Skip to main content
SpringerLink
Log in

Femur bowing could be a risk factor for implant flexion in conventional total knee arthroplasty and notching in navigated total knee arthroplasty

  • Knee
  • Published:
Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Purpose

This study aimed to investigate the relationship between preoperative femoral axes and femoral implant position and to determine how femoral sagittal axes, including femoral anterior bowing, influence the femoral component position in total knee arthroplasty (TKA).

Methods

The relationship between femoral axes (femoral anterior bowing, mechanical axis and the anterior cortical line, intramedullary axis) and implant position was compared in 50 conventional and 50 navigated TKAs. Outliers with more than a 3° margin of error in placement of the femoral component compared with the mechanical axis in the sagittal plane were calculated.

Results

The femoral component flexion angle was 3.1° in the conventional group and 1.6° in the navigation group (p < 0.001). Anterior femoral bowing correlated positively with the angle between the mechanical axis and implant (r = 0.360, p = 0.010) in the conventional group and negatively with the angle between the anterior cortical line and flange of the femoral component (r = −0.355, p = 0.010) in navigated TKAs. Incidence of outliers was 48 % (24 patients) in the conventional group compared with 10 % (five patients) in the navigated group (p = 0.008).

Conclusions

Femoral anterior bowing was an influential factor for implant position and could be a risk factor for both femoral implant flexion in conventional TKAs and notching in navigated TKAs. The results of this study should be considered by surgeons when assessing the risk factors for femoral geometry before performing TKAs, as these results may help them to avoid an overly flexed or extended position of the femoral component, which would affect clinical long-term survival.

Level of evidence

Retrospective comparative study, Level III.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others

References

  1. Bathis H, Perlick L, Tingart M, Luring C, Zurakowski D, Grifka J (2004) Alignment in total knee arthroplasty. A comparison of computer-assisted surgery with the conventional technique. J Bone Joint Surg Br 86(5):682–687

    Article  CAS  PubMed  Google Scholar 

  2. Bolognesi M, Hofmann A (2005) Computer navigation versus standard instrumentation for TKA: a single-surgeon experience. Clin Orthop Relat Res 440:162–169

    Article  PubMed  Google Scholar 

  3. Bonner TJ, Eardley WG, Patterson P, Gregg PJ (2011) The effect of post-operative mechanical axis alignment on the survival of primary total knee replacements after a follow-up of 15 years. J Bone Joint Surg Br 93(9):1217–1222

    Article  CAS  PubMed  Google Scholar 

  4. Camera A, Biggi S, Cattaneo G, Brusaferri G (2015) Ten-year results of primary and revision condylar-constrained total knee arthroplasty in patients with severe coronal plane instability. Open Orthop J 9:379–389

    Article  PubMed  PubMed Central  Google Scholar 

  5. Chauhan SK, Scott RG, Breidahl W, Beaver RJ (2004) Computer-assisted knee arthroplasty versus a conventional jig-based technique. A randomised, prospective trial. J Bone Joint Surg Br 86(3):372–377

    Article  CAS  PubMed  Google Scholar 

  6. Chen X, Wang H, Cai Y, Zhu Q, Zhu J (2014) Sagittal component alignment is less reliable than coronal component alignment in a Chinese population undergoing navigated TKA. J Orthop Surg Res 9:51

    Article  PubMed  PubMed Central  Google Scholar 

  7. Chin PL, Foo LS, Yang KY, Yeo SJ, Lo NN (2007) Randomized controlled trial comparing the radiologic outcomes of conventional and minimally invasive techniques for total knee arthroplasty. J Arthroplasty 22(6):800–806

    Article  PubMed  Google Scholar 

  8. Chin PL, Yang KY, Yeo SJ, Lo NN (2005) Randomized control trial comparing radiographic total knee arthroplasty implant placement using computer navigation versus conventional technique. J Arthroplasty 20(5):618–626

    Article  PubMed  Google Scholar 

  9. Chung BJ, Kang YG, Chang CB, Kim SJ, Kim TK (2009) Differences between sagittal femoral mechanical and distal reference axes should be considered in navigated TKA. Clin Orthop Relat Res 467(9):2403–2413

    Article  PubMed  PubMed Central  Google Scholar 

  10. Dai Y, Bischoff JE (2013) Comprehensive assessment of tibial plateau morphology in total knee arthroplasty: influence of shape and size on anthropometric variability. J Orthop Res 31(10):1643–1652

