainlab software. Functional scores were collected prospectively preoperatively and at two years. The variable femoral component rotation was correlated with and compared with the functional outcome scores.

Results

The femoral rotation varied from 7° of internal rotation to 8°of external rotation relative to the posterior condylar axis. The mean rotation was 1.1° of external rotation. There was no significant difference in the Oxford score, WOMAC score, Forgotten Knee Score, KOOS Joint Replacement score or Patient Satisfaction in respect to the variable femoral rotation relative to the posterior condylar axis.

Conclusion

When a more anatomic-balanced TKA technique is used variable femoral rotation will not affect clinical outcome at two years

Level of evidence

II Prospective Cohort Study.

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Funding

No funding was received for this study.

Author information

Affiliations

  1. Orthopaedic Department, Aguiléra Private Clinic, Ramsey Santé, Biarritz, France

    Jérôme Murgier

  2. Department of Orthopaedics, Middlemore Hospital, 100 Hospital Rd, Otahuhu, Auckland, 2025, New Zealand

    Mark Clatworthy

Authors
  1. Jérôme Murgier
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  2. Mark Clatworthy
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Corresponding author

Correspondence to Mark Clatworthy.

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Conflict of interest

Mark Clatworthy is consultant for Depuy. Jérôme Murgier declares no conflict of interest in relation to this article.

Ethical approval

The study was approved by the New Zealand Ethics Committee.

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Murgier, J., Clatworthy, M. Variable rotation of the femur does not affect outcome with patient specific alignment navigated balanced TKA. Knee Surg Sports Traumatol Arthrosc 30, 517–526 (2022). https://doi.org/10.1007/s00167-020-06226-8

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  • DOI: https://doi.org/10.1007/s00167-020-06226-8

Keywords

  • Computer assisted surgery
  • Total knee arthroplasty
  • Distal femoral rotation
  • Balanced TKA