Abstract
Introduction
Proper rotational alignment is a critical step of total knee arthroplasty. For intraoperative determination of femoral rotation, Whiteside suggests a perpendicular line to the axis of the center of the trochlea and the intercondylar notch (Whiteside’s line).
Method
In a prospective clinical study, the intraoperative position of Whiteside’s line was measured in 30 patients with the help of a navigation system.
Results
Whiteside’s line was 2.1° ± 1.5° externally rotated compared to a navigation based computer calculated preliminary AP axis of the femur. The intraobserver-reliability after 3 repeated measurements each was 1.6° for the senior surgeon and 1.4° for the junior surgeon (p = 0.598, p = 0.968). The interobserver reliability between the measurements by the senior and junior surgeon was 1.4° (p = 0.547).
Conclusion
Navigated intraoperative measurements of Whiteside’s line showed a high inter- and intraobserver reliability. Considering the variability between Whiteside’s line and the transepicondylar axis, intraoperative assessment of both the methods is recommended.
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Reference list
Arima J, Whiteside LA, McCarthy DS, White SE (1995) Femoral rotational alignment, based on the anteroposterior axis, in total knee arthroplasty in a valgus knee. A technical note. J Bone Joint Surg Am 77(9):1331–1334
Berger RA, Crossett LS, Jacobs JJ, Rubash HE (1998) Malrotation causing patellofemoral complications after total knee arthroplasty. Clin Orthop Relat Res (356):144-153
Clayton ML, Thirupathi R (1982) Patellar complications after total condylar arthroplasty. Clin Orthop Relat Res 170:152–155
Dennis DA, Komistek RD, Kim RH, Sharma A (2010) Gap balancing versus measured resection technique for total knee arthroplasty. Clin Orthop Relat Res 468(1):102–107
Feinstein WK, Noble PC, Kamaric E, Tullos HS (1996) Anatomic alignment of the patellar groove. Clin Orthop Relat Res 331:64–73
Jenny JY, Boeri C (2004) Low reproducibility of the intra-operative measurement of the transepicondylar axis during total knee replacement. Acta Orthop Scand 75(1):74–77
Jerosch J, Peuker E, Philipps B, Filler T (2002) Interindividual reproducibility in perioperative rotational alignment of femoral components in knee prosthetic surgery using the transepicondylar axis. Knee Surg Sports Traumatol Arthrosc 10(3):194–197
Katz JN (2001) Preferences, quality, and the (under)utilization of total joint arthroplasty. Med Care 39(3):203–205
Katz MA, Beck TD, Silber JS, Seldes RM, Lotke PA (2001) Determining femoral rotational alignment in total knee arthroplasty: reliability of techniques. J Arthroplasty 16(3):301–305
Kinzel V, Ledger M, Shakespeare D (2005) Can the epicondylar axis be defined accurately in total knee arthroplasty? Knee 12(4):293–296
Kohn D, Rupp S (2000) Knee endoprosthesis: aspects of surgical techniques. Orthopade 29(8):697–707
Laskin RS (1995) Flexion space configuration in total knee arthroplasty. J Arthroplasty 10(5):657–660
Matziolis G, Krocker D, Weiss U, Tohtz S, Perka C (2007) A prospective, randomized study of computer-assisted and conventional total knee arthroplasty. Three-dimensional evaluation of implant alignment and rotation. J Bone Joint Surg Am 89(2):236–243
Olcott CW, Scott RD (1999) The Ranawat Award. Femoral component rotation during total knee arthroplasty. Clin Orthop Relat Res 367:39–42
Olcott CW, Scott RD (2000) A comparison of 4 intraoperative methods to determine femoral component rotation during total knee arthroplasty. J Arthroplasty 15(1):22–26
Poilvache PL, Insall JN, Scuderi GR, DE Font-Rodriguez (1996) Rotational landmarks and sizing of the distal femur in total knee arthroplasty. Clin Orthop Relat Res 331:35–46
Siston RA, Patel JJ, Goodman SB, Delp SL, Giori NJ (2005) The variability of femoral rotational alignment in total knee arthroplasty. J Bone Joint Surg Am 87(10):2276–2280
Stiehl JB, Cherveny PM (1996) Femoral rotational alignment using the tibial shaft axis in total knee arthroplasty. Clin Orthop Relat Res 331:47–55
Stockl B, Nogler M, Rosiek R, Fischer M, Krismer M, Kessler O (2004) Navigation improves accuracy of rotational alignment in total knee arthroplasty. Clin Orthop Relat Res 426:180–186
van der Linden-van der Zwaag HM, Bos J, van der Heide HJ, Nelissen RG (2010) A computed tomography based study on rotational alignment accuracy of the femoral component in total knee arthroplasty using computer-assisted orthopaedic surgery. Int Orthop (in press)
Victor J, Van Doninck D, Labey L, Van Glabbeek F, Parizel P, Bellemans J (2009) A common reference frame for describing rotation of the distal femur: a ct-based kinematic study using cadavers. J Bone Joint Surg Br 91(5):683–690
Walde TA, Bussert J, Sehmisch S et al (2010) Optimized functional femoral rotation in navigated total knee arthroplasty considering ligament tension. Knee 17(6):381–386
Whiteside LA, Arima J (1995) The anteroposterior axis for femoral rotational alignment in valgus total knee arthroplasty. Clin Orthop Relat Res 321:168–172
Yau WP, Leung A, Liu KG, Yan CH, Wong LL, Chiu KY (2007) Interobserver and intra-observer errors in obtaining visually selected anatomical landmarks during registration process in non-image-based navigation-assisted total knee arthroplasty. J Arthroplasty 22(8):1150–1161
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Vanin, N., Panzica, M., Dikos, G. et al. Rotational alignment in total knee arthroplasty: intraoperative inter- and intraobserver reliability of Whiteside’s line. Arch Orthop Trauma Surg 131, 1477–1480 (2011). https://doi.org/10.1007/s00402-011-1329-y
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DOI: https://doi.org/10.1007/s00402-011-1329-y