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Kikuchi K, Holleman GT, Cardona JJ, Lesser ER, Kim CY, Tabuchi K, Watanabe K, Iwanaga J, Tubbs RS. Evolution of the term "epicondyle of the femur": Revisiting the anatomical and surgical literature. Clin Anat 2024; 37:571-577. [PMID: 38520312 DOI: 10.1002/ca.24160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2024] [Revised: 03/06/2024] [Accepted: 03/10/2024] [Indexed: 03/25/2024]
Abstract
The femoral epicondyle is an anatomical bony landmark essential for surgeons and anatomists, but there are discrepancies between the two fields when using this term. In current orthopedic surgery, it commonly denotes the small bony prominence of the femoral condyle. Given the derivation, "epicondyle" should be a region projecting laterally from the articular surface rather than a point. These discrepancies in usage are found not only between the fields but also in the literature. This article reviews the narrative definition of "epicondyle of the femur" in surgery and the evolution of the term in anatomy. The outcomes of the review suggest a relationship between the differing perceptions of the epicondyle and the evolution of the term. In reports of studies related to the epicondyle, it is strongly recommended that the definition of the word is clearly stated, with an understanding of its evolution.
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Affiliation(s)
- Keishiro Kikuchi
- Department of Neurosurgery, Tulane Center for Clinical Neurosciences, Tulane University School of Medicine, New Orleans, Louisiana, USA
- Department of Orthopaedic Surgery, Kurume University School of Medicine, Kurume, Fukuoka, Japan
- Division of Gross and Clinical Anatomy, Department of Anatomy, Kurume University School of Medicine, Kurume, Fukuoka, Japan
| | - Gerrit T Holleman
- Department of Neurosurgery, Tulane Center for Clinical Neurosciences, Tulane University School of Medicine, New Orleans, Louisiana, USA
| | - Juan J Cardona
- Department of Neurosurgery, Tulane Center for Clinical Neurosciences, Tulane University School of Medicine, New Orleans, Louisiana, USA
| | - Emma R Lesser
- Department of Neurosurgery, Tulane Center for Clinical Neurosciences, Tulane University School of Medicine, New Orleans, Louisiana, USA
| | - Chung Yoh Kim
- Department of Neurosurgery, Tulane Center for Clinical Neurosciences, Tulane University School of Medicine, New Orleans, Louisiana, USA
| | - Kosuke Tabuchi
- Department of Orthopaedic Surgery, Kurume University School of Medicine, Kurume, Fukuoka, Japan
| | - Koichi Watanabe
- Division of Gross and Clinical Anatomy, Department of Anatomy, Kurume University School of Medicine, Kurume, Fukuoka, Japan
| | - Joe Iwanaga
- Department of Neurosurgery, Tulane Center for Clinical Neurosciences, Tulane University School of Medicine, New Orleans, Louisiana, USA
- Division of Gross and Clinical Anatomy, Department of Anatomy, Kurume University School of Medicine, Kurume, Fukuoka, Japan
- Department of Neurology, Tulane Center for Clinical Neurosciences, Tulane University School of Medicine, New Orleans, Louisiana, USA
- Department of Structural and Cellular Biology, Tulane University School of Medicine, New Orleans, Louisiana, USA
- Department of Neurosurgery and Ochsner Neuroscience Institute, Ochsner Health System, New Orleans, Louisiana, USA
- Department of Oral and Maxillofacial Anatomy, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
- Dental and Oral Medical Center, Kurume University School of Medicine, Kurume, Fukuoka, Japan
| | - R Shane Tubbs
- Department of Neurosurgery, Tulane Center for Clinical Neurosciences, Tulane University School of Medicine, New Orleans, Louisiana, USA
- Department of Neurology, Tulane Center for Clinical Neurosciences, Tulane University School of Medicine, New Orleans, Louisiana, USA
- Department of Structural and Cellular Biology, Tulane University School of Medicine, New Orleans, Louisiana, USA
- Department of Neurosurgery and Ochsner Neuroscience Institute, Ochsner Health System, New Orleans, Louisiana, USA
- Department of Anatomical Sciences, St. George's University, St. George's, Grenada
- Department of Surgery, Tulane University School of Medicine, New Orleans, Louisiana, USA
- University of Queensland, Brisbane, Queensland, Australia
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Park KT, Nam TS, Son DW, Lee JK, Ahn JH. The Impact of Patellar Position on Mediolateral Joint Gap in Cruciate-Retaining and Posterior-Stabilized Total Knee Arthroplasty: A Prospective Study. J Arthroplasty 2024; 39:884-890. [PMID: 37858710 DOI: 10.1016/j.arth.2023.10.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Revised: 10/03/2023] [Accepted: 10/06/2023] [Indexed: 10/21/2023] Open
Abstract
BACKGROUND This prospective study aimed to investigate the influence of patellar position (ie, eversion, lateralization, and reduction) on medial and lateral gap measurements during total knee arthroplasty (TKA) in both cruciate-retaining (CR) and posterior-stabilized (PS) TKA designs. METHODS The present work analyzed 50 knees with primary osteoarthritis that underwent TKA between July and November 2019. Medial and lateral gaps were measured at different knee flexion angles (0°, 45°, 90°, and 120°) in 3 patellar positions after sequentially inserting CR type and PS type trial component in the same knee. RESULTS In CR TKA, medial gaps in patellar reduction showed significantly smaller gaps at 90° and 120° of knee flexion compared to those in eversion and lateralization (P < .001). Lateral gaps in patellar reduction were also significantly larger than those in eversion and lateralization (P < .001). The mediolateral gap difference in patellar reduction was significantly greater at all flexion angles compared to those in eversion and lateralization (P < .001). In PS TKA, similar patterns were observed for medial gaps, lateral gaps, and mediolateral gap differences (P < .001). CONCLUSIONS The ligament balancing with the patella everted or subluxed may lead to an overly tight medial gap and/or loose lateral gap in the knee with a closed arthrotomy, which has potential consequences for knee function in both CR and PS TKA designs. The results of this study highlight the importance of considering patellar position to ensure optimal soft-tissue balance and joint stability in TKA.
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Affiliation(s)
- Ki Tae Park
- Department of Orthopaedic Surgery, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Tae Seok Nam
- Department of Orthopedic Surgery, Sahmyook Medical Center, Seoul, Republic of Korea
| | - Dong Wook Son
- Department of Orthopaedic Surgery, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Jin Kwang Lee
- Department of Orthopaedic Surgery, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Ji Hyun Ahn
- Department of Orthopaedic Surgery, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
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Hirakawa M, Miyazaki M, Nagashima Y, Akase H, Matsuda S, Kaku N. Asymmetric Implant Design for Posterolateral Overhang of the Femoral Component in Total Knee Arthroplasty: A Retrospective Computed Tomography-Based Study. Cureus 2024; 16:e56862. [PMID: 38659568 PMCID: PMC11040276 DOI: 10.7759/cureus.56862] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/25/2024] [Indexed: 04/26/2024] Open
Abstract
Introduction During total knee arthroplasty (TKA), also referred to as total knee replacement (TKR), patients may experience pain in the posterolateral knee. One possible cause is the impingement between the popliteus tendon and the femoral components. The purpose of this study was to analyze the posterolateral overhang of the femoral component using 3D template software. Methods Preoperative CT scan images of 50 knees (11 males and 39 females) with osteoarthritis of grade 2 or lower according to the Kellgren-Lawrence classification were analyzed. The mean age of the subjects was 73.8±7.6 years (range 52-84 years). The Athena (Soft Cube Co., Ltd., Osaka, Japan) knee 3D image-matching software was used for the analysis. The positions of the two femoral components (symmetrical and asymmetrical) were simulated. In the coronal plane, the component overhang was measured between the resected lateral part of the posterior femur and its corresponding component size, and the two designs were compared in three zones (proximal, central, and distal). Results In the simulated femoral component, the asymmetric design had a significantly lower component overhang than the symmetric design in the proximal zone of the lateral posterior condyle (0.2±1.9 mm vs. 3.5±1.6 mm, p<0.01). In the proximal zone, significant overhang (>3 mm) was observed in 30 knees (60.0%) with the symmetric design, but only three knees (6.0%) had asymmetric designs (p<0.01). Conclusions The posterolateral overhang of the lateral posterior condyle occurs when a symmetrical prosthesis is used. The use of an asymmetric implant with a small, rounded proximal portion of the lateral posterior condyle improves this overhang and is expected to decrease problems such as impingement of the popliteus tendon and improve patient satisfaction.
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Affiliation(s)
| | | | - Yu Nagashima
- Department of Orthopaedic Surgery, Oita University, Yufu, JPN
| | - Hiroya Akase
- Department of Orthopaedic Surgery, Oita University, Yufu, JPN
| | - Shogo Matsuda
- Department of Orthopaedic Surgery, Oita University, Yufu, JPN
| | - Nobuhiro Kaku
- Department of Orthopaedic Surgery, Oita University, Yufu, JPN
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Liu K, Liu Y, Fan Z, Fu D. Accuracy and reproducibility of two-dimensional computed tomography-based positioning of femoral component rotational alignment in preoperative planning for total knee arthroplasty. J Orthop Surg Res 2023; 18:964. [PMID: 38098082 PMCID: PMC10722822 DOI: 10.1186/s13018-023-04466-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2023] [Accepted: 12/12/2023] [Indexed: 12/17/2023] Open
Abstract
BACKGROUND Poor rotation of the femoral component in total knee arthroplasty (TKA) can result in various postoperative complications, underscoring the critical importance of preoperative planning. PURPOSE To improve the accuracy of femoral component positioning during TKA, this study compared the accuracy and repeatability of different two-dimensional (2D) computed tomography (CT) measurement methods for measuring the posterior condylar angle (PCA) in preoperative TKA planning. METHODS A retrospective analysis was conducted on 75 patients (150 knees) who underwent bilateral lower extremity computed tomography angiography (CTA) at Fuyang People's Hospital from January 2021 to July 2021. Three different methods were used to measure the PCA based on 2D CT images (axial CT slices) and three-dimensional(3D) models (femoral models reconstructed from CT data) in this study. Method 1: Single-plane 2D CT measurement, measuring PCA in the most obvious single-plane CT slice of the surgical transepicondylar axis (sTEA); Method 2: multi-plane 2D CT measurement, identifying and locating anatomical landmarks in multiple 2D CT slices and measuring PCA; Method 3: 3D model measurement, measuring PCA in the reconstructed femur 3D model. Compare the differences in PCA measurements between the three measurement methods. A positive PCA measurement was recorded when the sTEA was externally rotated relative to the posterior condylar line (PCL). Any difference exceeding 3° between the PCA measurement in the 2D CT and the PCA reference value in the 3D model was classified as an outlier. The intraclass correlation coefficient (ICC) and Bland-Altman method were utilized to assess the intra- and inter-observer reproducibility of the three measurement methods. RESULTS The PCA measurement in the single-plane 2D CT was 1.91 ± 1.94°, with a measurement error of - 1.22 ± 1.32° and 12.7% of outlier values. In the multi-plane 2D CT, the PCA measurement was 2.96 ± 1.68°, with a measurement error of -0.15 ± 0.91° and 6.0% of outlier values. The PCA measurement in the 3D model was 3.12 ± 1.69°. The PCA measurement in single-plane 2D CT was notably smaller than that in multi-plane 2D CT and 3D models, with no significant difference between the latter two. The multi-plane 2D CT showed significantly lower measurement error and outlier values than the single-plane 2D CT. All three PCA measurement methods exhibited high reproducibility (ICC: 0.93 ~ 0.97). CONCLUSIONS Using of multi-plane 2D CT for measuring PCA in preoperative planning of TKA has high reproducibility and accuracy, with fewer outlier values. We recommend preoperative measurement of PCA using muti-plane 2D CT to improve the accuracy of positioning the femoral component rotational alignment during surgery.
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Affiliation(s)
- Kun Liu
- Fuyang People's Hospital, Anhui Medical University, Fuyang, 236000, Anhui Province, China
| | - Yuandong Liu
- Fuyang People's Hospital, Anhui Medical University, Fuyang, 236000, Anhui Province, China
| | - Zongqing Fan
- Fuyang People's Hospital, Anhui Medical University, Fuyang, 236000, Anhui Province, China.
| | - Donglin Fu
- Fuyang People's Hospital, Anhui Medical University, Fuyang, 236000, Anhui Province, China.
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Inoue A, Arai Y, Nakagawa S, Yoshihara Y, Kobayashi M, Takahashi K. The clinical results of bi-cruciate vs posterior stabilized total knee arthroplasty for flexion contracture in osteoarthritic knee. J Orthop Surg (Hong Kong) 2023; 31:10225536231190524. [PMID: 37817454 DOI: 10.1177/10225536231190524] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/12/2023] Open
Abstract
BACKGROUND The improvement of flexion contracture is important in knee arthroplasty since residual flexion contracture postoperatively is associated with decreased quality of life and patient satisfaction. In this study, we investigated the effect of bi-cruciate stabilized (BCS)-type total knee arthroplasty (TKA) as compared to posterior stabilized (PS)-type TKA on osteoarthritic primary knees with flexion contractures. METHODS 59 TKAs from January 2014 to December 2020, of which 30 were PS-type TKAs (NexGen LPS-flexⓇ; 76.3 years, BMI 27.5) and 29 BCS-type TKAs (Journey IIⓇ; 72.5 years, BMI 28.6), were performed for knee osteoarthritis with preoperative flexion contracture of 15° or greater. Full extension was obtained intraoperatively during all TKAs. Clinical outcomes, radiological evaluations, and the amount of additional distal femoral osteotomy during TKA were evaluated in a retrospective study design. RESULTS The range of motion improved in the both groups. Postoperative flexion contracture was significantly improved in the BCS group. Knee Society Score improved significantly in both groups, with no difference between the two groups. The amount of additional distal femoral osteotomy was 2.5 ± 1.3 mm for the PS group, and 1.8 ± 1.5 mm for the BCS group, showing a significant difference (p = 0.04). DISCUSSION The BCS-type TKA significantly improved preoperative flexion contracture and reduced the amount of additional distal femoral osteotomy compared to PS-type TKA. This is attributed to the anterior cam in the BCS-type TKA, which leads to a smaller amount of protrusion of the posterior femoral condyle from the posterior margin of the tibial component in the BCS-type in knee extension, as compared to the PS-type.
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Affiliation(s)
- Atsuo Inoue
- Department of Orthopaedics, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
- Department of Orthopaedic Surgery, Japanese Red Cross Kyoto Daiichi Hospital, Kyoto, Japan
| | - Yuji Arai
- Department of Sports and Para-Sports Medicine, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Shuji Nakagawa
- Department of Sports and Para-Sports Medicine, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Yasushi Yoshihara
- Department of Orthopaedic Surgery, Japanese Red Cross Kyoto Daiichi Hospital, Kyoto, Japan
| | - Masashi Kobayashi
- Department of Orthopaedic Surgery, Japanese Red Cross Kyoto Daiichi Hospital, Kyoto, Japan
- Kobayashi Orthopaedic Clinic, Kyoto, Japan
| | - Kenji Takahashi
- Department of Orthopaedics, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
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Sohail M, Kim JY, Park J, Kim HS, Lee J. Femoral coordinate system based on articular surfaces: Implications for computer-assisted knee arthroplasty. Comput Biol Med 2023; 163:107229. [PMID: 37413852 DOI: 10.1016/j.compbiomed.2023.107229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Revised: 05/28/2023] [Accepted: 07/01/2023] [Indexed: 07/08/2023]
Abstract
Osteoarthritis knee can be restored by total knee arthroplasty (TKA). Imageless TKA requires several anatomical points to construct a reference coordinate system to measure bone resections and implant placement. Inaccuracies in the definition of the coordinate system lead to malalignment and failure of the implant. While the surgical transepicondylar axis (sTEA) is a reliable anatomical axis to define the lateromedial axis for the femoral coordinate system (FCS), the presence of the collateral ligaments and deterioration of the medial sulcus (MS) make the registration of sTEA a challenging task. In this work, sTEA is assigned using the articular surfaces of the femoral condyles, independent of the lateral epicondyle (LE) and MS. A single 3D arc is marked on each condyle, which is transformed into a 2D arc to get the best-fit curve according to the profile of condyles. The turning point of each best-fit curve, when transformed back to 3D, defines an axis parallel to sTEA. The condyles-based sTEA is measured experimentally on a 3D-printed bone using an Optitrack tracking setup. Using the proposed method, the angle between the aTEA, sTEA, and Whiteside's line was (3.77, 0.55, and 92.72)°, respectively. The proposed method provides the same level of accuracy and improves the anatomical points registration efficiency, as there is no need to register the LE or MS.
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Affiliation(s)
- Muhammad Sohail
- Department of Mechanical, Robotics and Energy Engineering, Dongguk University-Seoul, 30 Pildong-ro 1-gil, Jung-gu, Seoul, 04620, Republic of Korea
| | - Jun Young Kim
- Department of Mechanical, Robotics and Energy Engineering, Dongguk University-Seoul, 30 Pildong-ro 1-gil, Jung-gu, Seoul, 04620, Republic of Korea
| | - Jaehyun Park
- Department of Mechanical, Robotics and Energy Engineering, Dongguk University-Seoul, 30 Pildong-ro 1-gil, Jung-gu, Seoul, 04620, Republic of Korea
| | - Heung Soo Kim
- Department of Mechanical, Robotics and Energy Engineering, Dongguk University-Seoul, 30 Pildong-ro 1-gil, Jung-gu, Seoul, 04620, Republic of Korea.
| | - Jaehun Lee
- Department of Mechanical, Robotics and Energy Engineering, Dongguk University-Seoul, 30 Pildong-ro 1-gil, Jung-gu, Seoul, 04620, Republic of Korea.
