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Investigation of femoral condyle height changes during flexion of the knee: implication to gap balance in TKA surgery

  • Knee Arthroplasty
  • Published:
Archives of Orthopaedic and Trauma Surgery Aims and scope Submit manuscript

Abstract

Background

Gap balance of the knee at 0° and 90° of flexion has been pursued in total knee arthroplasty (TKA) with the trans-epicondyle axis (TEA) as a reference. This study investigated the height changes of the tibiofemoral articulation and compared the data with the femoral condyle height changes measured using different flexion axes.

Materials and methods

Twenty healthy knees were investigated during an in vivo weightbearing flexion using a technique combining MRI and a dual fluoroscopic imaging system (DFIS). The tibiofemoral contact points and the femoral condyle heights [measured using: TEA, geometric center axis (GCA), and iso-height axis (IHA)] were determined at each flexion angle. The height changes of the articular contact points and the femoral condyles were compared along the flexion path.

Results

The changes of the medial and lateral contact point heights were within 2.5 mm along the flexion path. The changes of the medial and lateral condyle heights were within 8.9 mm for TEA, within 4.2 mm for GCA and within 3.0 mm for IHA. The height changes measured by the contact points and IHA are similar (p > 0.05), and both are significantly smaller than those measured using the TEA and GCA (p < 0.05).

Conclusions

The TEA and GCA measured varying femoral condyle heights, but the IHA resulted in minimal condyle height changes and could better represent the articulation characteristics of the knee. The data suggested that the IHA could be used as an alternative reference to guide surgical preparation of gap balance along the knee flexion path during TKA surgeries.

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Acknowledgements

This work was partially supported by the NIH (R01 AR052408) and the Department of Orthopaedic Surgery at Newton-Wellesley Hospital.

Funding

The research was in part supported by National Institutes of Health.

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Author notes

  1. Zhenming Zhang and Chaochao Zhou have contributed equally to this work.

Authors and Affiliations

  1. Orthopaedic Bioengineering Research Center, Newton-Wellesley Hospital, 159 Wells Ave, Newton, MA, 02459, USA

    Zhenming Zhang, Chaochao Zhou, Zhitao Rao, Timothy Foster, Hany Bedair & Guoan Li

  2. Department of Orthopedic Surgery, Newton-Wellesley Hospital, Newton, MA, USA

    Timothy Foster, Hany Bedair & Guoan Li

  3. Department of Orthopaedic Surgery, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA

    Chaochao Zhou & Hany Bedair

  4. Department of Orthopaedics, China-Japan Union Hospital of Jilin University, Changchun, Jilin, China

    Zhenming Zhang

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  1. Zhenming Zhang
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  2. Chaochao Zhou
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  3. Zhitao Rao
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Correspondence to Guoan Li.

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The authors declare that there is no conflict of interest.

Ethical approval

This study containing human participants was approved by the institutional review board at one of our institutions.

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

IRB statement

This study was approved by Partners Human Research Committee (Protocol #: 2003P000337/PHS), Somerville, MA, USA. All subjects signed informed consent prior to any test.

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Zhang, Z., Zhou, C., Rao, Z. et al. Investigation of femoral condyle height changes during flexion of the knee: implication to gap balance in TKA surgery. Arch Orthop Trauma Surg 142, 2849–2855 (2022). https://doi.org/10.1007/s00402-021-04155-w

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  • DOI: https://doi.org/10.1007/s00402-021-04155-w

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