Femur bowing could be a risk factor for implant flexion in conventional total knee arthroplasty and notching in navigated total knee arthroplasty

Ko, Jae Han; Han, Chang Dong; Shin, Kyoo Ho; Nguku, Levis; Yang, Ick Hwan; Lee, Woo Suk; Kim, Kwang Il; Park, Kwan Kyu

doi:10.1007/s00167-015-3863-6

Cited by 32 publications

(35 citation statements)

References 40 publications

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“…Recently, more and more surgeons have realized the significance of the femoral shape in the sagittal plane. Ko et al thought sFBA was a risk factor for femoral implant flexion in conventional intramedullary TKA and notching in navigated TKA [ 8 ]. Nakahara et al promoted an idea that sagittal femoral cutting error could change femoral anteroposterior sizing in TKA, for example, downsizing of the femoral component could occur if the distal osteotomy was performed in a flexed position [ 9 ].…”

Section: Discussionmentioning

confidence: 99%

“…Unlike the recognized results in the coronal plane, there is no unified peri-operative alignment assessment system of femur in the sagittal plane. It has been shown sFBA is associated with the degree of femoral component flexion [ 8 ]. An overly flexional position will limit knee extension and result in posterior insert wear caused by impingement between the polyethylene insert and the intercondylar box in TKA using post-cam mechanism [ 9 ].…”

Section: Introductionmentioning

confidence: 99%

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The assessment of femoral shaft morphology in the sagittal plane in Chinese patients with osteoarthritis—a radiographic analysis

Bao¹,

Qiao²,

Qin³

et al. 2017

J Orthop Surg Res

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BackgroundThe purpose of this study was to analyze femoral shaft sagittal parameters in Chinese osteoarthritis (OA) patients undergoing total knee arthroplasty (TKA) and identify whether the parameters in the coronal plane could be predictors of those in the sagittal plane.MethodsStandard long-standing anteroposterior and femoral lateral radiographs of 50 lower limbs in 50 Chinese OA patients were included. Sagittal femoral bowing angle (sFBA), angle between femoral distal anterior cortex axis and sagittal mechanical axis (DACSMA), angle between femoral distal anterior cortex axis and sagittal distal anatomic axis (DACSDAA), and angle between femoral sagittal mechanical axis and sagittal distal anatomic axis (SMADAA) were measured. Then the relationship between femoral shaft parameters in the sagittal and coronal planes were identified, including coronal femoral bowing angle (cFBA), valgus angle, hip-knee-ankle angle (HKA), length of femur (LF), femoral offset, femoral neck stem angle (FNS), and mechanical lateral distal femoral angle (mLDFA). A two-sided Pearson correlation coefficient was obtained to identify the correlations between parameters in the coronal and sagittal planes. P values <0.05 were considered statistically significant.ResultsThe mean sFBA was 15.08° ± 3.79°, the mean DACSMA was 1.35° ± 2.70°, the mean DACSDAA was −2.66° ± 2.05°, and the mean SMADAA was 4.01° ± 2.55°. No correlation between parameters in the coronal and sagittal planes was found.ConclusionsIn this study, the discreteness of DACSMA, DACSDAA, and SMADAA in Chinese OA patients is high and this may affect the position of femoral prosthesis after TKA using the conventional intramedullary device. No parameters in the coronal plane are found correlated with those in the sagittal plane.Trial registration Researchregistry2337

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

The assessment of femoral shaft morphology in the sagittal plane in Chinese patients with osteoarthritis—a radiographic analysis

Bao¹,

Qiao²,

Qin³

et al. 2017

J Orthop Surg Res

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“…We should make an adequate bone bed for the anterior flange of the femoral component with proper cementing technique. Furthermore, caution should be taken to avoid anterior notching in knees with severe femoral anterior bowing, particularly when using computer assisted navigation [4,13,17]. Postoperative rehabilitation is also impo rtant.…”

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confidence: 99%

Clinical Faceoff: Do We Need Special Strategies for Asian Patients with TKA?