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Liu K, Liu X, Guan Y, Ma H, Fu D, Fan Z. Accuracy and reproducibility analysis of different reference axes for femoral prosthesis rotation alignment in TKA based on 3D CT femoral model. BMC Musculoskelet Disord 2023; 24:660. [PMID: 37596664 PMCID: PMC10439596 DOI: 10.1186/s12891-023-06781-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Accepted: 08/04/2023] [Indexed: 08/20/2023] Open
Abstract
BACKGROUND There are many reference axes to determine the rotational positioning of the femoral prosthesis in total knee arthroplasty (TKA), mainly including the surgical transepicondylar axis (sTEA), anatomical transepicondylar axis (aTEA), Whiteside line, and the posterior condylar line (PCL), etc., but there is still no definite conclusion on which is the most accurate reference axis. OBJECTIVE To explore the reproducibility of each reference axis of femoral external osteotomy based on the 3D CT femoral model, compare the deviation of the simulated femoral prosthesis rotation alignment, positioned based on each reference axis, with the gold standard sTEA, and analyze the accuracy of each reference axis. METHODS The imaging data of 120 patients with knee osteoarthritis who underwent a 3D CT examination of the knee in our hospital from June 2018 to December 2021 were retrospectively collected. The 3D model of the femur was established by Mimics software. The line relative to PCL externally rotated 3° (PCL + 3°), aTEA, and the vertical line of the Whiteside line were constructed and compared with the gold standard sTEA. Intra-observer, as well as inter-observer reproducibility analysis, was performed by the intra-group correlation coefficient (ICC) and Bland-Altman method. RESULTS The angle ∠WS, between the vertical line of Whiteside and sTEA, was 2.54 ± 2.30°, with an outlier of 54.2%; the angle ∠aTEA, between aTEA and sTEA, was 4.21 ± 1.01°, with an outlier of 99.1%; the angle ∠PCL, between PCL + 3° external rotation and sTEA, was 0.50 ± 1.06°, with the highest accuracy and an outlier of 5.8%, and the differences among all three were statistically significant, P < 0.05. The intra-observer ICC values of ∠WS, ∠aTEA, and ∠PCL were 0.975 (0.964-0.982), 0.926 (0.896-0.948), and 0.924(0.892,0.946), respectively, and the reproducibility levels were excellent; the inter-observer ICC values of ∠WS, ∠aTEA, and ∠PCL were 0.968(0.955-0.978), 0.906 (0.868-0.934) and 0.970 (0.957,0.979), respectively, with excellent reproducibility levels; Bland-Altman plots suggested that the scatter points of intra-observer and inter-observer measurement differences more than 95% were within the limits of agreement. CONCLUSION The reference axis for locating the distal femoral external rotation osteotomy based on the 3D CT femoral model has good reproducibility. The PCL is easy to operate, has the highest precision, and the lowest outliers among the reference axes is therefore recommended.
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Affiliation(s)
- Kun Liu
- Fuyang People's Hospital, Anhui Medical University, NO.501 Sanqing Road, Yingzhou District, Fuyang, 236000, Anhui Province, China
| | - Xuande Liu
- China Railway Fuyang Hospital, Fuyang, 236000, Anhui Province, China
| | - Yujun Guan
- Fuyang People's Hospital, Anhui Medical University, NO.501 Sanqing Road, Yingzhou District, Fuyang, 236000, Anhui Province, China
| | - Haotong Ma
- Fuyang People's Hospital, Anhui Medical University, NO.501 Sanqing Road, Yingzhou District, Fuyang, 236000, Anhui Province, China
| | - Donglin Fu
- Fuyang People's Hospital, Anhui Medical University, NO.501 Sanqing Road, Yingzhou District, Fuyang, 236000, Anhui Province, China.
| | - Zongqing Fan
- Fuyang People's Hospital, Anhui Medical University, NO.501 Sanqing Road, Yingzhou District, Fuyang, 236000, Anhui Province, China.
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Chen X, Ji G, Xu C, Wang F. Association Between Femoral Anteversion and Distal Femoral Morphology in Patients With Patellar Dislocation and Trochlear Dysplasia. Orthop J Sports Med 2023; 11:23259671231181937. [PMID: 37576457 PMCID: PMC10413895 DOI: 10.1177/23259671231181937] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Accepted: 03/31/2023] [Indexed: 08/15/2023] Open
Abstract
Background Increased femoral anteversion (FA) is reportedly associated with patellar dislocation (PD) and trochlear dysplasia (TD), and the increase in FA may occur at different segments of the femur. In addition, TD is associated with dysplasia of the posterior femoral condyle. Among patients with PD, whether FA is greater with or without TD remains unclear. Purpose To explore differences in FA and torsion distribution at different femoral sections among patients with PD and TD, patients with PD and no TD, and sex- and age-matched controls and to investigate the association between FA and distal femoral morphology. Study Design Cross-sectional study; Level of evidence, 3. Methods This study involved 132 knees: 44 knees with PD and TD, 44 knees with PD but no TD, and 44 control knees. FA, proximal torsion (PT), middle torsion (MT), distal torsion (DT), and distal femoral morphology were measured. Differences were investigated by 1-way analysis of variance. Pearson correlation analysis was conducted to explore the association between FA and each parameter. Results FA was significantly larger in the PD with TD group (25.4° ± 4.7°) than in the other groups (controls: 18.9° ± 5.6°; PD without TD: 19.9° ± 4.8°) (P < .01). DT was significantly larger in the PD with TD group (15.8° ± 2.9°) than in the other groups (controls: 9.0° ± 4.3°; PD without TD: 8.8° ± 3.9°) (P < .01). In all 3 groups, FA was strongly positively correlated with DT (control, PD without TD, and PD with TD, respectively: r = 0.76, 0.80, and 0.88; P < .01), strongly positively correlated with the posteromedial condylar length (r = 0.48, 0.48, and 0.70; P < .01) and negatively correlated with the posterolateral condylar length (r = -0.30, -0.35, and -0.78, respectively; P < .05). Conclusion The increased FA in knees with TD was due mainly to DT rather than PT or MT, which may provide a reference for choosing the optimal position for femoral derotation osteotomy.
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Affiliation(s)
- Xiaobo Chen
- Department of Orthopaedic Surgery, Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, China
| | - Gang Ji
- Department of Orthopaedic Surgery, Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, China
| | - Chenyue Xu
- Department of Orthopaedic Surgery, Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, China
| | - Fei Wang
- Department of Orthopaedic Surgery, Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, China
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Panicker J, Thilak J. A computed tomographic evaluation of femoral and tibial rotational reference axes in total knee arthroplasty. SICOT J 2023; 9:4. [PMID: 36705527 PMCID: PMC9878997 DOI: 10.1051/sicotj/2023002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Accepted: 01/05/2023] [Indexed: 01/28/2023] Open
Abstract
INTRODUCTION The surgical trans epicondylar axis (sTEA) is considered the gold standard for optimum rotation of the femoral component; however, no consensus exists on tibial component positioning. The objectives of this study were to determine the relationship of sTEA to various femoral and tibial reference axes in varus osteoarthritis (OA) knees and (ii) to study the intra-observer and inter-observer variability of the axis relationships. MATERIALS AND METHODS The study was done on preoperative computerised tomogram (CT) scans of 110 varus knees to assess the rotational relationships respectively of femoral side sTEA with whitesides line (WSL), posterior condylar axis (PCA), clinical trans epicondylar axis (cTEA) and on the tibial side sTEA with posterior tibial margin (PTM), anterior condylar axis (ACA), Akagi's line and line from the geometric centre of the tibial plateau to 1/3rd tibial tubercle (line GC 1/3rd TT). RESULTS On the femoral side the mean angles of sTEA with WSL, PCA, cTEA were 95.64° ± 2.85°, 1.77° ± 1.88°, 4.19° ± 0.99° respectively. On the tibial side, the mean angles of sTEA with, PTM, ACA, Akagi's line, and line GC 1/3rd TT were 1.10° ± 4.69°, 11.98° ± 4.51°, 2.43° ± 4.35°, 16.04° ± 5.93° respectively. CONCLUSION Contrary to the generalization, TEA has variable relationships. The surgical trans epicondylar axis was not at the assumed 3° of external rotation to PCA in 85% of knees, nor perpendicular to WSL in >95% of knees. Of the four tibial axes, Akagi's line was the least variable with sTEA. Furthermore, surgeons should also be aware of the multiple reference axes and the range of deviation from sTEA to optimize the rotational alignment of components.
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Affiliation(s)
- Johncy Panicker
- Amrita Institute of Medical Sciences Kochi Kerala 682041 India
| | - Jai Thilak
- Clinical Professor in Orthpaedics, Amrita Institute of Medical Sciences Kochi Kerala 682041 India,Corresponding author:
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Tsubosaka M, Muratsu H, Nakano N, Kamenaga T, Kuroda Y, Inokuchi T, Miya H, Kuroda R, Matsumoto T. Knee Stability following Posterior-Stabilized Total Knee Arthroplasty: Comparison of Medial Preserving Gap Technique and Measured Resection Technique. J Knee Surg 2023; 36:95-104. [PMID: 33992036 DOI: 10.1055/s-0041-1729968] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Novel medial preserving gap technique (MPGT) focuses on medial compartment stability and allows lateral physiological laxity. This study aimed to compare the MPGT with the measured resection technique (MRT) to determine which provides better postoperative knee stability after posterior-stabilized total knee arthroplasty (PS-TKA). Primary PS-TKA, using either MPGT (n = 65) or MRT (n = 65), was performed in 130 patients with varus knee osteoarthritis. Postoperative knee stabilities at extension and flexion were assessed using varus-valgus stress radiographs and stress epicondylar view, respectively (at 1 month, 6 months, 1 year, and 3 years postoperatively). The distance between the femoral prosthesis and polyethylene insert was measured on each medial and lateral side, defined as the medial joint opening (MJO) and lateral joint opening (LJO), respectively. Decreasing MJO or LJO translated to increasing postoperative stability. The femoral external rotation angle was compared between the two surgical techniques; postoperative knee stability was also compared between the medial and lateral compartments, as well as the surgical techniques. A significant difference was found in the femoral external rotation angle between MPGT (4.2 ± 0.2 degrees) and MRT (3.6 ± 0.1 degrees, p < 0.01). Postoperative MJOs both at extension and flexion were significantly smaller than LJOs using MPGT and MRT at all time points (p < 0.05). MJOs and LJOs at extension using MPGT were significantly smaller than those when using MRT, at 1 and 3 years postoperatively (p < 0.05). Furthermore, MJOs at flexion using MPGT were significantly smaller than those when using MRT at 6 months, 1 year, and 3 years postoperatively (p < 0.05). MPGT provided higher postoperative medial knee stability than MRT both at extension and flexion, even at 3 years after PS-TKA. This suggests that this newly developed surgical technique is a more feasible option than MRT for the preservation of postoperative medial knee stability.
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Affiliation(s)
- Masanori Tsubosaka
- Department of Orthopedic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Hirotsugu Muratsu
- Department of Orthopedic Surgery, Steel Memorial Hirohata Hospital, Himeji, Japan
| | - Naoki Nakano
- Department of Orthopedic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Tomoyuki Kamenaga
- Department of Orthopedic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Yuichi Kuroda
- Department of Orthopedic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Takao Inokuchi
- Department of Orthopedic Surgery, Steel Memorial Hirohata Hospital, Himeji, Japan
| | - Hidetoshi Miya
- Department of Orthopedic Surgery, Steel Memorial Hirohata Hospital, Himeji, Japan
| | - Ryosuke Kuroda
- Department of Orthopedic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Tomoyuki Matsumoto
- Department of Orthopedic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
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11
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Axial orientation of the femoral trochlea is superior to femoral anteversion for predicting patellar instability. Knee Surg Sports Traumatol Arthrosc 2022:10.1007/s00167-022-07259-x. [PMID: 36446909 DOI: 10.1007/s00167-022-07259-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Accepted: 11/25/2022] [Indexed: 12/05/2022]
Abstract
PURPOSE The femoral anteversion angle is considered to be the same as femoral torsion; however, the femoral anteversion angle is strongly influenced by the femoral posterior condylar morphology. It remains unclear whether the femoral anteversion angle and axial orientation of the femoral trochlea can predict patellar instability. This study aimed to redefine the femoral inherent torsion, verify whether the femoral anteversion angle reflects the femoral inherent torsion, and compare the validity and calculate the cut-off values of the femoral anteversion angle and femoral trochlear axial orientation for predicting patellar instability. METHODS Seventy-three patients with patellar instability and 73 matched controls underwent computed tomography to measure the femoral anteversion angle, femoral inherent torsion, and femoral trochlear axial orientation. Pearson's product moment correlation coefficients and linear regression were calculated to determine correlations between measurements. Receiver operating characteristic curves and nomograms were plotted to evaluate the predictive validity of the femoral anteversion angle and femoral trochlear axial orientation for patellar instability. RESULTS All measurements showed excellent intra- and inter-observer reliability. Compared with the control group, the patellar instability group had a significantly larger femoral anteversion angle (25.4 ± 6.4° vs. 20.2 ± 4.5°) and femoral inherent torsion (18.3 ± 6.7° vs. 15.8 ± 3.4°), and significantly smaller femoral trochlear axial orientation (58.1 ± 7.3° vs. 66.9 ± 5.1°). The femoral anteversion angle and femoral trochlear axial orientation had area under the receiver operating characteristic curve values of 79 and 84%, respectively, and cut-off values of 24.5° and 62.7°, respectively. The calibration curve and decision curve analysis showed that the femoral trochlear axial orientation performed better than the femoral anteversion angle in predicting patellar instability. There was a strong correlation between the femoral anteversion angle and femoral inherent torsion (r > 0.8). Linear regression analysis of the femoral inherent torsion with the femoral anteversion angle as the prediction variate showed moderate goodness-of-fit (adjusted R2 = 0.69). CONCLUSION The femoral anteversion angle moderately reflects the femoral inherent torsion. The femoral trochlear axial orientation is better than the femoral anteversion in predicting patellar instability in terms of predictive efficiency, consistency with reality, and net clinical benefit. These findings warn orthopaedists against overstating the role of the femoral anteversion angle in patellar instability, and suggest that the femoral trochlear axial orientation could aid in identifying at-risk patients and developing surgical strategies for patellar instability. LEVEL OF EVIDENCE III.
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12
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Ishibashi S, Mizu-uchi H, Kawahara S, Tsushima H, Akasaki Y, Nakashima Y. Preoperative Virtual Total Knee Arthroplasty Surgery Using a Computed Tomography-based 3-dimensional Model With Variation in Reference Points and Target Alignment to Predict Femoral Component Sizing. Arthroplast Today 2022; 17:27-35. [PMID: 36032795 PMCID: PMC9399891 DOI: 10.1016/j.artd.2022.07.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Revised: 06/20/2022] [Accepted: 07/08/2022] [Indexed: 12/04/2022] Open
Abstract
Background The purpose of this study was to investigate the size differences of 19 different femoral component placements from the standard position in total knee arthroplasty using 3-dimensional virtual surgery. Methods Three-dimensional bone models were reconstructed from the computed tomography data of 101 varus osteoarthritic knees. The distal femoral bone was cut perpendicular to the femoral mechanical axis (MA) in the coronal plane. Twenty different component placements consisting of 5 cutting directions (perpendicular to MA, 3° and 5° extension relative to MA [3°E-MA and 5°E-MA, respectively], and 3° and 5° flexion relative to MA [3°F-MA and 5°F-MA, respectively]) in the sagittal plane, 2 rotational alignments (clinical epicondylar axis [CEA] and surgical epicondylar axis [SEA]), and 2 rotational types of anterior reference guide (central [CR] and medial [MR]) were simulated. Results The mean anteroposterior dimension of femur ranged from 54.3 mm (5°F-MA, SEA, CR) to 62.5 mm (5°E-MA, CEA, MR). The largest and smallest differences of anteroposterior dimension from the standard position (3°F-MA, SEA, and CR) were 7.1 ± 1.3 mm (5°E-MA, CEA, and MR) and −1.2 ± 0.2 mm (5°F-MA, SEA, and CR), respectively. Multiple regression analysis revealed that flexion cutting direction, SEA, and CR were associated with smaller component size. Conclusions The femoral component size can be affected easily by not only cutting direction but also the reference guide type and the target alignment. Our findings could provide surgeons with clinically useful information to fine-tune for unintended loose or tight joint gaps by adjusting the component size.
