Abstract
Purpose
Restoring the joint line (JL) improves clinical and functional outcome in total knee arthroplasty (TKA). Therefore, anatomical landmarks to approximate the JL have been published. So far, the natural deviation of the JL 90° to the mechanical tibial axis has not been considered. Thus, we designed this study to: (1) determine the natural JL of knees in healthy persons in respect to the mechanical tibial axis, (2) validate and double-check intra-operative bony landmarks already been published in respect to the natural JL and (3) find possible correlations between distances from bony landmarks to the JL and femoral and tibial width.
Methods
Eighty MRI scans of knees of healthy persons were examined by two independent observers. Distances from the tip of the fibular head (FH), the medial (ME) and lateral (LE) epicondyles and the adductor tubercle (AT) to the JL within the medial and lateral compartment were measured. Further, we determined the orientation of the JL in respect to the mechanical axis of the tibia. Interobserver correlations were calculated. Differences were analyzed using Student’s t test. Linear regression models were calculated to analyze correlations.
Results
Interobserver correlation was excellent. Mean JL deviation was 4.2° varus. Distance between the FH, ME, LE and AT to the JL within the medial compartment was 12.2, 33.9, 33.4 and 45.4 mm, respectively. Within in the lateral compartment, distances were 15.3, 31.0, 30.6 and 42.3 mm to the JL. Strong correlation was found between femoral width and distances from the AT, ME and LE to the JL.
Conclusion
In TKA, the JL is usually altered due to the classic resection technique, which does not respect the natural deviation of the JL. Estimating the natural JL by adding absolute values to bony landmarks, as proposed in the literature, is not recommended. According to our data, the JL can be best estimated by adding the calculated value: 6.40 + (width femur [mm] × 0.49) to the AT.
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References
Singerman R, Davy DT, Goldberg VM (1994) Effects of patella alta and patella infera on patellofemoral forces. J Biomech 27:1059
Singerman R, Heiple KG, Davy DT et al (1995) Effect of tibial component position on patellar strain following total knee arthroplasty. J Arthroplasty 10:651
Martin JW, Whiteside LA (1990) The influence of joint line position on knee stability after condylar knee arthroplasty. Clin Orthop 259:146
Laskin RS (2002) Joint line position restoration during revision total knee replacement. Clin Orthop Relat Res 404:169–171
Figgie HE III, Goldberg VM, Heiple KG, Moller HS III, Gordon NH (1986) The influence of tibial-patellofemoral location on function of the knee in patients with the posterior stabilized condylar knee prosthesis. J Bone Joint Surg Am 68:1035–1040
Partington PF, Sawhney J, Rorabeck CH et al (1999) Joint line restoration after revision total knee arthroplasty. Clin Orthop 367:165
Servien E, Viskontas D, Giuffre BM, Coolican MRJ, Parker DA (2008) Reliability of bony landmarks for restoration of the joint line in revision knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 16:263–269
Jawhar A, Wasnik S, Scharf HP, Roehl H (2013) Fibula head is a useful landmark to predict the location of posterior cruciate ligament footprint prior to total knee arthroplasty. Int Orthop [Epub ahead of print]
Stiehl JB, Abott BD (1995) Morphology of the transepicondylar axis and its application in primary and revision total knee arthroplasty. J Artroplasty 10:185–189
Iacono F, Lo Presti M, Bruni D, Raspugli GF, Bignozzi S, Sharma B, Marcacci M (2013) The adductor tubercle: a reliable landmark for analysing the level of the femorotibial joint line. Knee Surg Sports Traumatol Arthrosc 21(12):2725–2729
Moreland JR, Bassett LW, Hanker GJ (1987) Radiographic analysis of the axial alignment of the lower extremity. J Bone Joint Surgery Am 69(5):745–749
Bellemans J, Colyn W, Vandenneucker H, Victor J (2012) The Chitranjan Ranawat award: is neutral mechanical alignment normal for all patients? the concept of constitutional varus. Clin Orthop Relat Res 470(1):45–53
Jawhar A, Shah V, Sohoni S, Scharf HP (2013) Joint line changes after primary total knee arthroplasty: navigated versus non-navigated. Knee Surg Sports Traumatol Arthrosc 21:2355–2362
Havet E, Gabrion A, Leiber-Wackenheim F, Vernois J, Olory B, Mertl P (2007) Radiological study of the knee joint line position measured from the fibular head and proximal tibial landmarks. Surg Radiol Anat 29(4):285–289
Lee HJ, Lee JS, Jung HJ, Song KS, Yang JJ, Park CW (2011) Comparison of joint line position changes after primary bilateral total knee arthroplasty performed using the navigation-assisted measured gap resection or gap balancing techniques. Knee Surg Sports Traumatol Arthrosc 19(12):2027–2032
Issa SN, Dunlop D, Chang A, Song J, Prasad PV, Guermazi A, Peterfy C, Cahue S, Marshall M, Kapoor D, Hayes K, Sharma L (2007) Full-limb and knee radiography assessments of varus-valgus alignment and their relationship to osteoarthritis disease features by magnetic resonance imaging. Arthritis Rheum 57(3):398–406
Partington PF, Sawhney J, Rorabeck CH et al (1999) Joint line restoration after revision total knee arthroplasty. Clin Orthop 367:165–171
Griffin FM, Math K, Scuderi GR, Insall JN, Poilvache PL (2000) Anatomy of the epicondyles of the distal femur: MRI analysis of normal knees. J Arthroplasty 15:354–359
Liu F, Yue B, Gadikota HR, Kozanek M, Liu W, Gill T, Rubish HE, Li G (2010) Morphology of the medial collateral ligament of the knee. J Orthop Surg Res 5:69
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Maderbacher, G., Keshmiri, A., Schaumburger, J. et al. Accuracy of bony landmarks for restoring the natural joint line in revision knee surgery: an MRI study. International Orthopaedics (SICOT) 38, 1173–1181 (2014). https://doi.org/10.1007/s00264-014-2292-3
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DOI: https://doi.org/10.1007/s00264-014-2292-3