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Influence of femoral malrotation on knee joint alignment and intra-articular contract pressures

Archives of Orthopaedic and Trauma Surgery volume 131, pages 1115–1120 (2011)Cite this article

Abstract

Introduction

The standard treatment of femoral diaphyseal fractures is intramedullary nailing. Torsion error remains a largely unsolved problem. We hypothesized that femoral malrotation would change the coronal alignment of the lower extremity and the center of force (COF) in the tibiofemoral joint as compared to the native state.

Method

Ten cadaveric legs were used. Intraarticularly placed sensor foil was used to measure contact pressures for each condyle. The resultant pressure of this two-force measurement was calculated as the COF for the joint. Mechanical axis was defined by the navigation system. Two novel devices were used: (1) to simulate bodyweight with leg attachment and fixation to the anterior pelvis and (2) to fix the femur at various degrees of malrotation. A mid-diaphyseal osteotomy was performed and the distal fragment was rotated both internally and externally in 5° increments to a maximum of 25°. COF and axial alignment were assessed at each step with application of a half-bodyweight specific to each specimen.

Results

Internal rotation resulted in valgus deviation of the mechanical axis and a shift in COF towards the lateral condyle (P < 0.05). External rotation caused varus deviation and switched COF towards the medial condyle (P < 0.05). This study shows that femoral malrotation has a significant effect on mechanical axis alignment and force vectors within the knee. Correlation with clinical outcomes is necessary and further research into minimizing such errors of torsion is warranted.

Conclusion

Torsion errors are not merely cosmetic issues, but may result in further morbidity, such as varus or valgus deformity and shifting of the COF, which may lead to joint arthrosis.

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Acknowledgments

We would like to thank the Dr. hc. Robert Mathys Foundation for scientific and financial support.

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Affiliations

  1. Department of Traumatology, Hand and Reconstructive Surgery St. Josefs-Hospital, Krankenhausstraße 13, 49661, Cloppenburg, Germany

    Philipp Bretin

  2. Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, USA

    Padhraig F. O’Loughlin, Eduardo M. Suero & Daniel Kendoff

  3. Department of Orthopaedics, Hannover Medical School, Hannover, Germany

    Sven Ostermeier

  4. Trauma Department, Hannover Medical School, Hannover, Germany

    Tobias Hüfner, Christian Krettek & Musa Citak

Authors
  1. Philipp Bretin
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  2. Padhraig F. O’Loughlin
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  3. Eduardo M. Suero
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  4. Daniel Kendoff
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  5. Sven Ostermeier
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  6. Tobias Hüfner
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  7. Christian Krettek
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  8. Musa Citak
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Correspondence to Philipp Bretin.

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Bretin, P., O’Loughlin, P.F., Suero, E.M. et al. Influence of femoral malrotation on knee joint alignment and intra-articular contract pressures. Arch Orthop Trauma Surg 131, 1115–1120 (2011). https://doi.org/10.1007/s00402-010-1210-4

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  • DOI: https://doi.org/10.1007/s00402-010-1210-4

Keywords

  • Femoral malrotation
  • Joint pressure
  • Malalignment
  • CAS