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Affiliation(s)
- Shojiro Ishibashi
- Department of Orthopedic Surgery, Saiseikai Fukuoka General Hospital, Chuo-ku, Fukuoka, Japan
- Department of Orthopedic Surgery, Graduate School of Medical Sciences, Kyushu University, Higashi-ku, Fukuoka, Japan
| | - Hideki Mizu-uchi
- Department of Orthopedic Surgery, Saiseikai Fukuoka General Hospital, Chuo-ku, Fukuoka, Japan
- Department of Orthopedic Surgery, Graduate School of Medical Sciences, Kyushu University, Higashi-ku, Fukuoka, Japan
- Corresponding author. Department of Orthopedic Surgery, Saiseikai Fukuoka General Hospital, 1-3-46, Tenjin, Chuo-ku, Fukuoka 810-0001, Japan. Tel. +81 92 771 8151.
| | - Shinya Kawahara
- Department of Orthopedic Surgery, Graduate School of Medical Sciences, Kyushu University, Higashi-ku, Fukuoka, Japan
| | - Hidetoshi Tsushima
- Department of Orthopedic Surgery, Graduate School of Medical Sciences, Kyushu University, Higashi-ku, Fukuoka, Japan
| | - Yukio Akasaki
- Department of Orthopedic Surgery, Graduate School of Medical Sciences, Kyushu University, Higashi-ku, Fukuoka, Japan
| | - Yasuharu Nakashima
- Department of Orthopedic Surgery, Graduate School of Medical Sciences, Kyushu University, Higashi-ku, Fukuoka, Japan
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13
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Dobbelaere A, Müller JH, Aït-Si-Selmi T, Gousopoulos L, Saffarini M, Bonnin MP. Sagittal femoral condylar shape varies along a continuum from spherical to ovoid: a systematic review and meta-analysis. Arch Orthop Trauma Surg 2022; 143:3347-3361. [PMID: 36121475 DOI: 10.1007/s00402-022-04613-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Accepted: 09/03/2022] [Indexed: 11/27/2022]
Abstract
INTRODUCTION Considerable anatomic variations of sagittal femoral condylar shape have been reported, with a continuum between spherical (or single-radius) and ovoid (or multi-radius) condyles. The purpose of this systematic review and meta-analysis was to critically appraise and synthesise the available literature on the sagittal femoral profile. The hypothesis was that studies would reveal considerable variability among individuals, but also in their methodology to quantify sagittal profiles. METHODS This systematic review was performed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. On 10 September 2021 two authors searched for Level I to IV studies that reported on the sagittal curvature of the medial and/or lateral femoral condyles using the MEDLINE®, EMBASE® and Cochrane Library. Results were summarised by tabulating means, standard deviations and/or ranges for the reported radii-of-curvature, or ellipsoidal semi-major and semi-minor lengths of the condyles. To quantify sagittal 'ovoidicity' and asymmetry, results were stratified according to coordinate reference frame (posterior condylar axis (PCA), clinical and surgical transepicondylar axis (cTEA and sTEA), unified sagittal plane (USP), or unclear) and summarised in forest plots as standardised mean differences (SMD). RESULTS Thirty-eight articles were eligible for full text extraction, quantifying sagittal radii-of-curvature by best-fit circles (BFC), ellipsoids, polynomials, spherical or cylindrical fitting. Studies with clear definition of the measurement plane revealed that both condyles were generally ovoid, with considerably greater 'ovoidicity' at the medial condyle (SMD, 4.09) versus the lateral condyle (SMD, 3.33). In addition, distal condylar radii were greater medially when measured normal to the TEA (cTEA: SMD, 0.81; sTEA: SMD, 0.79), but greater laterally when measured in a USP (SMD, - 0.83). Posterior condylar radii were greater laterally when measured in a USP (SMD, - 0.60). CONCLUSION Studies reported considerable variability of sagittal femoral condylar radii-of-curvature, which are not incremental, but rather a continuum that ranges from spherical to ovoid. Although this variation could be accommodated by single-, dual- and multi-radii femoral components, a surgeon typically uses only one or two TKA designs. Hence, there is a risk of mismatch between the native and prosthetic sagittal profile that could result in mid-flexion ligament imbalance unless other parameters are changed. These findings support the drive towards patient-specific implants to potentially achieve accurate sagittal bone-implant fit through implant customisation. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Andreas Dobbelaere
- Centre Orthopédique Santy, Hôpital Privé Jean Mermoz, Ramsay Santé, Lyon, France
| | | | - Tarik Aït-Si-Selmi
- Centre Orthopédique Santy, Hôpital Privé Jean Mermoz, Ramsay Santé, Lyon, France
| | - Lampros Gousopoulos
- Centre Orthopédique Santy, Hôpital Privé Jean Mermoz, Ramsay Santé, Lyon, France
| | - Mo Saffarini
- ReSurg SA, Rue Saint-Jean 22, 1260, Nyon, Switzerland.
| | - Michel P Bonnin
- Centre Orthopédique Santy, Hôpital Privé Jean Mermoz, Ramsay Santé, Lyon, France
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14
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Kawahara S, Hara D, Murakami K, Hamai S, Akasaki Y, Tsushima H, Banks SA, Nakashima Y. Smaller Femoral Neck Anteversion in Varus Knees than in Healthy and Valgus Knees. Clin Anat 2022; 35:1044-1050. [PMID: 35333417 DOI: 10.1002/ca.23862] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Revised: 03/19/2022] [Accepted: 03/20/2022] [Indexed: 11/09/2022]
Abstract
INTRODUCTION It is important to investigate anatomical differences of the femur and tibia three-dimensionally between varus and valgus knees to enhance surgical approaches and better understand structural factors related to specific patterns of osteoarthritis progression. MATERIALS AND METHODS Three-dimensional femoral and tibial bone models were reconstructed from transverse computed-tomography scans in varus osteoarthritis (43 knees), valgus osteoarthritis (40 knees) and healthy (32 knees) groups. Different coordinate systems were defined in each femoral bone model ("Knee" and "Hip" Coordinate System). Femoral neck inclination, lateral bowing, anterior bowing and neck anteversion were measured and compared between Knee and Hip Coordinate Systems. Those parameters were also compared between varus, valgus and healthy groups. The tibial anterior and lateral bowing, external torsion and the fibular axis relative to the tibial mechanical axis were measured and compared between varus and valgus groups. RESULTS Femoral neck anteversion was significantly 1-2° greater in the Hip Coordinate System compared to the Knee Coordinate System. Femoral neck anteversion was significantly smaller in varus knees than in healthy or valgus knees, with average difference of approximately 5°. The knee and hip joint are often rotated externally relative to the trunk axis in patients with varus osteoarthritis, perhaps maintaining the geometric relations between pelvis and proximal femur (including peripheral hip muscles) regardless of knee deformities. The fibular axis was inclined slightly valgus and posteriorly in two groups. CONCLUSIONS The results may inform hypotheses on, and future studies of, skeletal morphologic development and factors contributing to the progression of knee osteoarthritis. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Shinya Kawahara
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, Japan.,Department of Mechanical and Aerospace Engineering, University of Florida, 318 MAE-A, 116250, Gainesville, Florida, USA
| | - Daisuke Hara
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, Japan.,Department of Mechanical and Aerospace Engineering, University of Florida, 318 MAE-A, 116250, Gainesville, Florida, USA
| | - Koji Murakami
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, Japan
| | - Satoshi Hamai
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, Japan.,Department of Mechanical and Aerospace Engineering, University of Florida, 318 MAE-A, 116250, Gainesville, Florida, USA
| | - Yukio Akasaki
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, Japan
| | - Hidetoshi Tsushima
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, Japan
| | - Scott A Banks
- Department of Mechanical and Aerospace Engineering, University of Florida, 318 MAE-A, 116250, Gainesville, Florida, USA
| | - Yasuharu Nakashima
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, Japan
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Ohmori T, Kabata T, Kajino Y, Inoue D, Ueno T, Taga T, Yamamoto T, Takagi T, Yoshitani J, Ueoka K, Yamamuro Y, Tsuchiya H. Importance of Three-Dimensional Evaluation of Surgical Transepicondylar Axis in Total Knee Arthroplasty. J Knee Surg 2022; 35:32-38. [PMID: 32512597 DOI: 10.1055/s-0040-1712087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
In total knee arthroplasty, the surgical transepicondylar axis (SEA) is one of the most reliable rotation axes for stabilizing of the patellofemoral joint. The SEA is identified with reference to the lateral epicondyle and the medial sulcus of the medial epicondyle. However, these two structures rarely appear on the same plane on computed tomography (CT), and it is necessary to take two points in separate images. Many surgeons measure the SEA on the same image (pseudo SEA) instead. We aimed to determine the difference between true SEAs and pseudo SEAs. A total of 31 normal knees and 24 varus knees were included in this study. Three-dimensional (3D) models of the femur were reconstructed from CT images, and a reconstructed plane was made using the International Society of Biomechanics coordinate system. Pseudo SEAs drawn in the plane passing through the lateral epicondyle and medial sulcus were defined as l-SEA and m-SEA, respectively. L-SEA, m-SEA, true SEA, and posterior condylar axis (PCA) were projected onto the International Society of Biomechanics coordinate plane and, "p l-SEA," "p m-SEA," "p true SEA," and "p PCA" were obtained. The true SEA angle was defined as the angle between p true SEA and p PCA. The l-SEA angle or m-SEA angle was defined as the angle between the p l-SEA or p m-SEA and p PCA, respectively. There were no statistically significant differences between true SEA angle (2.64 ± 2.01 degrees) and pseudo SEA angle (l-SEA angle: 2.74 ± 2.07 degrees, m-SEA: 2.54 ± 2.19 degrees). Conversely, 12 knees in the normal group and 2 knees in the varus group had differences of more than 1 degree (p = 0.01). Among them, 6 knees in the normal group and 0 knees in the varus group had a difference of 2 degrees or more (p = 0.03). In most cases, pseudo SEA can be substituted for true SEA.
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Affiliation(s)
- Takaaki Ohmori
- Department of Orthopedic Surgery, Graduate School of Medical Science, Kanazawa University, Kanazawa, Ishikawa, Japan
| | - Tamon Kabata
- Department of Orthopedic Surgery, Graduate School of Medical Science, Kanazawa University, Kanazawa, Ishikawa, Japan
| | - Yoshitomo Kajino
- Department of Orthopedic Surgery, Graduate School of Medical Science, Kanazawa University, Kanazawa, Ishikawa, Japan
| | - Daisuke Inoue
- Department of Orthopedic Surgery, Graduate School of Medical Science, Kanazawa University, Kanazawa, Ishikawa, Japan
| | - Takuro Ueno
- Department of Orthopedic Surgery, Graduate School of Medical Science, Kanazawa University, Kanazawa, Ishikawa, Japan
| | - Tadashi Taga
- Department of Orthopedic Surgery, Graduate School of Medical Science, Kanazawa University, Kanazawa, Ishikawa, Japan
| | - Takashi Yamamoto
- Department of Orthopedic Surgery, Graduate School of Medical Science, Kanazawa University, Kanazawa, Ishikawa, Japan
| | - Tomoharu Takagi
- Department of Orthopedic Surgery, Graduate School of Medical Science, Kanazawa University, Kanazawa, Ishikawa, Japan
| | - Junya Yoshitani
- Department of Orthopedic Surgery, Graduate School of Medical Science, Kanazawa University, Kanazawa, Ishikawa, Japan
| | - Ken Ueoka
- Department of Orthopedic Surgery, Graduate School of Medical Science, Kanazawa University, Kanazawa, Ishikawa, Japan
| | - Yuki Yamamuro
- Department of Orthopedic Surgery, Graduate School of Medical Science, Kanazawa University, Kanazawa, Ishikawa, Japan
| | - Hiroyuki Tsuchiya
- Department of Orthopedic Surgery, Graduate School of Medical Science, Kanazawa University, Kanazawa, Ishikawa, Japan
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Yang D, Zhou Y, Shao H, Deng W. Different Deformity Origins and Morphological Features in Subtypes of Valgus Knees: A Radiological Classification System. Orthop Surg 2022; 14:96-103. [PMID: 34870368 PMCID: PMC8755874 DOI: 10.1111/os.13178] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2020] [Revised: 10/14/2021] [Accepted: 10/20/2021] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE To analyze the deformity origins and distribution among valgus knees to individualize their morphological features. METHODS Radiographic images of 105 valgus knees were analyzed. Long-film radiographs and computed tomography were collected for every knee. A malalignment test was performed on standing long-film radiographs. The hip-knee-ankle angle (HKA), the anatomical lateral distal femoral angle (aLDFA), and the anatomical medial proximal tibial angle (aMPTA) were measured on long-film radiographs. The distal condylar angle and posterior condylar angle on distal femur were further measured on computed tomography scans. The tibial bone varus angle was measured on long-film radiographs as well. All the valgus knees were sorted into different subtypes according to the origins of bony deformity, and the prevalence of each subtype was reported. Finally, to examine the inter-observer reproducibility of this classification system, two observers measured the deformities and did the classification for all the 105 knees independently and then the intraclass correlation coefficient (ICC) was calculated. RESULTS Among the 105 knees, 48 knees (45.7%) had apparent deformity from the tibial plateau, and 62 knees (59.0%) had apparent deformity from the supracondylar region of the femur. Eighteen knees (17.1%) had distal condylar angle >7°, among which 11 knees had posterior condylar angle >3° simultaneously. Valgus knees had five subtypes of bone deformity origins-the supracondylar part of the femur, the distal aspect of the lateral femoral condyle, both distal and posterior aspects of the lateral femoral condyle, the tibial plateau, or the metaphyseal segment of the tibia. A valgus knee could be labeled as only one subtype, or a combination of two or more subtypes. Labeling 105 knees with origin of the most severe deformity, the prevalence of each subtype was 40.0%, 5.7%, 9.5%, 28.6%, and 16.2%, respectively. The intra-observer and inter-observer ICC of this classification system was 0.992 and 0.976, respectively. CONCLUSIONS Valgus knees can be classified into different subtypes according to deformity origins. This radiological classification system has satisfactory reproducibility. It helps surgeons better individualize morphological features of valgus knees.
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Affiliation(s)
- Dejin Yang
- Department of Orthopaedic SurgeryBeijing Jishuitan Hospital, Fourth Clinical College of Peking University, Jishuitan Orthopaedic College of Tsinghua UniversityBeijingChina
| | - Yixin Zhou
- Department of Orthopaedic SurgeryBeijing Jishuitan Hospital, Fourth Clinical College of Peking University, Jishuitan Orthopaedic College of Tsinghua UniversityBeijingChina
| | - Hongyi Shao
- Department of Orthopaedic SurgeryBeijing Jishuitan Hospital, Fourth Clinical College of Peking University, Jishuitan Orthopaedic College of Tsinghua UniversityBeijingChina
| | - Wang Deng
- Department of Orthopaedic SurgeryBeijing Jishuitan Hospital, Fourth Clinical College of Peking University, Jishuitan Orthopaedic College of Tsinghua UniversityBeijingChina
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17
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Farinelli L, Baldini M, Faragalli A, Carle F, Ulisse S, Gigante A. Surgical Epicondylar Axis of the Knee and Its Relationship to the Axial Tibia Alignment in Knee Osteoarthritis: The Concept of Proximal Twist Tibia. J Knee Surg 2021; 36:710-715. [PMID: 34952546 DOI: 10.1055/s-0041-1740998] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
The proximal tibia and distal femur are intimately linked with the biomechanics of the knee and they are to be considered in total knee arthroplasty (TKA). The aim of the present study was to evaluate the proximal tibial torsion (PTT) in relation to surgical epicondylar axis (SEA) in a healthy cohort and a pathological cohort affected by knee osteoarthritis (OA). We retrospectively analyzed computed tomography of OA knee of 59 patients before they underwent TKA and nonarthritic knee of 39 patients as control. Posterior condylar angle (PCAn), femoral tibial torsion (SEA-proximal tibial condyle [PTC] and SEA-PTT), PTT (PTC-PTT and posterior condylar axes [PCAx]-PTC), and distance between tibial tuberosity and the trochlear groove (TT-TG) were measured. No differences were found for gender, age, TT-TG, and PCAn angles. Statistically significant differences were found for all the other angles considered. Significant correlation was found between tibial torsion and SEA-PTT angles, between PCAx-PTC and SEA-PTC, between SEA-PTT and SEA-PTC, and between PCAx-PTC and SEA-PTT. All measures, except TT-TG and PCAn angles, showed high validity (area under the curve [AUC] > 75%) in associating with OA, with SEA-PTT displaying the highest validity with an AUC of 94.38%. This is the first study to find significant differences in terms of proximal tibia geometry and anatomy between nonarthritic and OA knees. From our results, we reported that OA group was characterized by a greater internal rotation of tibia with respect to SEAs compared with control group. Since the design of the study cannot evaluate a cause-effect relationship, further studies need to be performed to assess the potential implications of these anatomic differences for knee OA and arthroplasty surgeries.
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Affiliation(s)
- Luca Farinelli
- Department of Clinical and Molecular Sciences, Clinical Orthopedics, Università Politecnica delle Marche, Ancona, Italy
| | - Marco Baldini
- Department of Clinical and Molecular Sciences, Clinical Orthopedics, Università Politecnica delle Marche, Ancona, Italy
| | - Andrea Faragalli
- Centre of Epidemiology, Biostatistics and Medical Information Technology, Università Politecnica delle Marche, Ancona, Italy
| | - Flavia Carle
- Centre of Epidemiology, Biostatistics and Medical Information Technology, Università Politecnica delle Marche, Ancona, Italy
| | - Serena Ulisse
- Department of Radiological Sciences, Università Politecnica delle Marche, Ancona, Italy
| | - Antonio Gigante
- Department of Clinical and Molecular Sciences, Clinical Orthopedics, Università Politecnica delle Marche, Ancona, Italy
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18
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Kang MW, Kim YT, Lee JH, Lee JK, Kim JI. Preoperative rotational assessment of the distal femur with CT may cause femoral component malrotation in TKA. Knee 2021; 33:24-30. [PMID: 34536765 DOI: 10.1016/j.knee.2021.08.022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2020] [Revised: 03/11/2021] [Accepted: 08/25/2021] [Indexed: 02/02/2023]
Abstract
BACKGROUND Before total knee arthroplasty (TKA), rotational assessment of the distal femur can be performed using either magnetic resonance imaging (MRI) or computed tomography (CT). Until now, there has been no study comparing the two modalities regarding rotational assessment of the distal femur in the same patients. METHODS We retrospectively reviewed the preoperative CT and MRI images of 110 knees in 110 patients who underwent TKA. In the axial planes of CT and MRI scan, the posterior condylar axis (PCA), anatomical transepicondylar axis (aTEA), and perpendicular line to anteroposterior axis (pAPA) were identified; the angles between these studied lines were calculated. During TKA, the angles measured on the preoperative CT and MRI were compared with the measurements obtained in the intraoperative field. RESULTS The mean aTEA-PCA angle was 6.2 ± 1.9° with CT and 5.1 ± 1.8° with MRI. The mean pAPA-PCA angle was 4.7 ± 2.1° with CT and 3.5 ± 2.0° with MRI. The mean aTEA-PCA (1.1 ± 1.3°, p = 0.001) and pAPA-PCA (1.2 ± 1.2°, p = 0.012) angles significantly differed between CT and MRI. Intra-operatively, the mean aTEA-PCA angle was 4.7 ± 1.1° and the mean pAPA-PCA angle was 3.2 ± 0.9°. Reliability analysis between the preoperative CT/MRI and the intraoperative measurements gave kappa values of 0.72 for aTEA-PCA and 0.66 for pAPA-PCA with CT, and 0.82 for aTEA-PCA and 0.84 for pAPA-PCA with MRI. CONCLUSIONS Preoperative rotational assessment of the distal femur with CT may cause higher external rotation of femoral component in TKA.
