Computed tomographic evaluation of femoral component rotation in total knee arthroplasty

Vaidya, Shrinand V; Gadhiya, Rajesh M; Bagaria, Vaibhav; Ranawat, Amar S.; Ranawat, Chitranjan S.

doi:10.4103/0019-5413.106898

Cited by 10 publications

(11 citation statements)

References 33 publications

(21 reference statements)

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“…Despite the simplicity and reproducibility of this method, it may lead to considerable rotational malalignment due to interindividual variations in anatomy (Victor, 2009;Talbot et al, 2017Talbot et al, , 2015. These individual variations have been shown in knees with coexistent distortion of the posterior condylar anatomy, coronal plane varus/valgus knees, morphological and or/disease-related changes, racial and geographical variations and sex, possibly due to individualized body frame (Yoshioka et al, 1987;Poilvache et al, 1996;Griffin et al, 1998;Nagamine et al, 1998;Olcott and Scott, 2000;Akagi et al, 2001;Barrack et al, 2001;Yoshino et al, 2001;Yip et al, 2004;Mullaji et al, 2009;Victor et al, 2009;Victor, 2009;Yue et al, 2011;Mahfouz et al, 2012;Zhang et al, 2012;Vaidya et al, 2013;Daines and Dennis, 2014;Kobayashi et al, 2014;Moghtadaei et al, 2015;Pun et al, 2015;Zhang et al, 2016).…”

Section: Introductionmentioning

confidence: 99%

Femoral rotational asymmetry is a common anatomical variant

2018

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The sulcus line (SL) is a three-dimensional landmark that corrects for individual variation in the coronal alignment of the trochlear groove in contrast to the traditional Whiteside's line (WL). Femoral rotational asymmetry (FRA) is an anatomical variation in which the posterior condyles and trochlear groove are not perpendicular to each other. This study aims to measure the SL and assess its reliability relative to WL, in addition to measuring and classifying the FRA. A retrospective analysis of a series of 191 CT scans of nonarthritic knees was performed. Measurements were taken of rotational landmarks in three-dimensional reconstructions. The variability and outlier rate of SL was less than WL (P < 0.05), however, it was also greater than the posterior condylar line (PC) (P < 0.05). Averaging the PC + 3° and the SL did not change the rate of femoral malrotation relative to the surgical epicondylar axis (SEA) (P > 0.05), however it decreased the rate of change of the rotational alignment of the trochlear groove between the native knee and the prosthetic knee from 31% to 5% (P < 0.05). FRA was classified and was >5° in 56/191 (29%) of cases. The SL technique is more accurate than WL for determining the rotational alignment of the trochlear groove. Nonarthritic femora have a high rate of rotational asymmetry. Identifying and classifying FRA in individual cases allows the femoral component to be inserted in a position which gives the best possible match to both the native posterior condyles and trochlear groove. Clin. Anat. 31:551-559, 2018. © 2018 Wiley Periodicals, Inc.

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Section: Introductionmentioning

confidence: 99%

Femoral rotational asymmetry is a common anatomical variant

2018

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“…Unbalanced knees can lead to instability, patellofemoral problems, persistent pain, stiffness, and generally poorer outcomes including early failure. 23 Although the desired positions and guiding landmarks for placement of the femoral and tibial components in the coronal and sagittal planes have been well described, rotational positioning of the components can still be problematic. 24,25,26 Performing a TKA requires the accurate execution of key bone cuts in the correct orientation to the appropriate axes.…”

Section: Discussionmentioning

confidence: 99%

“…11,31 However, recent biomechanical analyses using instant centers of motion analysis have suggested that the TEA parallels the primary center of rotation of the knee joint but not the posterior condylar axis. 23 The fixed axis that closely approximate the epicondylar axis reported is the TEA has currently attracted attention as an ideal rotational reference that provides functional kinematics (31 Doro LC). Furthermore, several authors also reported that the TEA most consistently recreates a balanced flexion gap.…”

Section: Discussionmentioning

confidence: 99%

Identifying the Rotational Axes of Distal Femur in South Andhra Population of India Using Image Tool Software

