An Additional Reference Axis for Determining Rotational Alignment of the Femoral Component in Total Knee Arthroplasty

Won, Ye Yeon; Cui, Wen; Baek, Myong Hyun; Yun, Tae-Bong; Han, Seung‐Ho

doi:10.1016/j.arth.2007.02.005

Cited by 22 publications

(27 citation statements)

References 13 publications

(19 reference statements)

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“…Prior studies have shown certain demographic and anthropometric variables, including age, sex, and HKA, to influence the PCL-TEA relationship, but no such simple relationships were seen in our dataset. 8,30,43,44 Tibia vara has previously been shown to influence the PCL-TEA relationship. 32,33 Pagnano and Hanssen , comparing intraoperative measurements and preoperative radiographs in 60 knees, found the PCL to be more internally rotated compared with the TEA.…”

Section: Discussionmentioning

confidence: 99%

Relationship of the Posterior Condylar Line and the Transepicondylar Axis: A CT-Based Evaluation

et al. 2019

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Posterior condylar referencing, a common method for determining femoral axial orientation during total knee arthroplasty (TKA), relies upon an assumed consistent relationship between the posterior condylar line (PCL) and the transepicondylar axis (TEA) of 3 degrees rotation. A total of 3,010 computed tomography (CT) scans and three-dimension (3D)-reconstructions for presurgical creation of patient-matched TKA instrumentation were analyzed. Demographic data and five anthropometric measurements (hip–knee angle [HKA], distal femoral angle [DFA], proximal tibial angle [PTA], tibial slope [TS], and PCL–TEA relationship) were recorded for each scan. A logistic regression model was fit to assess interaction between the PCL–TEA relationship and demographic and radiological variables. The mean (standard deviation [SD]) PCL–TEA was +2.9 degrees (0.8 degree). The range varied between +0.5 and +16.5 degrees. In 2,758 knees (91.6%), the PCL–TEA was within 3 ± 1 degrees, whereas 252 knees (8.4%) fell outside this range. There were no significant demographic or anthropometric differences between those knees with PCL–TEA relationship between 3 ± 1 degrees and those falling outside that range. The posterior condyles of diseased knees undergoing TKA can be reliably used to indirectly reference the TEA of the distal femur with an error of only 1 degree in 92% of patients.

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Section: Discussionmentioning

confidence: 99%

Relationship of the Posterior Condylar Line and the Transepicondylar Axis: A CT-Based Evaluation

et al. 2019

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“…To achieve more accurate rotational alignment, not only further refinements in navigation technology but also more careful and precise registration will be necessary. Additional reference lines such as a posterior condylar line and a trochlear line may reduce the registration error and improve femoral rotational accuracy [29,31]. Improvements in rotational accuracy may lead to a better postoperative outcome [32].…”

Section: Discussionmentioning

confidence: 99%

Influence of navigation system updates on total knee arthroplasty

Inui

Taketomi

Nakamura

et al. 2013

BMC Sports Sci Med Rehabil

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BackgroundThe purpose of this study was to evaluate the influence of image-free computer-assisted navigation system update on outcome in total knee arthroplasty.MethodsThirty-three knees were replaced using the Stryker 3.1 image-free navigation system and 49 knees were replaced using the Stryker 4.0 system. One surgeon took part in all procedures as chief surgeon or first assistant. All patients received the Stryker Scopio NRG CR total knee prosthesis. We compared the accuracy of component positioning measured using radiographs and CT scans, operating time and clinical outcome 1 year after surgery.ResultsThe mean hip-knee-ankle, frontal femoral and tibial component angle were 179.8° (ideally implanted 85%), 89.8° (88%), 90.4° (88%) respectively for the 3.1 group and 179.5° (96%), 90.6° (92%), 90.2° (94%) for the 4.0 group. The mean sagittal tibial component angle was 85.5° (82%) for the 3.1 group and 85.6° (92%) for the 4.0 group. The mean rotational femoral and tibial component angle were −0.5° (81%), −0.7° (73%) for the 3.1 group and 0.0° (84%), 0.4° (72%) for the 4.0 group. There were no statistically significant findings with regard to component positioning.Operating time was significantly longer in the 3.1 group (3.1 group: 137 min, 4.1group: 125 min, P < 0.01).No significant difference was detected in postoperative clinical outcome.ConclusionThe navigation system update from Stryker 3.1 to Stryker 4.0 reduced operating time by 12 min. However, there were no statistically significant findings with regard to component positioning and clinical outcome.

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“…As a standard of femoral component's rotational axis, there are many methods, such as posterior condylar axis, Whiteside anteroposterior axis, transepicondylar axis, and flexion gap rectangularity balancing, but each method has an issue of variation. 8 , 15 Among various methods, the method of making rotation with the focus of TEA has been known to have the least individual variation. 2 , 6 , 11 , 16 , 17 Since TEA is the approximate value of flexion-extension axis and the origin of both collateral ligaments, it is considered as the most valid reference in many studies.…”

Section: Discussionmentioning

confidence: 99%

How to Minimize Rotational Conflict between Femoral & Tibial Component in Total Knee Arthroplasty: The Use of Femoro-Tibial Axial Synchronizer (Linker)

et al. 2015

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PurposeThe purpose of this study was to investigate the correlation between rotational axes of femur and tibia with the use of Linker.Materials and MethodsThis study was carried out from August 2009 to February 2010 on 54 patients (106 knees), who were diagnosed with simultaneous bilateral total knee arthroplasty. With the use of postoperative computed tomography scans, it was investigated how much the rotational angle of femoral and tibial components matched.ResultsThe tibial component was internally rotated for the femoral component at an angle of 0.8°. The femoral component was externally rotated for the surgical transepicondylar axis (TEA) at an angle of 1.6 (range: from 4.8° of internal rotation to 7.9° of external rotation, SD=2.2°), and the tibial component was externally rotated for the surgical TEA at an average angle of 0.9 (range: from 5.1° of internal rotation to 8.3° of external rotation, SD=3.1°).ConclusionThe femoro-tibial synchronizer helped to improve the orientation and positioning of both femoral component and tibial component, and also increase the correlation of the rotational axes of the two components.

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An Additional Reference Axis for Determining Rotational Alignment of the Femoral Component in Total Knee Arthroplasty

Cited by 22 publications

References 13 publications

Relationship of the Posterior Condylar Line and the Transepicondylar Axis: A CT-Based Evaluation

Relationship of the Posterior Condylar Line and the Transepicondylar Axis: A CT-Based Evaluation

Influence of navigation system updates on total knee arthroplasty

How to Minimize Rotational Conflict between Femoral & Tibial Component in Total Knee Arthroplasty: The Use of Femoro-Tibial Axial Synchronizer (Linker)

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