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Affiliation(s)
- Min Wook Kang
- Department of Orthopaedic Surgery, Hallym University Kangnam Sacred Heart Hospital, 1, Singil-ro, Yeongdeungpo-gu, Seoul, South Korea.
| | - Yong Tae Kim
- Department of Orthopaedic Surgery, Hallym University Kangnam Sacred Heart Hospital, 1, Singil-ro, Yeongdeungpo-gu, Seoul, South Korea.
| | - Jong Hwa Lee
- Department of Orthopaedic Surgery, Hallym University Kangnam Sacred Heart Hospital, 1, Singil-ro, Yeongdeungpo-gu, Seoul, South Korea.
| | - Joon Kyu Lee
- Department of Orthopaedic Surgery, Konkuk University Medical Center, 120-1, Neungdong-ro, Gwangjin-gu, Seoul, South Korea.
| | - Joong Il Kim
- Department of Orthopaedic Surgery, Hallym University Kangnam Sacred Heart Hospital, 1, Singil-ro, Yeongdeungpo-gu, Seoul, South Korea.
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Cho BW, Hong HT, Koh YG, Choi J, Park KK, Kang KT. Analysis of Gender Differences in the Rotational Alignment of the Distal Femur in Kinematically Aligned and Mechanically Aligned Total Knee Arthroplasty. J Clin Med 2021; 10:jcm10163691. [PMID: 34441989 PMCID: PMC8396944 DOI: 10.3390/jcm10163691] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Revised: 08/17/2021] [Accepted: 08/19/2021] [Indexed: 11/17/2022] Open
Abstract
To compare the angle between the external rotation references of the femoral components in the axial plane by gender and lower limb alignment in Korean patients with osteoarthritis (OA). Magnetic resonance (MR) images of 1273 patients were imported into a modeling software and segmented to develop three-dimensional femoral bony and cartilaginous models. The surgical transepicondylar axis (sTEA), posterior condylar axis (PCA), the kinematically aligned axis (KAA), and anteroposterior axis were used as rotational references in the axial plane for mechanically aligned (MA) TKA. The relationship among axes were investigated. Among 1273 patients, 942 were female and 331 were male. According to lower limb alignment, the varus and valgus knee groups comprised 848 and 425 patients, respectively. All measurements, except PCA-sTEA, differed significantly between men and women; all measurements, except PCA-sTEA, did not differ significantly between the varus and valgus knee groups. In elderly Korean patients with OA, rotational alignment of the distal femur showed gender differences, but no differences were seen according to lower limb alignment. The concern for malrotation of femoral components during kinematically aligned TKA is less in Koreans than in Caucasians and relatively less in women than in men. In MA TKA, malrotation of the femoral components can be avoided by setting different rotational alignments for the genders.
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Affiliation(s)
- Byung-Woo Cho
- Department of Orthopaedic Surgery, Severance Hospital, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul 03722, Korea; (B.-W.C.); (J.C.)
| | - Hyoung-Taek Hong
- Department of Mechanical Engineering, Yonsei University, 50 Yonsei-ro, Seodaemun-gu, Seoul 03722, Korea;
| | - Yong-Gon Koh
- Joint Reconstruction Center, Department of Orthopaedic Surgery, Yonsei Sarang Hospital, 10 Hyoryeong-ro, Seocho-gu, Seoul 06698, Korea;
| | - Jeehoon Choi
- Department of Orthopaedic Surgery, Severance Hospital, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul 03722, Korea; (B.-W.C.); (J.C.)
| | - Kwan-Kyu Park
- Department of Orthopaedic Surgery, Severance Hospital, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul 03722, Korea; (B.-W.C.); (J.C.)
- Correspondence: (K.-K.P.); (K.-T.K.); Tel.: +82-2-1599-1004 (K.-K.P.); +82-2-588-1006 (K.-T.K.)
| | - Kyoung-Tak Kang
- Department of Mechanical Engineering, Yonsei University, 50 Yonsei-ro, Seodaemun-gu, Seoul 03722, Korea;
- Correspondence: (K.-K.P.); (K.-T.K.); Tel.: +82-2-1599-1004 (K.-K.P.); +82-2-588-1006 (K.-T.K.)
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Tiefenboeck S, Sesselmann S, Taylor D, Forst R, Seehaus F. Preoperative planning of total knee arthroplasty: reliability of axial alignment using a three-dimensional planning approach. Acta Radiol 2021; 63:1051-1061. [PMID: 34229468 DOI: 10.1177/02841851211029076] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Preoperative templating of total knee arthroplasty (TKA) can nowadays be performed three-dimensionally with software solutions using computed tomography (CT) datasets. Currently there is no consensus concerning the axial orientation of TKA components in three-dimensional (3D) planning. PURPOSE To assess intra-/inter-observer reliability of detection of different bony landmarks in planning axial component alignment using axial CT images and 3D reconstructions. MATERIAL AND METHODS Intra- and inter-observer reliability of determination of four predefined axial femoral and tibial axes was calculated using data from CT scans. Axes determination was performed on the axial slices and on the 3D reconstruction using preoperative planning software. In summary, 61 datasets were analyzed by one medical student (intra-observer reliability) and 15 datasets were analyzed by four different observers independently (inter-observer reliability). RESULTS For the femur, clinical epicondylar axis and posterior condylar axis showed the best reliability with an inter-observer variability of 0.7° and 0.5°, respectively. For the tibia, posterior condylar axis provided best reliability (inter-observer variability: 1.7°). Overall variability was greater for tibial than for femoral axes. Reliability of axis determination was more accurate using axial CT slices rather than 3D reconstructions. CONCLUSION The femoral clinical epicondylar axis is highly reliable. Landmarks for the tibia are not as easily identifiable as for the femur. The tibial posterior condylar axis presents the axis with highest reliability. Based on these results, clinical epicondylar axis for orientation of the femoral TKA component and posterior condylar axis for the tibial implant, both defined on axial slices can be recommended.
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Affiliation(s)
- Stefan Tiefenboeck
- Department of Orthopaedic Surgery, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Stefan Sesselmann
- Institute for Medical Engineering, Ostbayerische Technische Hochschule Amberg-Weiden, Weiden, Germany
| | - Dominic Taylor
- Department of Orthopaedic Surgery, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Raimund Forst
- Department of Orthopaedic Surgery, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Frank Seehaus
- Department of Orthopaedic Surgery, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
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Mochizuki T, Yano K, Ikari K, Okazaki K. Difference in patient-reported outcomes of various patellar component designs in total knee arthroplasty: A randomized clinical study. J Orthop Surg (Hong Kong) 2021; 29:2309499021996068. [PMID: 33629887 DOI: 10.1177/2309499021996068] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
PURPOSE This study investigated the clinical effects of different patellar components without being affected by the femoral component design in total knee arthritis (TKA) for patients with knee osteoarthritis (OA). METHODS In total, 48 patients with OA who met the criteria of the American College of Rheumatology for OA were enrolled and randomly assigned in a 1:1 ratio to two groups according to the usage of patellar component design for TKA (medialized dome type [dome group] or medialized anatomic type [anatomic group]). To evaluate the clinical outcomes for TKA, knee range of motion (ROM), pain intensity of 0-100 mm visual analog scale (pain VAS), and the Japanese Knee Osteoarthritis Measure (JKOM) score were obtained at baseline and year 1. RESULTS The difference in knee ROM, pain VAS, or total JKOM score at year 1 was not significant between the dome and anatomic groups (p = 0.398, 0.733 and 0.536, respectively). Moreover, similar results were obtained for changes in knee ROM, pain VAS, or total JKOM scores from baseline. In both groups, the pain VAS and total JKOM scores were significantly improved at year 1. CONCLUSION Both dome and anatomic groups in TKA are significantly effective for pain and function using the JKOM score. However, their efficacy did not differ, according to the JKOM score. Results of this study are rare information focusing on the patellar component design and provide one of the insights into the TKA clinical management.
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Affiliation(s)
- Takeshi Mochizuki
- Department of Orthopaedic Surgery, Kamagaya General Hospital, Chiba, Japan
| | - Koichiro Yano
- Department of Orthopaedic Surgery, Tokyo Women's Medical University, Tokyo, Japan
| | - Katsunori Ikari
- Department of Orthopaedic Surgery, Tokyo Women's Medical University, Tokyo, Japan
| | - Ken Okazaki
- Department of Orthopaedic Surgery, Tokyo Women's Medical University, Tokyo, Japan
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Zhou C, Zhang Z, Rao Z, Foster T, Bedair H, Li G. Physiological articular contact kinematics and morphological femoral condyle translations of the tibiofemoral joint. J Biomech 2021; 123:110536. [PMID: 34023755 DOI: 10.1016/j.jbiomech.2021.110536] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2021] [Revised: 05/10/2021] [Accepted: 05/11/2021] [Indexed: 10/21/2022]
Abstract
The changes of tibiofemoral articular cartilage contact locations during knee activities represent a physiological functional characteristic of the knee. However, most studies reported relative motions of the tibia and femur using morphological flexion axes. Few data have been reported on comparisons of morphological femoral condyle motions and physiological tibiofemoral cartilage contact location changes. This study compared the morphological and physiological kinematic measures of 20 knees during an in vivo weightbearing single leg lunge from full extension to 120° of flexion using a combined MRI and dual fluoroscopic imaging system (DFIS) technique. The morphological femoral condyle motion was measured using three flexion axes: trans-epicondylar axis (TEA), geometric center axis (GCA) and iso-height axis (IHA). At low flexion angles, the medial femoral condyle moved anteriorly, opposite to that of the contact points, and was accompanied with a sharp increase in external femoral condyle rotation. At 120° of flexion, the morphological measures of the lateral femoral condyle were more posteriorly positioned than those of the contact locations. The data showed that the morphological measures of femoral condyle translations and axial rotations varied with different flexion axes and did not represent the physiological articular contact kinematics. Biomechanical evaluations of the knee joint motion should include both morphological and physiological kinematics data to accurately demonstrate the functionality of the knee.
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Affiliation(s)
- Chaochao Zhou
- Orthopaedic Bioengineering Research Center, Newton-Wellesley Hospital, Newton, MA, USA; Department of Orthopaedic Surgery, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Zhenming Zhang
- Orthopaedic Bioengineering Research Center, Newton-Wellesley Hospital, Newton, MA, USA; Department of Orthopaedics, China-Japan Union Hospital of Jilin University, Changchun, Jilin, China
| | - Zhitao Rao
- Orthopaedic Bioengineering Research Center, Newton-Wellesley Hospital, Newton, MA, USA
| | - Timothy Foster
- Orthopaedic Bioengineering Research Center, Newton-Wellesley Hospital, Newton, MA, USA; Department of Orthopedic Surgery, Newton-Wellesley Hospital, Newton, MA, USA
| | - Hany Bedair
- Orthopaedic Bioengineering Research Center, Newton-Wellesley Hospital, Newton, MA, USA; Department of Orthopedic Surgery, Newton-Wellesley Hospital, Newton, MA, USA; Department of Orthopaedic Surgery, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Guoan Li
- Orthopaedic Bioengineering Research Center, Newton-Wellesley Hospital, Newton, MA, USA; Department of Orthopedic Surgery, Newton-Wellesley Hospital, Newton, MA, USA.
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23
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Cho BW, Nam JH, Koh YG, Min JH, Park KK, Kang KT. Gender-Based Quantitative Analysis of the Grand Piano Sign in Mechanically Aligned Total Knee Arthroplasty in Asians. J Clin Med 2021; 10:jcm10091969. [PMID: 34064317 PMCID: PMC8125574 DOI: 10.3390/jcm10091969] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Revised: 04/16/2021] [Accepted: 04/29/2021] [Indexed: 11/16/2022] Open
Abstract
In mechanically aligned (MA) total knee arthroplasty (TKA), the grand piano sign helps surgeons to further ensure the proper external rotation of the femoral component. The goal of this study was to determine the sex-related differences in the shape of the anterior resection surface using 3D magnetic resonance imaging (MRI) models. MRI scans were performed on 267 consecutive patients (202 women and 65 men) with osteoarthritis who underwent TKA in order to reconstruct a 3D model. Virtual anterior condylar resection was performed based on the surgical transepicondylar axis (sTEA), Whiteside's line (WSL), and flexion-extension axis (FEA). On the anterior resection surface, both lateral length (LatL) and medial length (MedL) were measured, and the ratio between the two (MedL/LatL) was calculated. The mediolateral width of the distal femur (ML) and anterior resection surface (M'L') were measured, and the ratio between the M'L' and ML (M'L'/ML) was calculated. Both the lateral deviation (LD) and the ratio between LD and ML (LD/ML) were also determined. Morphological classification of the anterior resection surface was conducted based on the presence of a definite medial peak. When based on the sTEA or WSL, the MedL/LatL of female subjects was significantly greater than that of male subjects (p < 0.001 and p < 0.05, respectively). The MedL/LatL of the FEA was consistently larger than that obtained using the sTEA or WSL. Among female subjects, the MedL/LatL of the sTEA was significantly greater than that of the WSL, although this was not the case in either the total study population or the male subjects alone. When based on the sTEA, the M'L'/ML was statistically greater in the female subjects (p < 0.01). The LD was greater in the male subjects (p < 0.01), but there was no difference between the male and female subjects when comparing the LD/ML (p = 0.93). The proportion of double- and single-peak types was not significantly different between the sexes (p = 0.196). Surgeons should be aware that the shape of the anterior resection surface may differ depending on the sex of the patient. The results of this study provide more consistent surgical outcomes as well as fundamental anatomical data for designing suitable prostheses applicable to the Korean population.
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Affiliation(s)
- Byung-Woo Cho
- Department of Orthopedic Surgery, Severance Hospital, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul 03722, Korea; (B.-W.C.); (J.-H.M.)
| | - Ji-Hoon Nam
- Department of Mechanical Engineering, Yonsei University, 50 Yonsei-ro, Seodaemun-gu, Seoul 03722, Korea;
| | - Yong-Gon Koh
- Joint Reconstruction Center, Department of Orthopaedic Surgery, Yonsei Sarang Hospital, 10 Hyoryeong-ro, Seocho-gu, Seoul 06698, Korea;
| | - Ji-Hwan Min
- Department of Orthopedic Surgery, Severance Hospital, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul 03722, Korea; (B.-W.C.); (J.-H.M.)
| | - Kwan-Kyu Park
- Department of Orthopedic Surgery, Severance Hospital, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul 03722, Korea; (B.-W.C.); (J.-H.M.)
- Correspondence: (K.-K.P.); (K.-T.K.)
| | - Kyoung-Tak Kang
- Department of Mechanical Engineering, Yonsei University, 50 Yonsei-ro, Seodaemun-gu, Seoul 03722, Korea;
- Correspondence: (K.-K.P.); (K.-T.K.)
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Park JY, Kwon HM, Cho BW, Lee WS, Yang IH, Park KK. Accuracy of 2D CT-Based Measurements of Rotational Alignment of the Femoral Component for Total Knee Arthroplasty. Yonsei Med J 2021; 62:439-445. [PMID: 33908215 PMCID: PMC8084701 DOI: 10.3349/ymj.2021.62.5.439] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Revised: 02/05/2021] [Accepted: 02/15/2021] [Indexed: 11/27/2022] Open
Abstract
PURPOSE We aimed to investigate the accuracy of two-dimensional computed tomography (2D-CT)-based methods for measuring rotational alignment of the femoral component during total knee arthroplasty in comparison to reference values for three-dimensional (3D) reconstruction. MATERIALS AND METHODS We selected the "most protruding transepicondylar axis section," "most protruding posterior condylar line section," and "distal femoral cut section" on 2D-CT images for 100 knees. We investigated posterior condylar angle (PCA) and condylar twist angle (CTA) values using three different methods on 2D-CT and compared to these values to those obtained using a 3D model. RESULTS The mean PCA and CTA values were 2.8° and 7.0° on the 3D model and 2.0° to 2.1° and 5.9° to 6.0° on 2D-CT, respectively. Errors in PCA and CTA measurement included internal rotation of 0.8° and 1.1° with the 1-plane and 2-plane methods and 0.9° and 1.0° with the assumed resection method, respectively. CONCLUSION Mean errors in PCA and CTA values measured using three different methods on 2D-CT were not significantly different. However, PCA and CTA values measured on 2D-CT were approximately 1° smaller than their 3D values. Thus, we suggest that adding 1° to the mean PCA and CTA values obtained from a single plane of 2D-CT would provide values similar to those obtained from 3D reconstruction.