P¹,

K²,

Ravichandran³

et al. 2015

jebmh

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AIM: To study the normal relationship of the anteroposterior (APA), transepicondylar (TEA) and posterior condylar (PCA) axis of normal cadaveric femoral bones using digital technology and special computer program. MATERIAL AND METHOD: The study comprised of 196 dry adult femora from 98 right and 98 left sides irrespective of sex and age belonging to Andhra Pradesh population of India. The bone collections were obtained from the Anatomy department, Narayana medical college, Nellore, India. The femurs were kept in normal anatomical position on OB. The photographs were taken from the distal end of all the femurs placing the camera lens 10cm constantly away from it with a digital camera. Using the reference points, angle between APA-TEA, APA-PCA and TEA-PCA were identified. The statistical significance of difference between the right and left groups was evaluated by using Student paired t-test. Data were presented as mean±SD. P-value less than 0.05 were considered statistically significant. RESULTS: The relationship of the angle between the APA-TEA, APA-PCA and TEA-PCA were observed. The angle of AP-TE, AP-PC and TE-PC was 94.84±3.43°, 87.64±1.62° and 6.84±2.71° respectively on right side. On the left side, the angle of AP-TE, AP-PC and TE-PC was 92.36±4.06°, 93.61±2.54° and 3.19±0.99° respectively. CONCLUSION: The normal femoral rotational alignment from cadaveric bone study using computer aided software can be helpful to the surgeon in selecting appropriate reference axis in any particular knee surgeries. In this regard the present data can be taken into consideration for the femoral rotational alignment during any intraoperative surgeries of knee and in total knee arthroplasty.

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“…Balancing was done first in extension using spacer blocks. For creation of a rectangular flexion space, posterior condyle cut parallel to tibial condyle or the “gap balancing” technique was used, the efficacy of which has been published by the lead author 10. This is a modification of the original gap-balancing technique.…”

Section: Methodsmentioning

confidence: 99%

What have we learned from 100% success of press fit condylar rotating platform posterior stabilized knees?

Vaidya

Virani

Phunde

et al. 2016

IJOO

Self Cite

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Background:Total joint arthroplasties of the hip and knee represent a remarkable feat of modern medicine in terms of reducing pain and restoring function to millions of patients afflicted with severe arthritis. Oftentimes, the performance and longevity of new implants and devices are based on limited data. This is the first study by a non-designer on the press fit condylar rotating platform posterior stabilized (PFC-RP-PS) design with 100’ success. This has a relevance, vis-á -vis bias that one may have in terms of reproducibility of technique and funding from the manufacturer. We associate our excellent mid-term results to intra operative technical aspects and stringent intra operative exclusion criteria.Materials and Methods:Our study includes a cohort of 121 selected knees operated between January 2003 and October 2010. We used cemented, posterior stabilized (PS), mobile bearing (MB), and RP prosthesis from the same manufacturer in all these 121 knees. The patients were evaluated bi-annually with the calculation of their Knee Society Scores (KSS) and a radiological assessment for loosening/osteolysis.Results:120 knees were available for followup. The average Knee Society clinical and functional scores, respectively, were 27 points and 40 points preoperatively and 93 points and 95 points postoperatively. This indicates a mean increase of about 71’ in the clinical score and about 58’ in the functional score, which is statistically significant. The mean postoperative flexion was 124°, a mean increase of 23° from the preoperative flexion of 101°. There were no revisions (Kaplan-–Meier survivorship of 100’).Conclusions:We feel durable and reproducible results of PFC-RP-PS design knees are very technique sensitive. The way ahead with the PFC-RP-PS knees looks promising when the exclusion criteria for this design are strictly met. Coming from a non-designer, this study acquires a higher degree of relevance without any designer's or manufacturer's bias.

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Computed tomographic evaluation of femoral component rotation in total knee arthroplasty

Cited by 10 publications

References 33 publications

Femoral rotational asymmetry is a common anatomical variant

Femoral rotational asymmetry is a common anatomical variant

Identifying the Rotational Axes of Distal Femur in South Andhra Population of India Using Image Tool Software

What have we learned from 100% success of press fit condylar rotating platform posterior stabilized knees?

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