A comparison of 4 intraoperative methods to determine femoral component rotation during total knee arthroplasty

Olcott, Christopher W.; Scott, Richard D.

doi:10.1016/s0883-5403(00)91051-9

Cited by 140 publications

(80 citation statements)

References 5 publications

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“…The proper rotation of the femoral component in total knee arthroplasty is essential in avoiding symptomatic flexion gap asymmetry and patellar complications [14,17,22]. A well-established guideline concerning femoral component rotation is to avoid an internal rotation of the implant, as such malrotation of the femoral component makes the patella appear laterally tilted and increases the Q angle [1,18].…”

Section: Discussionmentioning

confidence: 99%

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Is referencing the posterior condyles sufficient to achieve a rectangular flexion gap in total knee arthroplasty?

Schnurr

Neßler

König

2008

International Orthopaedics (SICOT)

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Femoral malrotation in total knee arthroplasty causes flexion gap instability. Conventional instruments mostly reference the posterior condylar angle (PCA). The aim of this study was to verify whether the computernavigated flexion gap (GAP) method produces a rectangular flexion gap and if a balanced flexion gap could also be achieved by referencing the PCA. A total of 100 knee prostheses were analysed using the navigated GAP method, and flexion gap symmetry along with femoral rotation were recorded. The GAP technique resulted in a rectangular flexion gap with adequate femoral rotational alignment. If the PCA technique had been used, only 51% of the femoral components would have been implanted in correct femoral rotation; the remaining 49% would have implanted with flexion gap instability. The GAP technique produces a rectangular flexion gap. The referencing of the PCA was shown to be less reliable. Thus, modern knee prosthesis instrumentation should not base femoral rotation solely on the PCA.Résumé Les anomalies de rotations fémorales peuvent être à l'origine d'instabilité dans les prothèses totales du genou. Le matériel ancillaire conventionnel a pour référence l'angle postérieur des condyles (PCA). Le but de cette étude est de vérifier grâce à la navigation (GAP) si l'on peut avoir une meilleure balance ligamentaire et un meilleur équilibrage qu'en faisant référence à la PCA. Matériel et méthode: 100 prothèses de genou ont été analysées en utilisant la navigation de type GAP et les anomalies de l'espace en flexion et rotation ont été rapportées. Résultats: la technique utilisant la navigation de type GAP permet d'avoir un bon alignement en rotation alors que la technique conventionnelle faisant référence au condyle postérieur ne permet d'avoir une bonne implantation que dans 34% des cas, les 66% de cas restant présentent une instabilité. En conclusion: la technique avec navigation permet d'avoir un espace en flexion parfaitement rectangulaire, la référence au condyle postérieur est moins fiable. Le matériel ancillaire moderne des prothèses du genou ne doit plus se baser uniquement sur les condyles postérieurs en flexion.

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Section: Discussionmentioning

confidence: 99%

“…Despite this fact, several studies indicate an alarming margin of error for the bone landmark referencing techniques, especially for the frequently used PCA method, with a rotational deviation range up to 29° [2,6,10,14,17,21,24].…”

Section: Introductionmentioning

confidence: 99%

Is referencing the posterior condyles sufficient to achieve a rectangular flexion gap in total knee arthroplasty?

Schnurr

Neßler

König

2008

International Orthopaedics (SICOT)

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“…Several methods have been proposed to define the proper alignment during the implantation: the posterior condylar axis (Laskin 1995), the Whiteside line , the balancing technique (Insall et al 1985), the tibial axis (Stiehl and Cherveny 1996), and the transepicondylar axis (Berger et al 1993). The latter is supposed to represent the axis of the knee movement in flexionextension (Hollister et al 1993), and may be the most reliable method for determining rotational alignment of the femoral component (Olcott and Scott 2000). However, some authors have found in a cadaver study that it was less predictable than other techniques (Katz et al 2001), and that the inter-observer variability could reach 23° (Jerosch et al 2002).…”

Section: Discussionmentioning

confidence: 99%

Low reproducibility of the intra–operative measurement of the transepicondylar axis during total knee replacement

Jenny

Boéri

2004

Acta Orthopaedica Scandinavica

209

120

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Background The transepicondylar axis is often used for positioning of the femoral component in knee replacement. MethodsWe studied the reproducibility of the intra-operative palpation of the transepicondylar axis for rotational alignment of the femoral component in 20 total knee replacement (TKR) implantations with a non-image-based navigation system. 2 surgeons defined the transepicondylar axis 3 times each without changing the reference plane.Results The angle between the reference plane and the transepicondylar axis was measured by the navigation system. The mean intra-observer ranges of variation were 5° and 6° for both surgeons, with a maximum of 15°. The mean inter-observer range of variation was 9°, with a maximum of 15°. Variations occurred in either internal or external rotation. Intra-observer agreement was considered good for one surgeon and poor for the other. There was no agreement between the two observers.Interpretation To define the rotational alignment of the femoral component of a TKR according to the intra-operative palpation of the transepicondylar axis may not be as reproducible as expected. However, the exact effect of this variability on the outcome after TKR should be studied.

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“…The distal femur was then cut using an intramedullary alignment guide set at 5°of valgus with anterior referencing instrumentation. Femoral component rotation was determined using the posterior femoral condyles, the epicondylar axis, and Whiteside's line [12][13][14]. Flexion and extension gaps were balanced using spacer blocks, aiming at achieving rectangular and symmetric gaps.…”

Section: Surgical Techniquementioning

confidence: 99%

The natural history of a newly developed flexion contracture following primary total knee arthroplasty

Anania¹,

Abdel

Lee

et al. 2013

International Orthopaedics (SICOT)

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Purpose We investigated the incidence, natural history, and functional consequences of a newly developed flexion contracture after total knee arthroplasty (TKA). Methods Forty patients with full knee extension preoperatively who developed a postoperative flexion contracture were match-paired 1:2 with 80 patients who had full extension. The incidence of a newly developed flexion contracture, ROM, and Knee Society scores (KSS) at six weeks, four months, and one year were analysed. Results The incidence of a new flexion contracture at sixweeks was 14 %, but diminished to 5 % and 0.3 % at fourmonths and one year, respectively. One year after surgery, there was no difference in the KSS (p=0.5). Conclusions This study showed that the majority of patients who developed a new flexion contracture after TKA have full knee extension one year postoperatively. Moreover, knee extension and KSS at one year are equivalent to those patients who did not developed a flexion contracture.

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A comparison of 4 intraoperative methods to determine femoral component rotation during total knee arthroplasty

Cited by 140 publications

References 5 publications

Is referencing the posterior condyles sufficient to achieve a rectangular flexion gap in total knee arthroplasty?

Is referencing the posterior condyles sufficient to achieve a rectangular flexion gap in total knee arthroplasty?

Low reproducibility of the intra–operative measurement of the transepicondylar axis during total knee replacement

The natural history of a newly developed flexion contracture following primary total knee arthroplasty

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