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Affiliation(s)
- Jun Young Park
- Department of Orthopedic Surgery, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Hyuck Min Kwon
- Department of Orthopedic Surgery, Yong-In Severance Hospital, Yonsei University College of Medicine, Yongin, Korea
| | - Byung Woo Cho
- Department of Orthopedic Surgery, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Woo Suk Lee
- Department of Orthopedic Surgery, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Ick Hwan Yang
- Department of Orthopedic Surgery, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Kwan Kyu Park
- Department of Orthopedic Surgery, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea.
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Coronal and axial alignment relationship in Caucasian patients with osteoarthritis of the knee. Sci Rep 2021; 11:7836. [PMID: 33837279 PMCID: PMC8035173 DOI: 10.1038/s41598-021-87483-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Accepted: 03/30/2021] [Indexed: 01/26/2023] Open
Abstract
Individualized pre-operative assessment of the patterns of the lower extremity anatomy and deformities in patients undergoing total knee arthroplasty seems essential for a successful surgery. In the present study, we investigated the relationship among the coronal alignment and the rotational profile of the lower extremities in the Caucasian population with end-stage knee osteoarthritis. We conducted a prospective study of 385 knees that underwent a pre-operative three-dimensional computed tomography-based model. The lower extremity alignment was determined (mechanical tibiofemoral or hip-knee-ankle angle, supplementary angle of the femoral lateral distal angle, and proximal medial tibial angle). For each case, the femoral distal rotation (condylar twist angle), the femoral proximal version, and the tibial torsion were determined. As the coronal alignment changed from varus to valgus, the femoral external rotation increased (r = 0.217; p < 0.0005). As the coronal alignment changed from varus to valgus, the external tibial torsion increased (r = 0.248; p < 0.0005). No correlation was found between the global coronal alignment and the femoral version. The present study demonstrates a linear relationship between the coronal alignment and the rotational geometry of the distal femur. This correlation also occurs with the tibial torsion. Perhaps outcomes of total knee arthroplasty surgery might be improved by addressing these deformities as well.
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ALShammari SA, Choi KY, Koh IJ, Kim MS, In Y. Total knee arthroplasty in femoral bowing: does patient specific instrumentation have something to add? A randomized controlled trial. BMC Musculoskelet Disord 2021; 22:321. [PMID: 33794854 PMCID: PMC8017876 DOI: 10.1186/s12891-021-04198-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Accepted: 03/25/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Patient-specific instrumentation (PSI) proponents have suggested the benefits of improved component alignment and reduced outliers. In this randomized controlled trial, we attempted to assess the advantage of using PSI over conventional intermedullary (IM) guides for primary total knee arthroplasty (TKA) with bilateral severe femoral bowing (> 5°). A parallel trial design was used with 1:1 allocation. We hypothesize that PSI would support more accurate alignment of components and the lower-limb axis during TKA with severe femoral bowing in comparison with conventional IM guides. METHODS Among 336 patients undergoing bilateral TKAs due to knee osteoarthritis, 29 patients with bilateral lateral femoral bowing of more than 5° were included in this study. Every patient was assigned randomly to PSI on one side and to conventional instrumentation lateralization of the entry point of the femoral IM guide was applied on the other with a goal of neutral mechanical alignment. The assessment of coronal alignment was completed by measuring the hip-knee-ankle (HKA) angle on preoperative and postoperative long film standing radiographs. Coronal and sagittal orientations of femoral and tibial components were assessed on weight-bearing radiographs. The rotational alignment of the femoral component was evaluated using computed tomography. RESULTS The postoperative mean ± standard deviation (SD) HKA angle was varus 4.0° (± 2.7°) for conventional technique and varus 4.1° (± 3.1°) for PSI, with no differences between the two groups (p = 0.459). The component orientation showed no significant differences except with respect to the sagittal alignment of the femoral component (p = 0.001), with a PSI mean ± SD flexion of 5.8° (± 3.7°) and a conventional method mean ± SD flexion of 3.2° (± 2.5°), due to the intentional 3° flexion incorporated in the sagittal plane to prevent femoral notching in PSI planning. Computed tomography assessment for rotational alignment of the femoral components showed no difference between the two groups concerning the transepicondylar axis (p = 0.485) with a PSI mean ± SD external rotation of 1.5° (± 1.3°) and conventional mean ± SD external rotation of 1.5° (± 1.6°). CONCLUSION PSI showed no advantage over lateralization of the femoral entry for IM guidance. LEVEL OF EVIDENCE 1 TRIAL REGISTRATION: Registered on US national library of medicine ClinicalTrials.gov ( NCT02993016 ) on December 12th 2016.
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Affiliation(s)
- Sammy Abdullah ALShammari
- Department of Orthopaedic Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 222 Banpo-Daero, Seocho-Gu, Seoul, 06591, Republic of Korea
| | - Keun Young Choi
- Department of Orthopaedic Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 222 Banpo-Daero, Seocho-Gu, Seoul, 06591, Republic of Korea
| | - In Jun Koh
- Department of Orthopaedic Surgery, Eunpyeong St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Man Soo Kim
- Department of Orthopaedic Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 222 Banpo-Daero, Seocho-Gu, Seoul, 06591, Republic of Korea
| | - Yong In
- Department of Orthopaedic Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 222 Banpo-Daero, Seocho-Gu, Seoul, 06591, Republic of Korea.
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Robertson EL, Hengherr M, Amsler F, Hirschmann MT, Mathis DT. A comparison of femoral component rotation after total knee arthroplasty in Kanekasu radiographs, axial CT slices and 3D reconstructed images. Skeletal Radiol 2021; 50:1389-1397. [PMID: 33398456 PMCID: PMC8119264 DOI: 10.1007/s00256-020-03702-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2020] [Revised: 12/21/2020] [Accepted: 12/22/2020] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To compare the posterior condylar angle measured with Kanekasu radiograph and 2D-CT with the gold standard 3D-CT following primary total knee arthroplasty (TKA). METHODS Eighty-two knees with pain following TKA were included in this retrospective study. Two independent raters measured the anatomical and surgical posterior condylar angles twice on each Kanekasu radiograph and 2D-CT. These measurements were compared against the 3D-CT measurement. The intra- and interrater reliability of the Kanekasu radiograph and 2D-CT and the correlation with 3D-CT were calculated. RESULTS The intra- and interrater reliability for measurements of the anatomical posterior condyle angle for the Kanekasu radiograph and the 2D-CT were excellent for both raters (0.85-0.92). For the less experienced rater 1, the intrarater reliability was significantly better for 2D-CT than Kanekasu radiograph for measuring both the surgical (p < 0.01) and anatomical posterior condyle angles (p < 0.05). For the experienced rater 2, the intrarater reliability was significantly better for Kanekasu radiograph than 2D-CT for measurement of the surgical posterior condyle angle (p < 0.05). The correlation with 3D-CT is higher in 2D-CT than in Kanekasu radiograph (p < 0.01). While the Kanekasu radiograph predicts the 3D-CT angle with 65.9%, 2D-CT can measure the true angle with 82.9% certainty. CONCLUSION Measurements using the anatomical transepicondylar axis are easier to replicate compared to the surgical transepicondylar axis. In comparison with the gold standard 3D-CT, 2D-CT showed a significantly higher correlation with 3D-CT than the Kanekasu measurements. If 3D-CT is available, it should be preferred over 2D-CT and Kanekasu view radiograph for femoral component rotation measurements.
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Affiliation(s)
- Emma L. Robertson
- Department of Orthopaedic Surgery and Traumatology, Kantonsspital Baselland (Bruderholz, Liestal, Laufen), 4101 Bruderholz, Switzerland ,University of Basel, 4051 Basel, Switzerland
| | - Martin Hengherr
- Department of Radiology, Kantonsspital Baselland (Bruderholz, Liestal, Laufen), 4101 Bruderholz, Switzerland
| | | | - Michael T. Hirschmann
- Department of Orthopaedic Surgery and Traumatology, Kantonsspital Baselland (Bruderholz, Liestal, Laufen), 4101 Bruderholz, Switzerland ,University of Basel, 4051 Basel, Switzerland
| | - Dominic T. Mathis
- Department of Orthopaedic Surgery and Traumatology, Kantonsspital Baselland (Bruderholz, Liestal, Laufen), 4101 Bruderholz, Switzerland ,University of Basel, 4051 Basel, Switzerland
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The posterior cortical axis as an alternative reference for femoral component placement in total knee arthroplasty. J Orthop Surg Res 2020; 15:603. [PMID: 33308249 PMCID: PMC7730782 DOI: 10.1186/s13018-020-02146-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2020] [Accepted: 12/01/2020] [Indexed: 12/29/2022] Open
Abstract
Background Although several reference axes have been established for determining femoral rotational alignment during total knee arthroplasty (TKA), the most accurate axis is undetermined. This study determines the relationship between the posterior cortical axis (PCA) and the trochlear anterior line (TAL) of the femur in relation to the epicondylar axis. Methods A total of 341 patients who underwent TKA for osteoarthritis were enrolled. Patients who had undergone previous bony surgery or replacement that might have changed the femoral geometry were excluded. Finally, 336 patients (200 females and 136 males) were included in the study. The angles between the transepicondylar axis (TEA) and TAL and TEA and the femoral PCA (FPCA) were evaluated. We also assessed whether there was any significant differences in variance and gender in these two angles. Student’s t tests were used to determine the significance of coronal alignment and any gender-based differences. The variances between the TAL/TEA and FPCA/TEA angles were compared using F tests. Results The FPCA was externally rotated by 2.6° ± 3.6°, and the trochlear anterior line was internally rotated by 5.2° ± 5.5°, relative to the TEA. Gender-based differences were observed in the comparisons between anatomical references and TEA. Conclusions The FPCA is a more conservative landmark than the TAL for intraoperative or postoperative approximation of the TEA. When conventional reference axes, such as the posterior condylar axis and the anteroposterior axis, are inaccurate, surgeons can refer to this alternative reference. These findings demonstrate that the FPCA may be useful for determining the rotational alignment of the femoral component before and during TKA.
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Mahran MA, Khalifa AA, Ahmed MA, Bakr HM, Khalifa YE. Evaluating distal femoral torsion and posterior condylar line reliability for adjusting femoral component rotation in TKA, Egyptian population radiographic study. J Clin Orthop Trauma 2020; 13:99-105. [PMID: 33717884 PMCID: PMC7920017 DOI: 10.1016/j.jcot.2020.12.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Revised: 11/17/2020] [Accepted: 12/02/2020] [Indexed: 10/22/2022] Open
Abstract
BACKGROUND Femoral component rotational alignment is critical for successful TKA. The primary study objective is to measure the preoperative distal femoral torsion (DFT) of an Egyptian patient's cohort using a seated posteroanterior (PA) knee radiograph. The secondary objectives are to check the intraoperative reliability of using the posterior condylar line (PCL) as a reference for rotation and to measure postoperative component rotation using the same radiographic technique. METHODS 100 arthritic knees, 22 males, 78 females, 95 Varus and five valgus. A long anteroposterior radiograph [Hip to knee to ankle (HKA)] for coronal alignment assessment, and the anatomical posterior condylar angle (aPCA) between the anatomical transepicondylar axis (aTEA) and the PCL was measured in the seated PA knee radiographs for evaluating the DFT and component rotation. Intraoperative rotation was adjusted to 3° external rotation to the PCL. RESULTS HKA improved from a preoperative mean 170.4° ± 6.2 to a postoperative mean 178.3° ± 1.5 (p < 0.005). DFT was internal in all knees; the mean aPCA was -4.5 ± 2.4 (0° to -9°), femoral component rotation significantly changed to a mean aPCA of -3.6 ± 2.3 (0° to -7°) (p = 0.005). Acceptable intraoperative patellar tracking in 94%, and patellar subluxation needed a lateral retinacular release in 2% (two valgus knees). The preoperative DFT was not affected by sex or direction of coronal deformity; more external DFT noticed in severe varus deformity. CONCLUSIONS All keens had an internal DFT not affected by sex, or coronal deformity direction. Using PCL as a guide to adjust femoral component rotation is a valid technique in our population.
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Affiliation(s)
- Mohamed A. Mahran
- Orthopaedic and Traumatology Department, Assiut University Hospital, Assiut, Egypt
| | - Ahmed A. Khalifa
- Orthopaedic Department, Qena Faculty of Medicine and University Hospital, South Valley University, Qena, Egypt,Corresponding author. Orthopaedic and Traumatology Department, Qena University Hospital, South Valley University, Qena, Egypt.
| | | | - Hatem M. Bakr
- Orthopaedic and Traumatology Department, Assiut University Hospital, Assiut, Egypt
| | - Yaser E. Khalifa
- Orthopaedic and Traumatology Department, Assiut University Hospital, Assiut, Egypt
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Xiang BY, Wu XD, Zhou N, Li K, Xu W, Liang X, Hu N, Huang W, Qiu GX. Three-dimensional color map: a novel tool to locate the surgical transepicondylar axis. ANNALS OF TRANSLATIONAL MEDICINE 2020; 8:1401. [PMID: 33313146 PMCID: PMC7723629 DOI: 10.21037/atm-20-1887] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Background Accurate localization of the surgical transepicondylar axis (sTEA) in total knee arthroplasty (TKA), the most reliable anatomical reference for femoral rotation, has long been a challenge, primarily because it is intractable to locate the center of the sulcus of the medial epicondyle. This study aimed to introduce and verify a novel method to locate the sTEA more precisely. Methods This study included 26 adult femoral specimens and 80 adult patients with computed tomography (CT) scan data. Three dimensions (3D) models based on CT scans of the distal femurs were reconstructed with Mimics and imported into Geomagic Studio. The 3D color map method was applied to locate the sTEA. To further verify the accuracy of the method, the identified sTEA was transferred to the femoral specimens and compared with the points identified by the total station machine. We further compared the recognition rate of sTEA between 3D color map method and two-dimensional (2D) CT slices method. The repeatability of this novel method was also evaluated. Results The 3D color map method located the centers of the sulcus of the medial epicondyle and the most prominent point of the lateral epicondyle of all the femoral specimens, which were further identified and confirmed by patient-specific guide plates and total station machine on femoral specimens. The 3D color map method achieved a recognition rate of up to 96.23%, while the recognition rate of the 2D CT slices method was only 68.87%. The repeatability of this objective method was excellent. Conclusions The results of this study indicated that the 3D color map method could be used to accurately and objectively locate the sTEA, with high repeatability and recognition rate. However, the proposed novel method requires further validation in clinical applications.
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Affiliation(s)
- Bing-Yan Xiang
- Department of Orthopaedic Surgery, The Third Affiliated Hospital of Zunyi Medical University (The First People's Hospital of Zunyi), Zunyi, China.,Department of Orthopaedic Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Xiang-Dong Wu
- Department of Orthopaedic Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Nian Zhou
- Department of Orthopaedic Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Ke Li
- Department of Orthopaedic Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Wei Xu
- Department of Orthopaedic Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Xi Liang
- Department of Orthopaedic Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Ning Hu
- Department of Orthopaedic Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Wei Huang
- Department of Orthopaedic Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Gui-Xing Qiu
- Department of Orthopaedic Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
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Nam JH, Koh YG, Kim PS, Park JH, Kang KT. Effect of the presence of the articular cartilage on the femoral component rotation in total knee arthroplasty in female and varus osteoarthritis knees. J Orthop Surg Res 2020; 15:499. [PMID: 33121532 PMCID: PMC7597046 DOI: 10.1186/s13018-020-02030-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2020] [Accepted: 10/20/2020] [Indexed: 12/02/2022] Open
Abstract
Purpose Surgical techniques for total knee arthroplasty (TKA) require femoral rotational corrections that alter the position of the surface of the posterior femoral joint especially in kinematic alignment. However, preoperative planning of TKA based on computed tomography (CT), without knowing the femoral cartilage thickness, may cause post-surgery failures in femoral rotation. Therefore, this study aimed to evaluate the effects of posterior condyle cartilage thickness on rotational alignment in the femoral component. Methods Three-dimensional magnetic resonance imaging (MRI) scans were obtained for 139 male and 531 female osteoarthritis patients. The angles defined by the femoral posterior condylar axis (PCA) and the surgical transepicondylar axis (TEA) were evaluated with respect to the presence of cartilage. Additionally, these effects were evaluated with respect to patient gender and varus/valgus condition. Results In all patients, the angle between the TEA and PCA was significantly greater in the presence of cartilage than in the absence of cartilage. This result was also seen in female patients. However, there was no difference in the TEA/PCA angle in male patients based on the presence of cartilage. The TEA/PCA angle was significantly greater in the presence of cartilage than in the absence of cartilage in the female varus group. However, there were no differences in the TEA/PCA angle based on the presence of cartilage in the male varus/valgus and female valgus groups. Cartilage thickness in the posterior femoral condyle was significantly greater on the lateral side than on the medial side in all and male patients. However, there was no difference between the genders regarding cartilage thickness. Conclusion Surgical planning for TKA based on CT does not consider articular cartilage and could lead to external malrotation of the femoral implant. Therefore, the effect of the remaining posterior condylar cartilage should be considered by surgeons to prevent over-rotation of the femoral component, especially in female varus knees.
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Affiliation(s)
- Ji-Hoon Nam
- Department of Mechanical Engineering, Yonsei University, 50 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea
| | - Yong-Gon Koh
- Joint Reconstruction Center, Department of Orthopaedic Surgery, Yonsei Sarang Hospital, 10 Hyoryeong-ro, Seocho-gu, Seoul, 06698, Republic of Korea
| | - Paul Shinil Kim
- Department of Orthopaedic Surgery, The Bone Hospital, 67, Dongjak-daero, Dongjak-gu, Seoul, Republic of Korea
| | - Joon-Hee Park
- Department of Anesthesiology & Pain Medicine, Hallym University College of Medicine and Kangdong Sacred Heart Hospital, 150 Seongan-ro, Gangdong-gu, Seoul, 05355, Republic of Korea.
| | - Kyoung-Tak Kang
- Department of Mechanical Engineering, Yonsei University, 50 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea.
