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Intra- and postoperative assessment of femoral component rotation in total knee arthroplasty: an EKA knee expert group clinical review

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Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Purpose

Malrotation of the femoral component after primary total knee arthroplasty (TKA) is one of the most important problems leading to painful TKA requiring revision surgery.

Methods

A comprehensive systematic review of the literature was performed to present current evidence on how to optimally place the femoral component in TKA. Several landmarks and techniques for intraoperative determination of femoral component placement and examination of their reliability were analyzed.

Results

2806 articles were identified and 21 met the inclusion criteria. As there is no unquestioned gold standard, numerous approaches are possible which come along with specific advantages and disadvantages. In addition, imaging modalities and measurements regarding postoperative femoral component rotation were also investigated. Femoral component rotation measurements on three-dimensional (3D) reconstructed computerised tomography (CT) images displayed intraclass correlation coefficients (ICC) above 0.85, significantly better than those performed in radiographics or two-dimensional (2D) CT images. Thus, 3D CT images to accurately evaluate the femoral prosthetic component rotation are recommended, especially in unsatisfied patients after TKA.

Conclusion

The EKA Femoral Rotation Focus Group has not identified a single best reference method to determine femoral component rotation, but surgeons mostly prefer the measured resection technique using at least two landmarks for cross-checking the rotation.

Level of evidence

III.

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Abbreviations

CI:

Confidence intervals

CT:

Computer tomography

EKA:

European Knee Associates

GB:

Gap balance

ICC:

Intraclass correlation coefficients

KSS:

Knee Society Score

MR:

Measured resection

NRCT:

Nonrandomized controlled trial

PCA:

Posterior condylar axis

PRO:

Prospective trials

RCT:

Randomized controlled trials

RE:

Retrospective studies

ROM:

Range of motion

SD:

Standard deviation

TAPA:

Trochlear anterior–posterior axis

TEA:

Transepicondylar axis

TKA:

Total knee arthroplasty

WOMAC:

Western Ontario and McMaster University Osteoarthritis Index

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Authors and Affiliations

  1. Department of Orthopaedic and Trauma Surgery, S. Żeromski Hospital, Os. Na Skarpie 66, 31-913, Kraków, Poland

    Paweł Skowronek & Agnieszka Bartyzel

  2. LEONARDO-Physicians for Orthopaedic and Traumatologic Surgery, Hirslanden Clinic Birshof, Münchenstein, Switzerland

    Markus Arnold

  3. Universitätsklinikum A. ö. R, Orthopädische Universitätsklinik, Bereich Kniechirurgie Und Sportorthopädie, Leipziger Str. 44, 39120, Magdeburg, Germany

    Christian Starke

  4. Department of Orthopaedic Surgery and Traumatology, Kantonsspital Baselland (Bruderholz, Liestal, Laufen), 4101, Bruderholz, Switzerland

    Lukas B. Moser & Michael T. Hirschmann

  5. University of Basel, 4051, Basel, Switzerland

    Markus Arnold, Lukas B. Moser & Michael T. Hirschmann

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  1. Paweł Skowronek
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  2. Markus Arnold
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  3. Christian Starke
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  4. Agnieszka Bartyzel
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  5. Lukas B. Moser
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  6. Michael T. Hirschmann
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European Knee Associates (EKA)

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Correspondence to Paweł Skowronek.

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Christian Starke conflicted consultancy as Mathys, Implant-tec. The other authors declare that they have no conflict of interest.

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Skowronek, P., Arnold, M., Starke, C. et al. Intra- and postoperative assessment of femoral component rotation in total knee arthroplasty: an EKA knee expert group clinical review. Knee Surg Sports Traumatol Arthrosc 29, 772–782 (2021). https://doi.org/10.1007/s00167-020-06006-4

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