    Article  PubMed  Google Scholar 

  11. Dutton AQ, Yeo SJ, Yang KY, Lo NN, Chia KU, Chong HC (2008) Computer-assisted minimally invasive total knee arthroplasty compared with standard total knee arthroplasty. A prospective, randomized study. J Bone Joint Surg Am 90(1):2–9

    Article  PubMed  Google Scholar 

  12. Ecker ML, Lotke PA, Windsor RE, Cella JP (1987) Long-term results after total condylar knee arthroplasty. Significance of radiolucent lines. Clin Orthop Relat Res 216:151–158

    PubMed  Google Scholar 

  13. Ensini A, Catani F, Leardini A, Romagnoli M, Giannini S (2007) Alignments and clinical results in conventional and navigated total knee arthroplasty. Clin Orthop Relat Res 457:156–162

    CAS  PubMed  Google Scholar 

  14. Haaker RG, Stockheim M, Kamp M, Proff G, Breitenfelder J, Ottersbach A (2005) Computer-assisted navigation increases precision of component placement in total knee arthroplasty. Clin Orthop Relat Res 433:152–159

    Article  PubMed  Google Scholar 

  15. Insall JN, Binazzi R, Soudry M, Mestriner LA (1985) Total knee arthroplasty. Clin Orthop Relat Res 192:13–22

    PubMed  Google Scholar 

  16. Jenny JY, Clemens U, Kohler S, Kiefer H, Konermann W, Miehlke RK (2005) Consistency of implantation of a total knee arthroplasty with a non-image-based navigation system: a case-control study of 235 cases compared with 235 conventionally implanted prostheses. J Arthroplasty 20(7):832–839

    Article  PubMed  Google Scholar 

  17. Kim JM, Moon MS (1995) Squatting following total knee arthroplasty. Clin Orthop Relat Res 313:177–186

    PubMed  Google Scholar 

  18. Kim YH, Kim JS, Yoon SH (2007) Alignment and orientation of the components in total knee replacement with and without navigation support: a prospective, randomised study. J Bone Joint Surg Br 89(4):471–476

    Article  PubMed  Google Scholar 

  19. Kim YH, Sohn KS, Kim JS (2005) Range of motion of standard and high-flexion posterior stabilized total knee prostheses. A prospective, randomized study. J Bone Joint Surg Am 87(7):1470–1475

    Article  PubMed  Google Scholar 

  20. Kumar PJ, Dorr LD (1997) Severe malalignment and soft-tissue imbalance in total knee arthroplasty. Am J Knee Surg 10(1):36–41

    CAS  PubMed  Google Scholar 

  21. 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

    Article  PubMed  Google Scholar 

  22. Minoda Y, Kobayashi A, Iwaki H, Ohashi H, Takaoka K (2009) TKA sagittal alignment with navigation systems and conventional techniques vary only a few degrees. Clin Orthop Relat Res 467(4):1000–1006

    Article  PubMed  Google Scholar 

  23. Minoda Y, Kobayashi A, Iwaki H, Sugama R, Iwakiri K, Kadoya Y, Ohashi H, Takaoka K (2008) Sagittal alignment of the lower extremity while standing in Japanese male. Arch Orthop Trauma Surg 128(4):435–442

    Article  PubMed  Google Scholar 

  24. Moon YW, Han JH, Lee KH, Jang SW, Seo JG (2013) Clinical Outcome of IM-Guided Total Knee Arthroplasty with Inappropriate Femoral Resection in Coronal Plane. Knee Surg Relat Res 25(1):19–24

    Article  PubMed  PubMed Central  Google Scholar 

  25. O’Rourke MR, Callaghan JJ, Goetz DD, Sullivan PM, Johnston RC (2002) Osteolysis associated with a cemented modular posterior-cruciate-substituting total knee design: five to eight-year follow-up. J Bone Joint Surg Am 84-a(8):1362–1371

    PubMed  Google Scholar 

  26. Parratte S, Pagnano MW, Trousdale RT, Berry DJ (2010) Effect of postoperative mechanical axis alignment on the fifteen-year survival of modern, cemented total knee replacements. J Bone Joint Surg Am 92(12):2143–2149

    Article  PubMed  Google Scholar 

  27. Pfitzner T, von Roth P, Perka C, Matziolis G (2014) Intramedullary control of distal femoral resection results in precise coronal alignment in TKA. Arch Orthop Trauma Surg 134(4):459–465