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Koh YG, Nam JH, Chung HS, Kim HJ, Lee HY, Kang KT. Gender differences exist in rotational anatomy of the distal femur in osteoarthritic knees using MRI. Knee Surg Sports Traumatol Arthrosc 2020; 28:2990-2997. [PMID: 31549209 DOI: 10.1007/s00167-019-05730-w] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2019] [Accepted: 09/16/2019] [Indexed: 11/28/2022]
Abstract
PURPOSE Optimal rotational alignment of the femoral component is essential for total knee arthroplasty (TKA). The femoral transepicondylar axis (TEA), Whiteside's line (WSL), and posterior condylar axis (PCA) are various intra-operative references that can be used to determine femoral rotation, and each has advantages and disadvantages. This study aimed to define the rotational anatomy of the distal femur and investigate its relationship with gender in osteoarthritic knees. METHODS Magnetic resonance imaging (MRI) was obtained from 1522 patients (1298 females and 224 males) with end-stage knee osteoarthritis prior to TKA. MRI was constructed into three-dimensional models. The angles between the TEA and WSL, WSL and PCA, and TEA and PCA were calculated for each patient. In addition, gender differences in femoral rotation were evaluated. RESULTS The PCA was 2.2° ± 1.0° internally rotated relative to the TEA. WSL was 1.2° ± 2.8° externally rotated relative to the TEA. The WSL to TEA relationship exhibited greater variability than the PCA to TEA relationship. PCA was more internally rotated and WSL was more externally rotated relative to TEA in female group than male group. Based on the standard reference rules of 3° external rotation from the PCA that has been conventionally used, 15.7% of patients showed external rotation lower 1° or greater than 5° external rotation from the PCA. In the mean external rotation of the TEA from the PCA (2.2°) from this population; however, the percentage of patients showing ± 2° from their TEA dropped to 5.1% of patients. CONCLUSION Gender difference and variability exist in distal femoral rotational anatomy. These data can be useful in consideration of femoral anatomy variability and gender difference. The same cutting angle may lead to malrotation of the femoral component. LEVEL OF EVIDENCE Consecutive patients, level III.
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Affiliation(s)
- Yong-Gon Koh
- Department of Orthopaedic Surgery, Joint Reconstruction Center, Yonsei Sarang Hospital, 10 Hyoryeong-ro, Seocho-gu, Seoul, 06698, Republic of Korea
| | - Ji-Hoon Nam
- Department of Mechanical Engineering, Yonsei University, 50 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea
| | - Hyun-Seok Chung
- Department of Orthopaedic Surgery, Joint Reconstruction Center, Yonsei Sarang Hospital, 10 Hyoryeong-ro, Seocho-gu, Seoul, 06698, Republic of Korea
| | - Hyo-Jeong Kim
- Department of Sport and Healthy Aging, Korea National Sport University, 1239 Yangjaedaero, Songpa-gu, Seoul, 05541, Republic of Korea
| | - Hwa-Yong Lee
- Department of Mechanical Engineering, Yonsei University, 50 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea
| | - Kyoung-Tak Kang
- Department of Mechanical Engineering, Yonsei University, 50 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea.
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Schafer P, Mehaidli A, Zekaj M, Padela MT, Rizvi SA, Chen C, Sayeed Z, Darwiche H. Assessing knee anatomy using Makoplasty software a case series of 99 knees. J Orthop 2020; 20:347-351. [PMID: 32684671 DOI: 10.1016/j.jor.2020.05.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Accepted: 05/31/2020] [Indexed: 11/25/2022] Open
Abstract
Background Role of MAKOplasty software in determining femoral neck version, distal-femoral resection angle, tibial axis difference, distal-femoral rotation, medial/lateral tibial slope, and tibial tubercle alignment has yet to be fully explored. Methods Preoperative CT scans and plain films of 99 patients were obtained for each patient according to predetermined MAKO-protocol by four observers. Reliability analyses (Cronbach's Alpha-test) was performed to determine agreement between raters for angle measures. Results Anatomic measurements were similar to previously published literature, and cronbachs'alpha analysis demonstrated agreement amidst all observers. Conclusion MAKOplasty software produces similar results to anatomic measurements in planning for TKA with good reproducibility.
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Affiliation(s)
- Patrick Schafer
- Department of Orthopaedic Surgery- Adult Reconstruciton Division, Detroit Medical Center, Detroit, MI, 48201, USA
| | - Ali Mehaidli
- Department of Orthopaedic Surgery- Adult Reconstruciton Division, Detroit Medical Center, Detroit, MI, 48201, USA
| | - Mark Zekaj
- Department of Orthopaedic Surgery- Adult Reconstruciton Division, Detroit Medical Center, Detroit, MI, 48201, USA
| | - Muhammad T Padela
- Department of Orthopaedic Surgery- Adult Reconstruciton Division, Detroit Medical Center, Detroit, MI, 48201, USA
| | - Syed Ahmad Rizvi
- Department of Orthopaedic Surgery- Adult Reconstruciton Division, Detroit Medical Center, Detroit, MI, 48201, USA
| | - Chaoyang Chen
- Department of Orthopaedic Surgery- Adult Reconstruciton Division, Detroit Medical Center, Detroit, MI, 48201, USA
| | - Zain Sayeed
- Department of Orthopaedic Surgery- Adult Reconstruciton Division, Detroit Medical Center, Detroit, MI, 48201, USA
| | - Hussein Darwiche
- Department of Orthopaedic Surgery- Adult Reconstruciton Division, Detroit Medical Center, Detroit, MI, 48201, USA
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Nam JH, Koh YG, Kim PS, Kang K, Kang KT. The femoral trochlear anterior line is a better alternative intra-operative reference compared to femoral anterior tangent line for femoral rotation in both genders in total knee arthroplasty. J Exp Orthop 2020; 7:43. [PMID: 32514814 PMCID: PMC7280378 DOI: 10.1186/s40634-020-00259-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Accepted: 05/29/2020] [Indexed: 11/23/2022] Open
Abstract
Purpose To determine the most reliable reference axis for the femoral component rotation in TKA patients by comparing the trochlear anterior line (TAL) and the femoral anterior tangent line (FAT). To evaluate the variability of each anatomic parameter in a Korean population. Methods Magnetic resonance images (MRIs) were taken for 500 patients (400 females and 100 males) with knee joint osteoarthritis who had Kellgren and Lawrence grade 3 and 4 prior to TKA in our institution between February 2016 and September 2017. It was investigated that whether significant differences in variance and gender exist for TAL and FAT. Results TAL and the FAT were internally rotated by 5.1° ± 3.1° and 6.8° ± 6.1°, respectively, about the Transepicondylar axis (TEA). Although no gender-related differences were found for the TAL, they were found for the FAT. The variance of the TAL with respect to the TEA was significantly smaller compared with that for the FAT and thus exhibited a more consistent distribution. In addition, such a trend was found for both genders. Conclusions The results show that the TAL is a favorable index for appropriate rotational alignment of the femoral component in TKA.
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Affiliation(s)
- Ji-Hoon Nam
- Department of Mechanical Engineering, Yonsei University, 50 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea
| | - Yong-Gon Koh
- Joint Reconstruction Center, Department of Orthopaedic Surgery, Yonsei Sarang Hospital, 10 Hyoryeong-ro, Seocho-gu, Seoul, 06698, Republic of Korea
| | - Paul Shinil Kim
- Department of Orthopaedic Surgery, The bone hospital, 67, Dongjak-daero, Dongjak-gu, Seoul, Republic of Korea
| | - Kiwon Kang
- Orthopaedic Clinic, Gaja Yonsei Hospital, A-304,7, Janggogae-ro 337 beon-gil, Seo-gu, Incheon, Republic of Korea
| | - Kyoung-Tak Kang
- Department of Mechanical Engineering, Yonsei University, 50 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea.
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Sun ML, Zhang Y, Peng Y, Fu DJ, Fan HQ, He R. Accuracy of a Novel 3D-Printed Patient-Specific Intramedullary Guide to Control Femoral Component Rotation in Total Knee Arthroplasty. Orthop Surg 2020; 12:429-441. [PMID: 32087620 PMCID: PMC7189049 DOI: 10.1111/os.12619] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2019] [Revised: 12/09/2019] [Accepted: 12/23/2019] [Indexed: 11/25/2022] Open
Abstract
Objective Total knee arthroplasty (TKA) is one of the most universal and effective means for treating terminal stage osteoarthritis (OA) of knee. Accurate intramedullary guide of femur is the basis for the distal femoral cuts. Determining the surgical transepicondylar axis (sTEA) is the key to reconstruction of the femoral rotational alignment, because the correct rotational alignment can place the femoral component in the right position, balance the flexion gap so that the inner and outer tension is equal, get stability during the flexion process of the knee, and enhance the quality of life of patients. With the development of three‐dimensional printing (3DP) technology in the medical domain, the application of patient‐specific instrumentation (PSI) in arthroplasty has become more common. The aim of this study was to evaluate the accuracy of a novel 3D‐printed patient‐specific intramedullary guide to control femoral component rotation in TKA. Methods Eighty patients (65 females and 15 males) with knee OA were included in this prospective randomized study. The patients were divided into two groups by random number table method, 40 in each group. TKA assisted by PSI (PSI group) and conventional TKA (conventional group) was performed respectively. Clinical outcomes [operation time, postoperative drainage volume, duration of drainage, Hospital for Special Surgery knee score (HSS), American Knee Society knee score (AKS)] and radiological outcomes [hip‐knee‐ankle angle (HKA), posterior condylar angle (PCA), patella transverse axis‐femoral transepicondylar axis angle (PFA), depth of intramedullary guide] were compared between and within the two groups. Results PSI group had less postoperative drainage volume but longer operation time than the conventional group (P < 0.05). The AKS and HSS scores after surgery were improved compared with those before surgery in each group (P < 0.05). However, there was no significant difference in the duration of drainage and range of motion (ROM) after surgery between the two groups. For the radiological results, the HKA and PFA were improved after surgery in both groups (P < 0.05).The postoperative PFA and PCA of the PSI group were closer to 0°, which was better than that of the conventional group (P < 0.05). The depth of intramedullary guide in the PSI group was less than the conventional group (P < 0.05). But there was no significant difference in HKA before and after surgery between the two groups as well as the preoperative PFA. Conclusion The short‐term clinical efficacy of TKA assisted by PSI was similar to the conventional TKA. Although TKA assisted by PSI spent more time during operation, it could assist in intramedullary guide and align femoral rotation more accurately.
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Affiliation(s)
- Mao-Lin Sun
- Center for Joint Surgery, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, China
| | - Ying Zhang
- Center for Joint Surgery, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, China
| | - Yang Peng
- Center for Joint Surgery, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, China
| | - De-Jie Fu
- Center for Joint Surgery, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, China
| | - Hua-Quan Fan
- Center for Joint Surgery, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, China
| | - Rui He
- Center for Joint Surgery, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, China
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Trung DT, Huy PN, Son TP, Dinh TC, Dinh TC. Anatomical Study of Femoral Condylar Index in Magnetic Resonance Imaging: Implication to Total Knee Replacement Surgery for Vietnamese People. Open Access Maced J Med Sci 2019; 7:4362-4367. [PMID: 32215095 PMCID: PMC7084021 DOI: 10.3889/oamjms.2019.836] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2019] [Revised: 11/20/2019] [Accepted: 11/21/2019] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND The femoral rotation angle is important element in total knee replacement (TKR). AIM To measure this angle, we determine through the axes: the transepicondylar axis (cTEA and sTEA), the posterior condylar axis (PCA), the anteroposterior axis (APA - Whiteside axis). METHODS Measuring the angles created by the four axes: cTEA, sTEA, PCA and APA in magnetic resonance imaging (MRI); determining the femoral rotation angle and application TKR. RESULTS the angle between APA and cTEA: 90.41° ± 3.35°, the angle between APA and sTEA: 94.47° ± 3.31°, the angle between APA and PCA: 96.40° ± 4.59°, the angle between cTEA and sTEA: 4.00° ± 1.02°, the angle between cTEA and PCA: 6.53° ± 2.55°, the angle between sTEA and PCA: 3.48° ± 1.91°. CONCLUSION The angle between sTEA and PCA is the angle that best represents the femoral rotation angle. However, in case of sTEA or PCA is difficult to identify, it can be measure via the APA or cTEA. These angles don't differ by age, gender and place of knee joint.
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Affiliation(s)
- Dung Tran Trung
- Saint Paul University Hospital, Hanoi, Vietnam.,Hanoi Medical University, Hanoi, Vietnam
| | | | | | - Thien Chu Dinh
- Institute for Research and Development, Duy Tan University, 03 Quang Trung, Danang, Vietnam
| | - Toi Chu Dinh
- Department of Human and Animal Physiology, Faculty of Biology, Hanoi National University of Education, Hanoi, Vietnam
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Jang ES, Connors-Ehlert R, LiArno S, Geller JA, Cooper HJ, Shah RP. Accuracy of Reference Axes for Femoral Component Rotation in Total Knee Arthroplasty: Computed Tomography-Based Study of 2,128 Femora. J Bone Joint Surg Am 2019; 101:e125. [PMID: 31800427 DOI: 10.2106/jbjs.19.00438] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Many reference axes are used to evaluate rotation of the femoral component during total knee arthroplasty, including the Whiteside line, surgical transepicondylar axis (sTEA), anatomical transepicondylar axis (aTEA), posterior condylar axis externally rotated 3° (PCA+3°ER), sulcus line, and femoral transverse axis (FTA). There is no consensus about which of these axes is most accurate. METHODS The Stryker Orthopaedic Modeling and Analytics (SOMA) database was used to identify 2,128 entire-femur computed tomography (CT) scans. The Whiteside line, aTEA, PCA+3°ER, sulcus line, and FTA were constructed according to published guidelines. Every axis was compared with the sTEA, which is widely regarded as the gold standard reference axis for rotation of the distal part of the femur but has low intraobserver and interobserver reliability intraoperatively. RESULTS The PCA+3°ER differed from the sTEA by a mean (and standard deviation) of 0.60° ± 1.64°; it was the most accurate but also had the highest degree of intersubject variability. The mean PCA-sTEA angle was 2.40°, close to the accepted "rule of thumb" of 3°. This value was significantly higher in women (2.64° ± 1.74°) than in men (2.18° ± 1.52°; p < 0.001). The Whiteside line differed from the sTEA by a mean of 1.90° ± 1.38°, and the sulcus line differed from the sTEA by a mean of 1.94° ± 1.49°; neither of these values varied significantly with sex or ethnicity. The FTA differed from the sTEA by a mean of 2.04° ± 1.50°. Least accurate was the aTEA, which differed from the sTEA by a mean of 2.05° ± 1.33°. The combination of 3 axes that are readily available intraoperatively (the Whiteside line, aTEA, and PCA+3°ER) differed from the sTEA by a mean of 1.80° ± 0.70°. CONCLUSIONS In the largest study of its kind, analysis of CT scans of 2,128 femora revealed that no 1 axis could serve as a marker of femoral component rotation with both high accuracy and low variability. Utilizing a combination of 3 methods (PCA+3°ER, the Whiteside or sulcus line, and aTEA) to maximize accuracy and sex and ethnic generalizability when positioning the femoral component is recommended. CLINICAL RELEVANCE A large-scale study using a CT-based biomorphometric database demonstrated that use of a combination of 3 axes (PCA+3°ER, the Whiteside or sulcus line, and aTEA) was the optimal strategy for judging femoral component rotation.
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Affiliation(s)
- Eugene S Jang
- Department of Orthopaedic Surgery, Columbia University Medical Center, New York, NY
| | | | | | - Jeffrey A Geller
- Department of Orthopaedic Surgery, Columbia University Medical Center, New York, NY
| | - H John Cooper
- Department of Orthopaedic Surgery, Columbia University Medical Center, New York, NY
| | - Roshan P Shah
- Department of Orthopaedic Surgery, Columbia University Medical Center, New York, NY
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Wuertele N, Beckmann J, Meier M, Huth J, Fitz W. Posterior condylar resections in total knee arthroplasty: current standard instruments do not restore femoral condylar anatomy. Arch Orthop Trauma Surg 2019; 139:1141-1147. [PMID: 31209615 DOI: 10.1007/s00402-019-03221-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2019] [Indexed: 12/14/2022]
Abstract
INTRODUCTION Correct femoral rotational alignment in total knee arthroplasty (TKA) is important for femoropatellar knee kinematics as well as for the overall clinical success. The goal of the present study was to evaluate how accurately standard instruments of various manufacturers with specific rotational settings in posterior referencing restore the posterior femoral condylar anatomy and allow a rotational alignment which matches a particular anatomic rotational landmark on CT. METHODS The anatomical transepicondylar axis (aTEA) and the posterior condylar line (PCL) were identified and the angle formed by these two axes was measured on 100 consecutive CT scans of knees. A virtual posterior condylar resection was performed relative to the aTEA for femoral sizers of various manufacturers in different external rotations ranging from 3° to 7°. The resections of medial and lateral posterior condyle were calculated as well as the condylar twist angle (CTA) between PCL and aTEA. RESULTS The posterior condylar resection varied between 9 mm and 14 mm on the medial side and between 4 mm and 10.5 mm on the lateral side. The mean CTA was 5.5° of internal rotation (SD ± 1.9°). External femoral rotation resulted in increased resection of the medial posterior condyle and decreased resection of the lateral posterior condyle. CONCLUSION Femoral sizers using a posterior referencing technique increase, with rising external rotation, medial posterior condylar resection to an extent that may exceed the implant thickness in the majority of systems. Surgeons should be aware that current standard instruments do not restore the anatomy of the posterior medial and lateral condyle and do not align the femoral component parallel to the aTEA, which may result in internal rotation of a symmetric femoral component.
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Affiliation(s)
- Nina Wuertele
- Klinikum Stuttgart-Olgahospital, Kriegsbergstr. 62, 70174, Stuttgart, Germany
| | | | - Malin Meier
- Sportklinik Stuttgart Taubenheimstr. 8, 70372, Stuttgart, Germany
| | - Jochen Huth
- Sportklinik Stuttgart Taubenheimstr. 8, 70372, Stuttgart, Germany
| | - Wolfgang Fitz
- Harvard Medical School Brigham and Women'S Hospital, 75 Francis Street, Boston, MA, 02115, USA
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Ueyama H, Minoda Y, Sugama R, Ohta Y, Yamamura K, Nakamura S, Takemura S, Nakamura H. An accelerometer-based portable navigation system improved prosthetic alignment after total knee arthroplasty in 3D measurements. Knee Surg Sports Traumatol Arthrosc 2019; 27:1580-1586. [PMID: 30066018 DOI: 10.1007/s00167-018-5082-4] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2018] [Accepted: 07/27/2018] [Indexed: 11/29/2022]
Abstract
PURPOSE This study aimed to compare prosthetic alignment using three-dimensional (3D) measurements following total knee arthroplasty (TKA) performed using an accelerometer-based portable navigation system (KneeAlign2) versus the conventional technique. METHODS A total of 159 patients who had primary osteoarthritis of the knee with varus deformity underwent TKA. The KneeAlign2 system was used for distal femoral resection and tibial resection in 78 knees, and the conventional instrumentation (intramedullary for the femur and extramedullary for the tibia) was used in 81 knees. 3D computed tomography (CT) scans of the whole leg were taken after TKA. Femoral and tibial prosthetic alignments in the coronal, sagittal, and axial planes were measured using computer software. The operation time and estimated blood loss were calculated. Deep venous thrombosis (DVT) and pulmonary embolism (PE) were evaluated using the contrast-enhanced multi-detector row CT at 1 week after TKA. RESULTS In the femoral coronal plane, the mean and standard deviation of prosthetic alignment from neutral alignment were 1.2° [95% confidence interval (CI) 1.0°-1.4°) in the navigation group and 1.6° (95% CI 1.3°-2.0°) in the conventional group (p = 0.03). The femoral component outliers (> 3° away from the goal alignment) using the navigation system and the conventional technique were 3 and 15%, respectively, in the coronal plane (p < 0.01), and 15 and 43%, respectively, in the sagittal plane (p < 0.01). The outliers in tibial coronal and tibial sagittal planes were not statistically different between the two groups. There were no statistically significant differences between the two groups in operation time, blood loss, DVT, and PE. CONCLUSION Using an accelerometer-based portable navigation system decreased the outliers of prosthetic alignment in femoral coronal and sagittal planes, and did not increase the complications such as operation time, blood loss, DVT, and PE. To our knowledge, this study is the first to investigate the usefulness of an accelerometer-based portable navigation system using the validated 3D measurement. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Hideki Ueyama
- Department of Orthopedic Surgery, Osaka City University Graduate School of Medicine, 1-4-3 Asahimachi, Abeno ward, Osaka, 545-8585, Japan.
| | - Yukihide Minoda
- Department of Orthopedic Surgery, Osaka City University Graduate School of Medicine, 1-4-3 Asahimachi, Abeno ward, Osaka, 545-8585, Japan
| | - Ryo Sugama
- Department of Orthopedic Surgery, Osaka City University Graduate School of Medicine, 1-4-3 Asahimachi, Abeno ward, Osaka, 545-8585, Japan
| | - Yoichi Ohta
- Department of Orthopedic Surgery, Osaka City University Graduate School of Medicine, 1-4-3 Asahimachi, Abeno ward, Osaka, 545-8585, Japan
| | - Kazumasa Yamamura
- Department of Orthopedic Surgery, Osaka City University Graduate School of Medicine, 1-4-3 Asahimachi, Abeno ward, Osaka, 545-8585, Japan
| | - Suguru Nakamura
- Department of Orthopedic Surgery, Osaka City University Graduate School of Medicine, 1-4-3 Asahimachi, Abeno ward, Osaka, 545-8585, Japan
| | - Susumu Takemura
- Department of Orthopedic Surgery, Osaka City University Graduate School of Medicine, 1-4-3 Asahimachi, Abeno ward, Osaka, 545-8585, Japan
| | - Hiroaki Nakamura
- Department of Orthopedic Surgery, Osaka City University Graduate School of Medicine, 1-4-3 Asahimachi, Abeno ward, Osaka, 545-8585, Japan
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Hayasaka S, Newman C, Walter WL, Talbot S. Coronal tibial alignment is linked to femoral rotational asymmetry: Implications for total knee arthroplasty surgery. Knee 2019; 26:435-443. [PMID: 30745220 DOI: 10.1016/j.knee.2019.01.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2018] [Revised: 12/01/2018] [Accepted: 01/08/2019] [Indexed: 02/02/2023]
Abstract
BACKGROUND Femoral rotational asymmetry (FRA) is the difference in rotational alignment between the trochlear groove and posterior condyles. We hypothesize that FRA increases as the tibial plateau becomes more varus due to internal rotation of the posterior condyles and external rotation of the trochlear groove to ensure a vertical trochlear groove at 90o knee flexion. METHODS Seventy lower limb Computed Tomography (CT) scans were reviewed by two examiners. Comparisons were made between both the sulcus line (SL) and posterior condylar line (PCL) relative to the surgical epicondylar axis (SEA). Femoral and tibial coronal alignment were measured on CT scanograms and 3D reconstructions. Correlation analysis was performed to identify associations between FRA, SL and PCL and the coronal alignment of the tibia and femur. RESULTS The mean FRA was +2.9° (SL externally rotated to PCL) (-2.4° to +7.7°, SD 2.2o). FRA greater than four degrees occurred in (17/70) 24% of knees. A statistically significant correlation was found between the degree of FRA and proximal tibial varus (MPTA) (R2 = 0.67, p < 0.001). Furthermore, there were significant correlations between the SL and the MPTA (p < 0.001, R2 = 0.77) and the PCL and the MPTA (p < 0.001, R2 = -0.41). CONCLUSION Native femora are frequently rotationally asymmetrical. As the tibial plateau becomes increasingly varus there is an increase in external rotation of the SL and internal rotation of the PCL. The effect is to maintain a more vertical trochlear groove during flexion in the presence of a varus tibia.
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Affiliation(s)
- Shunsuke Hayasaka
- Department of Orthopaedic Surgery, Western Health, 160 Gordon Street, Footscray, Melbourne 3011, Australia.
| | - Chris Newman
- Department of Orthopaedic Surgery, Western Health, 160 Gordon Street, Footscray, Melbourne 3011, Australia
| | - William L Walter
- The University of Sydney & Northern Local Area Health District (Royal North Shore Hospital), Reserve Road, St Leonards NSW 2065, Australia
| | - Simon Talbot
- Department of Orthopaedic Surgery, Western Health, 160 Gordon Street, Footscray, Melbourne 3011, Australia; Warringal Private Hospital, 216 Burgundy Street, Heidelberg, Melbourne 3084, Australia
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Conti MS, Kleeblad LJ, Jones CW, Pearle AD, Sculco PK. Distal Femoral Rotation is not Associated With Preoperative Proximal Tibial Varus Angle in Patients With Isolated Medial Compartment Osteoarthritis. J Arthroplasty 2019; 34:281-285. [PMID: 30377013 DOI: 10.1016/j.arth.2018.09.080] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2018] [Revised: 09/20/2018] [Accepted: 09/20/2018] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Prior studies have found that greater proximal tibial varus was associated with increased external femoral rotation at time of total knee arthroplasty. These works suggest that measuring the tibial plateau-tibial shaft (TPTS) angle on preoperative weight-bearing long leg radiographs could predict significant variations in the posterior condylar angle. METHODS A minimum of 68 patients were needed to reach 80% power. Patients were included if they had primary medial compartment osteoarthritis and excluded if they had a valgus mechanical axis. The clinical posterior condylar angle (cPCA) was defined as the angle between the anatomic transepicondylar axis and posterior condylar line. Correlation analyses were performed to test for any relationship between the TPTS and cPCA. Two patient groups were created based on TPTS angle: TPTS ≤4° (mild varus) and TPTS >4° (moderate varus). Mechanical axis and rotational measurements were compared between the groups using independent t-tests. RESULTS The mean mechanical axis and TPTS angle were 6.9° and 4.8° of varus, respectively. The mean cPCA was 5.0° (standard deviation [SD], 1.4°; range, 2.4°-7.9°). No correlation was found between the TPTS angle and cPCA (P = .15). The mean cPCA in the mild varus group (n = 28 patients) was 5.2° (SD, 1.5°; range, 2.7°-7.9°), and the mean cPCA in the moderate varus group (n = 45 patients) was 4.4° (SD, 1.7°; range, 0.6°-7.5°). These groups were not statistically significantly different from each other (P = .62). CONCLUSION The present study does not support the conclusions of previous works and suggests that the amount of distal femoral rotation cannot be predicted by tibial varus alignment measured on preoperative long leg radiographs. Consequently, we believe that proximal tibial varus should not be used to preoperatively predict external rotation of the femoral component in patients with isolated medial compartment osteoarthritis.
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Affiliation(s)
- Matthew S Conti
- Adult Hip and Knee Replacement Service, Hospital for Special Surgery, New York, NY
| | - Laura J Kleeblad
- Adult Hip and Knee Replacement Service, Hospital for Special Surgery, New York, NY
| | - Christopher W Jones
- Adult Hip and Knee Replacement Service, Hospital for Special Surgery, New York, NY
| | - Andrew D Pearle
- Adult Hip and Knee Replacement Service, Hospital for Special Surgery, New York, NY
| | - Peter K Sculco
- Adult Hip and Knee Replacement Service, Hospital for Special Surgery, New York, NY
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Murgier J, Chantalat É, Li K, Chiron P, Telmon N, Huang W, Berard E, Cavaignac E. Distal femoral torsion: Differences between caucasians and asians. A multicentre computed tomography study of 515 distal femurs. Orthop Traumatol Surg Res 2018; 104:997-1001. [PMID: 30243675 DOI: 10.1016/j.otsr.2018.04.032] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2017] [Revised: 04/04/2018] [Accepted: 04/10/2018] [Indexed: 02/02/2023]
Abstract
BACKGROUND The posterior condylar angle (PCA) is formed by the posterior condylar line (PCL) and the clinical (or anatomic) transepicondylar line (TEL). The primary objective of this study was to compare the distribution of PCA values in Caucasians and Asians free of knee osteoarthritis. The secondary objectives were to assess PCA variability according to age, gender, and side. HYPOTHESIS PCA values differ between Caucasians and Asians. METHODS The study included the computed tomography scans of 515 healthy femurs, 259 from Asians in China and 256 from Caucasians in France. PCA values were determined based on four landmarks, namely, the two femoral epicondyles and the most prominent point of each condyle at the posterior aspect of the knee. The Mann-Whitney test was chosen to compare PCA values according to ethnic group, gender, and side and Spearman's correlation coefficient to assess correlations with age. Inter-observer and intra-observer variability of PCA measurements was assessed. RESULTS Mean PCA was 6.0°±2.5° (range, 0°-14°) overall, 6.4° (range, 0.31°-14.1°) in the Asians, and 5.5° (range, 0°-13.1°) in the Caucasians (p<0.0001). Chinese femurs are significantly more internally rotated. No differences in PCA values were found according to age (p=0.4307), gender (p=0.7113), or side (p=0.4304). Inter-observer and intra-observer variability was limited for each of the landmarks, indicating that PCA measurement was reliable. CONCLUSION PCA varies not only across individuals as reported previously, but also across ethnic groups. This finding further supports routine PCA measurement on imaging studies before total knee arthroplasty. LEVEL OF EVIDENCE III, comparative retrospective study.
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Affiliation(s)
- Jérôme Murgier
- CHU de Toulouse, hôpital Pierre-Paul Riquet, institut musculo squelettique, 31059 Toulouse, France
| | - Élodie Chantalat
- Laboratoire d'anatomie, faculté de médecine, 31000 Toulouse, France
| | - Ke Li
- Service de chirurgie orthopédique, Premier hôpital affilié de l'université de médecine de Chongqing, Chongqing, China
| | - Philippe Chiron
- CHU de Toulouse, hôpital Pierre-Paul Riquet, institut musculo squelettique, 31059 Toulouse, France
| | - Norbert Telmon
- UMR1027 Inserm, service d'épidémiologie, analyse en santé publique, université de Toulouse III, Centre Hospitalier Universitaire (CHU), Toulouse, France
| | - Wei Huang
- Service de chirurgie orthopédique, Premier hôpital affilié de l'université de médecine de Chongqing, Chongqing, China
| | - Emilie Berard
- UMR1027 Inserm, service d'épidémiologie, analyse en santé publique, université de Toulouse III, Centre Hospitalier Universitaire (CHU), Toulouse, France
| | - Etienne Cavaignac
- CHU de Toulouse, hôpital Pierre-Paul Riquet, institut musculo squelettique, 31059 Toulouse, France; Laboratoire AMIS, UMR 5288 CNRS, université Paul-Sabatier, 37, allée Jules-Guesdes, 31000 Toulouse, France.
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Nagai K, Muratsu H, Kanda Y, Tsubosaka M, Kamenaga T, Miya H, Matsushita T, Niikura T, Kuroda R, Matsumoto T. Intraoperative soft tissue balance using novel medial preserving gap technique in posterior-stabilized total knee arthroplasty: comparison to measured resection technique. Knee Surg Sports Traumatol Arthrosc 2018; 26:3474-3481. [PMID: 29680905 DOI: 10.1007/s00167-018-4945-z] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2017] [Accepted: 04/18/2018] [Indexed: 11/28/2022]
Abstract
PURPOSE To investigate intraoperative soft tissue balance with femoral component trial in place using a novel medial preserving gap technique, focusing on medial compartment stability and allowing lateral physiological laxity, with compared with using a measured resection technique in posterior-stabilized (PS) total knee arthroplasty (TKA). METHODS Primary PS TKA, using either medial preserving gap technique (n = 127) or measured resection technique (n = 148), was performed in 275 subjects with varus knee osteoarthritis. Intraoperative soft tissue balance with femoral component in place was assessed using Offset Repo-Tensor with 40 lbs. of joint distraction force throughout the range of motion, and medial and lateral compartment gaps (mm) were calculated. Medial and lateral joint gap changes (mm) were calculated by subtracting the medial/lateral compartment gap at 0° from the medial/lateral compartment gap at each knee flexion angle, respectively. RESULTS Medial and lateral joint gap changes in medial preserving gap technique were significantly smaller than measured resection technique respectively (mean difference between two procedures: medial; 0.9 ± 0.2 mm, lateral; 1.0 ± 0.3 mm). Medial and lateral joint gaps were significantly changed during knee flexion in measured resection technique, whereas medial and lateral joint gaps were not significantly changed during mid-to-deep knee flexion (30°-90° in medial, 30°-120° in lateral) in medial preserving gap technique. CONCLUSIONS Medial preserving gap technique provided more consistent intraoperative soft tissue balance during knee flexion than the measured resection technique, suggesting that this novel technique can be utilized to obtain a more stable joint gap in PS TKA. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Kanto Nagai
- Department of Orthopaedic Surgery, Steel Memorial Hirohata Hospital, 3-1, Yumesaki-cho, Hirohata-ku, Himeji, 671-1122, Japan.,Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Hirotsugu Muratsu
- Department of Orthopaedic Surgery, Steel Memorial Hirohata Hospital, 3-1, Yumesaki-cho, Hirohata-ku, Himeji, 671-1122, Japan.
| | - Yutaro Kanda
- Department of Orthopaedic Surgery, Steel Memorial Hirohata Hospital, 3-1, Yumesaki-cho, Hirohata-ku, Himeji, 671-1122, Japan.,Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Masanori Tsubosaka
- Department of Orthopaedic Surgery, Steel Memorial Hirohata Hospital, 3-1, Yumesaki-cho, Hirohata-ku, Himeji, 671-1122, Japan.,Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Tomoyuki Kamenaga
- Department of Orthopaedic Surgery, Steel Memorial Hirohata Hospital, 3-1, Yumesaki-cho, Hirohata-ku, Himeji, 671-1122, Japan
| | - Hidetoshi Miya
- Department of Orthopaedic Surgery, Steel Memorial Hirohata Hospital, 3-1, Yumesaki-cho, Hirohata-ku, Himeji, 671-1122, Japan
| | - Takehiko Matsushita
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Takahiro Niikura
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Ryosuke Kuroda
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Tomoyuki Matsumoto
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
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Fan A, Xu T, Li X, Li L, Fan L, Yang D, Li G. Using anatomical landmarks to calculate the normal joint line position in Chinese people: an observational study. J Orthop Surg Res 2018; 13:261. [PMID: 30340645 PMCID: PMC6194602 DOI: 10.1186/s13018-018-0963-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2018] [Accepted: 10/02/2018] [Indexed: 12/04/2022] Open
Abstract
Background Restoring the normal joint line (JL) is an important goal to achieve in total knee arthroplasty (TKA). We intended to study the veracity of several landmarks used to level the normal JL in Chinese people. Methods Two hundred fifteen standard CT scans of knee joint were included to measure the distances from landmarks to distal JL (DJL) and posterior JL (PJL), along with femoral width (FW) in order to calculate the ratios. Landmarks included adductor tubercle (AT), medial epicondyle (ME), lateral epicondyle (LE), tibial tubercle (TT), fibular head (FH) and the inferior pole of the patella (IPP). Ratios were calculated between distances and FW (e.g. FHDJL/FW). Linear regression analysis and t test were used to determine the accuracy and the differences amongst sides of the leg, genders and races. Results The average of IPPDJL/FW, TTDJL/FW, FHDJL/FW, LEDJL/FW, LEPJL/FW, MEDJL/FW, MEPJL/FW, ATDJL/FW and ATPJL/FW were 0.165, 0.295, 0.232, 0.297, 0.281, 0.327, 0.3PJL, 0.558 and 0.313, respectively. No significant difference had been found between the left and right leg. A gender difference was only found statistically on the ratio of IPP, and also, no linear correlation was observed only between IPP and FW. Most of the difference values lain in a 4-mm threshold for MEDJL (95.81%), LEDJL (94.88%), MEPJL (97.21%), LEPJL (94.88%), ATPJL (93.49%) and ATDJL (100%). Significant differences were observed amongst different races. Conclusions AT, ME and LE can be used as reliable landmarks to locate the normal JL in Chinese population intraoperatively. It is meaningful to come up with a set of ratios to different races.