    Article  PubMed  Google Scholar 

  28. Piazza SJ, Delp SL, Stulberg SD, Stern SH (1998) Posterior tilting of the tibial component decreases femoral rollback in posterior-substituting knee replacement: a computer simulation study. J Orthop Res 16(2):264–270

    Article  CAS  PubMed  Google Scholar 

  29. Puloski SK, McCalden RW, MacDonald SJ, Rorabeck CH, Bourne RB (2001) Tibial post wear in posterior stabilized total knee arthroplasty. An unrecognized source of polyethylene debris. J Bone Joint Surg Am 83-a(3):390–397

    CAS  PubMed  Google Scholar 

  30. Ritter MA, Thong AE, Keating EM, Faris PM, Meding JB, Berend ME, Pierson JL, Davis KE (2005) The effect of femoral notching during total knee arthroplasty on the prevalence of postoperative femoral fractures and on clinical outcome. J Bone Joint Surg Am 87(11):2411–2414

    Article  PubMed  Google Scholar 

  31. Rosenberger RE, Hoser C, Quirbach S, Attal R, Hennerbichler A, Fink C (2008) Improved accuracy of component alignment with the implementation of image-free navigation in total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 16(3):249–257

    Article  PubMed  Google Scholar 

  32. Shawen SB, Belmont PJ Jr, Klemme WR, Topoleski LD, Xenos JS, Orchowski JR (2003) Osteoporosis and anterior femoral notching in periprosthetic supracondylar femoral fractures: a biomechanical analysis. J Bone Joint Surg Am 85-a(1):115–121

    PubMed  Google Scholar 

  33. Sparmann M, Wolke B, Czupalla H, Banzer D, Zink A (2003) Positioning of total knee arthroplasty with and without navigation support. A prospective, randomised study. J Bone Joint Surg Br 85(6):830–835

    CAS  PubMed  Google Scholar 

  34. Tingart M, Luring C, Bathis H, Beckmann J, Grifka J, Perlick L (2008) Computer-assisted total knee arthroplasty versus the conventional technique: how precise is navigation in clinical routine? Knee Surg Sports Traumatol Arthrosc 16(1):44–50

    Article  PubMed  Google Scholar 

  35. Victor J, Hoste D (2004) Image-based computer-assisted total knee arthroplasty leads to lower variability in coronal alignment. Clin Orthop Relat Res 428:131–139

    Article  PubMed  Google Scholar 

  36. Yehyawi TM, Callaghan JJ, Pedersen DR, O’Rourke MR, Liu SS (2007) Variances in sagittal femoral shaft bowing in patients undergoing TKA. Clin Orthop Relat Res 464:99–104

    PubMed  Google Scholar 

  37. Yue B, Varadarajan KM, Ai S, Tang T, Rubash HE, Li G (2011) Differences of knee anthropometry between Chinese and white men and women. J Arthroplasty 26(1):124–130

    Article  PubMed  Google Scholar 

Download references

Acknowledgments

The authors thank Keun Jung Ryu, MD (Yonsei University, College of Medicine, Seoul, Korea), for his help with the statistics, Jeyoung Woo with graphic support and Hee Yeon Lee and Seojin Park with data organization. This study was supported by a faculty research grant of Yonsei University College of Medicine for 2015 (6-2015-0092).

Author information

Authors and Affiliations

  1. Department of Orthopedic Surgery, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu, Seoul, 120-752, Republic of Korea

    Jae Han Ko, Chang Dong Han, Kyoo Ho Shin, Ick Hwan Yang, Woo Suk Lee, Kwang Il Kim & Kwan Kyu Park

  2. AIC-CURE International Children’s Hospital of Kenya, Kijabe, Kenya

    Levis Nguku

Authors
  1. Jae Han Ko
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Chang Dong Han
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Kyoo Ho Shin
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Levis Nguku
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Ick Hwan Yang
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Woo Suk Lee
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Kwang Il Kim
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Kwan Kyu Park
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Kwan Kyu Park.

Ethics declarations

Conflict of interest

The authors have no conflicts of interest to declare.

Additional information

This study was approved by the institutional review board at the authors’ institute (4-2015-0047).

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Ko, J.H., Han, C.D., Shin, K.H. et al. Femur bowing could be a risk factor for implant flexion in conventional total knee arthroplasty and notching in navigated total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 24, 2476–2482 (2016). https://doi.org/10.1007/s00167-015-3863-6

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00167-015-3863-6

Keywords

Search

Navigation