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Affiliation(s)
- Aoyuan Fan
- Department of Orthopedics, Shanghai Tenth People's Hospital of Tongji University, 301 Yanchang Rd, Shanghai, 200072, China.,Tongji University School of Medicine, Shanghai, China
| | - Tianyang Xu
- Department of Orthopedics, Shanghai Tenth People's Hospital of Tongji University, 301 Yanchang Rd, Shanghai, 200072, China.,Tongji University School of Medicine, Shanghai, China
| | - Xifan Li
- Tongji University School of Medicine, Shanghai, China.,Department of Radiology, Shanghai Tenth People's Hospital of Tongji University, Shanghai, China
| | - Lei Li
- Department of Orthopedics, Shanghai Tenth People's Hospital of Tongji University, 301 Yanchang Rd, Shanghai, 200072, China.,Department of Neurosurgery, Shanghai Tenth People's Hospital of Tongji University, Shanghai, China
| | - Lin Fan
- Department of Orthopedics, Shanghai Tenth People's Hospital of Tongji University, 301 Yanchang Rd, Shanghai, 200072, China.,Tongji University School of Medicine, Shanghai, China
| | - Dong Yang
- Department of Orthopedics, Shanghai Tenth People's Hospital of Tongji University, 301 Yanchang Rd, Shanghai, 200072, China.,Tongji University School of Medicine, Shanghai, China
| | - Guodong Li
- Department of Orthopedics, Shanghai Tenth People's Hospital of Tongji University, 301 Yanchang Rd, Shanghai, 200072, China. .,Tongji University School of Medicine, Shanghai, China.
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Zhang Y, Wang X, Shao Y, Xia Q. The orientation of the surgical epicondylar axis varies in varus and non-varus knees in the coronal plane. Knee Surg Sports Traumatol Arthrosc 2018; 26:2580-2586. [PMID: 27896394 DOI: 10.1007/s00167-016-4386-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2016] [Accepted: 11/15/2016] [Indexed: 12/01/2022]
Abstract
PURPOSE To investigate the orientations of the surgical epicondylar axis (SEA) of varus and non-varus knees in the coronal plane. METHODS One-hundred and sixty-two knees from 81 Chinese patients undergoing total knee arthroplasty (TKA) were retrospectively investigated. The angle between the medial side of the femoral mechanical axis and the SEA (MA-SEA), as well as the physiological valgus angle, was measured in the coronal plane using three-dimensional reconstruction. The joint line angle (JLA) and hip-knee-ankle angle (HKAA) were measured in long-leg weight-bearing radiographs. The mean of each parameter was compared between the varus (HKAA < 177.0°) and the non-varus knees (HKAA ≥ 177.0°) using an independent t test. Linear regression was used to assess the correlation between MA-SEA with JLA and HKAA. RESULTS A total of 42 non-varus knees (6 valgus and 36 neutral knees) and 98 varus knees were measured, as 22 knees were abandoned due to unrecognizable bony landmarks. The mean MA-SEA and JLA were significantly larger in non-varus knees (both, p < 0.01). The mean physiological valgus angle was 5.9 ± 1.0° for Chinese TKA patients and was significantly larger in varus knees (p < 0.01). There was a strong positive correlation between the MA-SEA and JLA (R 2 = 0.35, p < 0.05). CONCLUSIONS There were significant differences in the orientation of the SEA between varus and non-varus knees, which was strongly correlated with the orientation of the femoral joint line. These findings will enhance the current knowledge of knee anatomy and should prove useful for coronal alignment in TKA. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Yunjie Zhang
- Department of Orthopedic, Zhongshan Hospital, Fudan University, No. 180, Rd. Fenglin, Shanghai, China
| | - Xiaofeng Wang
- Department of Orthopedic, Zhongshan Hospital, Fudan University, No. 180, Rd. Fenglin, Shanghai, China
| | - Yunchao Shao
- Department of Orthopedic, Zhongshan Hospital, Fudan University, No. 180, Rd. Fenglin, Shanghai, China.
| | - Qing Xia
- Department of Orthopedic, Zhongshan Hospital, Fudan University, No. 180, Rd. Fenglin, Shanghai, China.
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Beranger JS, Dujardin D, Taburet JF, Boisrenoult P, Steltzlen C, Beaufils P, Pujol N. Is distal femoral torsion the same in both of a patient's legs? Morphometric CT study. Orthop Traumatol Surg Res 2018; 104:481-484. [PMID: 29679683 DOI: 10.1016/j.otsr.2018.02.014] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2017] [Revised: 01/09/2018] [Accepted: 02/19/2018] [Indexed: 02/02/2023]
Abstract
INTRODUCTION The rotational position of the femoral component is a primary driver of success in total knee arthroplasty. However, distal femoral torsion (DFT) varies greatly between individuals. Measuring DFT preoperatively by CT in combination with computer-assisted surgery can significantly improve the rotational positioning of the femoral component. However, a preoperative CT scan is costly and exposes the patient to radiation. These are doubled when the patient is undergoing bilateral arthroplasty. The aim of this study was to determine the DFT in both knees of a patient undergoing bilateral arthroplasty. We hypothesized that DFT was symmetric between a patient's two knees and was independent of frontal alignment. MATERIAL AND METHODS In this retrospective study of TKA cases performed between December 2008 and March 2015, 82 patients (mean age 73years) who underwent two-stage bilateral TKA (164 knees) were included. A preoperative CT scan of each knee was performed to measure the DFT using the surgical posterior condylar angle (PCA) described by Yoshioka. Two observers performed the measurements twice each, to allow calculation of the intraclass and interclass correlation coefficients. RESULTS The mean PCA was 5.4° (±1.48) in the right knee and 5.4° (±1.45) in the left knee, with a left/right difference ranging from 0 to 2.2° (p=0.8). In the entire cohort, 84.6% of patients had a left/right difference of less than 1°. We found no significant differences in DFT in knees with large or small frontal deformity (deformity<10°, p=0.7; deformity>10°, p=0.5) or the presence of varus or valgus (p=0.9). The intraclass correlation coefficient was excellent (94%) and the interclass correlation coefficient was moderate to good (60% for left knees, 53% for right knees). DISCUSSION Based on CT scan measurements, the DFT in both knees of an arthritic patient is comparable and this measurement is reproducible. This means that a single, unilateral preoperative CT scan is sufficient for planning purposes. LEVEL OF EVIDENCE IV (retrospective cohort study).
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Affiliation(s)
- J-S Beranger
- Service d'orthopédie traumatologie, centre hospitalier de Versailles, hôpital André-Mignot, 78150 Le Chesnay, France.
| | - D Dujardin
- Service d'orthopédie traumatologie, centre hospitalier de Versailles, hôpital André-Mignot, 78150 Le Chesnay, France
| | - J-F Taburet
- Service d'orthopédie traumatologie, centre hospitalier de Versailles, hôpital André-Mignot, 78150 Le Chesnay, France
| | - P Boisrenoult
- Service d'orthopédie traumatologie, centre hospitalier de Versailles, hôpital André-Mignot, 78150 Le Chesnay, France
| | - C Steltzlen
- Service d'orthopédie traumatologie, centre hospitalier de Versailles, hôpital André-Mignot, 78150 Le Chesnay, France
| | - P Beaufils
- Service d'orthopédie traumatologie, centre hospitalier de Versailles, hôpital André-Mignot, 78150 Le Chesnay, France
| | - N Pujol
- Service d'orthopédie traumatologie, centre hospitalier de Versailles, hôpital André-Mignot, 78150 Le Chesnay, France
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47
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Aihara AY, Cardoso FN, Debiex P, Castro AM, Luzo MVM, Fernandes ARC. Femoral Component Axial Rotation in the Gap-Balancing Approach to Total Knee Arthroplasty: Measurement by Computed Tomography. J Arthroplasty 2018; 33:1222-1230.e2. [PMID: 29224991 DOI: 10.1016/j.arth.2017.10.038] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2015] [Revised: 10/04/2017] [Accepted: 10/24/2017] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Rotational malalignment of total knee arthroplasty (TKA) is a potential cause for revision surgery; therefore, it is important to have valid criteria for evaluation of normal component rotational alignment. Because computed tomography (CT) is considered the most accurate method to assess the rotational alignment of prosthetic components, the objectives in this study were define the femoral component (FC) rotation by measuring the posterior condylar angle (PCA) and the condylar twist angle (CTA) in a patient population that underwent gap-balancing TKA; determine the reliability of the FC rotation by using these measurements; evaluate the inter-relationship between the PCA and CTA; and finally evaluate the frequency and agreement in identification of the medial epicondyle sulcus (MES). METHODS AND RESULTS In this retrospective study, 2 radiologists examined 50 CT scans. Mean PCA values of -2.26° and -2.56° (internal rotation) and CTA values of -5.54° and -6.28° (internal rotation) were attained by 2 observers with a higher interobserver concordance for the PCA. Both measurements were considered to be reliable. There was moderate interobserver agreement for MES identification, with the MES present in 64% and 78% of patients, as identified by 2 observers. CONCLUSION Mean FC rotation values as evaluated by PCA were -2.26° and -2.56° and as evaluated by CTA were -5.54° and -6.28°. PCA and CTA measurement by CT is reliable; however, the use of PCA is preferable because of the higher observer concordance. PCA can be inferred by subtracting 3° or 4° from the CTA. MES was identified in 64% and 78% of patients, with only moderate interobserver agreement.
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Affiliation(s)
- André Y Aihara
- Department of Radiology, São Paulo Federal University/UNIFESP, São Paulo, Brazil; DASA Diagnostic Medicine Imaging Department, São Paulo, Brazil
| | - Fabiano N Cardoso
- Department of Radiology, São Paulo Federal University/UNIFESP, São Paulo, Brazil; DASA Diagnostic Medicine Imaging Department, São Paulo, Brazil
| | - Pedro Debiex
- Orthopaedic Department, São Paulo Federal University/UNIFESP, São Paulo, Brazil
| | - Antonio M Castro
- Orthopaedic Department, São Paulo Federal University/UNIFESP, São Paulo, Brazil
| | - Marcus V M Luzo
- Orthopaedic Department, São Paulo Federal University/UNIFESP, São Paulo, Brazil
| | - Artur R C Fernandes
- Department of Radiology, São Paulo Federal University/UNIFESP, São Paulo, Brazil
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48
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Newman CR, Walter WL, Talbot S. Femoral rotational asymmetry is a common anatomical variant. Clin Anat 2018; 31:551-559. [DOI: 10.1002/ca.23053] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2017] [Revised: 12/18/2017] [Accepted: 01/19/2018] [Indexed: 11/06/2022]
Affiliation(s)
| | | | - Simon Talbot
- Department of Orthopaedic Surgery; Western Health, Footscray; Melbourne Australia
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49
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Oshima Y, Iizawa N, Kataoka T, Majima T, Takai S. A computed-tomography-scan-based template to place the femoral component in accurate rotation with respect to the surgical epicondylar axis in total knee arthroplasty. Knee 2018; 25:195-202. [PMID: 29325834 DOI: 10.1016/j.knee.2017.11.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2017] [Revised: 10/28/2017] [Accepted: 11/23/2017] [Indexed: 02/02/2023]
Abstract
BACKGROUND Femoral rotational alignment is considered an essential factor for total knee arthroplasty because malrotation of femoral components results in poor outcomes. To obtain proper alignment, we developed a superimposable computed tomography (CT) scan-based template to intraoperatively determine the accurate surgical epicondylar axis (SEA), and evaluated the effectiveness of this CT template. METHODS In the experimental group (n=55), three serial slices of CT images, including medial and lateral epicondyles, were merged into a single image, and SEA was overlaid. SEA was traced onto an image of an assumed distal femoral resection level; this combined image was then printed out onto a transparent film as a CT template. Following a distal femoral resection in TKA, SEA was duplicated onto the femoral surface. Thereafter, the posterior condyle was resected parallel to this SEA. In the control group (n=53), posterior condyles were resected at three degrees of the external rotation from the posterior condylar line (PCL). A posterior condylar angle (PCA) between PCL of the femoral component and SEA was postoperatively evaluated. Positive values indicated external rotation of the femoral component from the SEA. RESULTS In the experimental group, PCA was 0.01°±1.61°, and three cases were considered as outliers (greater than three degrees or less than -3 degrees). Conversely, in the control group, PCA was 0.10°±2.4°, and 12 cases were considered as outliers. Consequently, dispersion of PCA data was significantly smaller in the experimental group (P=0.004). CONCLUSIONS The CT template accurately determined intraoperative SEA.
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Affiliation(s)
- Yasushi Oshima
- Department of Orthopaedic Surgery, Nippon Medical School, 1-1-5 Sendagi, Bunkyo-ku, Tokyo 113-8603, Japan.
| | - Norishige Iizawa
- Department of Orthopaedic Surgery, Nippon Medical School, 1-1-5 Sendagi, Bunkyo-ku, Tokyo 113-8603, Japan
| | - Tatsunori Kataoka
- Department of Orthopaedic Surgery, Nippon Medical School, 1-1-5 Sendagi, Bunkyo-ku, Tokyo 113-8603, Japan
| | - Tokifumi Majima
- Department of Orthopaedic Surgery, Nippon Medical School, 1-1-5 Sendagi, Bunkyo-ku, Tokyo 113-8603, Japan
| | - Shinro Takai
- Department of Orthopaedic Surgery, Nippon Medical School, 1-1-5 Sendagi, Bunkyo-ku, Tokyo 113-8603, Japan
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50
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Chmurny M, Krivanek S, Melisik M, Rovnak M, Necas L. The comparison of femoral component rotation in the total knee arthroplasty. ACTA MEDICA MARTINIANA 2017. [DOI: 10.1515/acm-2017-0014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Abstract
Introduction Background: Optimal femoral component rotation in total knee arthroplasty (TKA) is crucial to establish a balanced knee reconstruction. Unbalanced knees can lead to instability, patellofemoral problems, persistent pain, stiffness, and generally poorer outcomes including early failure. There are several methods to achieve the femoral component rotation such as balanced gap technique, measured resection technique, and bone landmarks such as transepicondylar line (TEA) and Whiteside line. The purpose of this study was to compare the balan ced gap technique with the TEA technique.
Materials and Methods: This randomised prospective study compares the femoral component rotation obtained with the use of balanced gap technique and the TEA, as well as compares the differences due to preoperative knee desaxations. The study includes 50 knees, 19 with neutral alignment, 22 with varus, and 9 with valgus desaxation. The femoral component rotation was measured postoperatively on photodocumentation taken after determining the TEA and balanced gap technique line peroperatively. These lines were compared to the posterior femoral condyles obtaining the degree of rotation. In case of transepicondylar line it is condylar twist angle (CTA) and in case of ligament balancer rotation axis it is ligament balancer angle (LBA).
Results: The statistically significant differences in femoral component rotation using the techniques mentioned above as well as differences in individual knee desaxations were observed. The average LBA was 3.42 degrees and average CTA 3.58 in neutral knees group, but in the varus knees the average CTA value was 2.27 degrees and LBA value was 1.05 degrees. The average CTA value in patients with valgus desaxation is 4.78 degrees and LBA value is 5.22 degrees. According to Tukey Post Hoc test a statistically significant difference in LBA value is between neutral and varus knees with a significance level of p = 0.000022 and the most significant difference between varus and valgus knees with a significance level of p = 0.000011.
Conclusion: The statistically significant differences in femoral component rotation using the techniques mentioned above as well as differences in individual knee desaxations were observed.
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Affiliation(s)
- M Chmurny
- Orthopedic Clinic, Jessenius Faculty of Medicine in Martin , Comenius University and University Hospital in Martin , Slovak Republic
| | - S Krivanek
- Orthopedic Clinic, Jessenius Faculty of Medicine in Martin , Comenius University and University Hospital in Martin , Slovak Republic
| | - M Melisik
- Orthopedic Clinic, Jessenius Faculty of Medicine in Martin , Comenius University and University Hospital in Martin , Slovak Republic
| | - M Rovnak
- Orthopedic Clinic, Jessenius Faculty of Medicine in Martin , Comenius University and University Hospital in Martin , Slovak Republic
| | - L. Necas
- Orthopedic Clinic, Jessenius Faculty of Medicine in Martin , Comenius University and University Hospital in Martin , Slovak Republic
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