Kim

Matsuda

Kim

2016

Clinical Orthopaedics &Amp; Related Research

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“…Neither the surgeons nor the implant manufacturers had a clear consensus on the direction and depth in using the intramedullary rod in TKA. The operation was often decided by the surgeon, based on the preoperative image data and intraoperative experience, so the accuracy of the sagittal position of the femoral component could not be ensured 20 . Earlier studies had demonstrated that using the conventional alignment technique a femoral flexion within the range from 0 to 5 flexion was achieved in only 25% and 48% of TKA, respectively.…”

Section: Sagittal Insertion Depth and Direction Of The Femoral Intrammentioning

confidence: 99%

“…Earlier studies had demonstrated that using the conventional alignment technique a femoral flexion within the range from 0 to 5 flexion was achieved in only 25% and 48% of TKA, respectively. 20,21 However, that study did not explore how to improve the accurate placement of the component. Up to now, no clinical or anatomical studies have explored this.…”

Section: Sagittal Insertion Depth and Direction Of The Femoral Intrammentioning

confidence: 99%

Optimal Sagittal Insertion Depth and Direction of Femoral Intramedullary Rod in Total Knee Arthroplasty in Chinese Osteoarthritis Patients

Xia

2020

Orthopaedic Surgery

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Objective To identify the optimal femoral intramedullary rod insertion depth and direction on the sagittal plane in total knee arthroplasty (TKA) of Chinese osteoarthritis (OA) patients. Methods From January to December 2019, CT data were collected for 85 consecutive entire lower extremity Chinese OA patients. A three‐dimensional method was used to simulate intramedullary rod penetration. The intramedullary rods were inserted toward the anterior (TA), center (TC), and posterior (TP) of the femoral canal, respectively. Four penetration depths of 150, 200, 250, and 300 mm from the joint line were set. The intersection angle was measured between the simulated intramedullary rod and the mechanical axis of the femur (FMA) on the sagittal plane. Results Our study included 85 Chinese OA patients: 46 women, with a mean age of 65.7 ± 8.4 years (range, 51–85 years) and 39 men, with a mean age of 65.6 ± 8.1 years (range, 46–86 years). The intersection angle between the FMA and the femoral anatomical axis was smaller in men, 2.4° ± 1.6° (range, 0°–4.8°), than in women, 3.5° ± 2.3° (range, 0.7º–8.2°), with a significant statistical difference (P < 0.01). In the comparison of the intersection angle between the simulated intramedullary rod and the FMA, there was no statistical difference between TA200 and TC200 in women (P > 0.05). The proportions were up to 91% and 96% of TA200 at 0°–3° and 0°–5° intervals, respectively, but just 63% and 78% in TC200. In TA150, 76% of intersection angles were greater than 5°. Only approximately 60% in TA250 and TA300 were within the 0°–5° interval and 40% were less than 0°. Only 57% of intersection angles in TC150 were in the 0°–3° interval. TC250, TC300, and TP150 were mostly below 0°. In men, there were statistical differences between all groups. All intersection angles were greater than 5° in TA150. TA200 and TA250 were mostly greater than 5° (87% and 59%, respectively) and 72% of intersection angles were within 0°–5° interval in TA300. TC150 had 92% of intersection angles within the 0°–5° interval but only 62% between the 0° and 3° interval. In the TC200, up to 90% and 97% were within 0°–3° and 0°–5° intervals, respectively. TC300, TP150, and TP200 were mostly below 0°. Conclusion We described an innovative method for rapidly, simply, and accurately identifying the sagittal insertion depth and direction of the femoral intramedullary rod in TKA, which can optimize the position of the femoral prosthetic component on the sagittal plane in TKA.

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Femur bowing could be a risk factor for implant flexion in conventional total knee arthroplasty and notching in navigated total knee arthroplasty

Abstract: Retrospective comparative study, Level III.

Cited by 32 publications

References 40 publications

The assessment of femoral shaft morphology in the sagittal plane in Chinese patients with osteoarthritis—a radiographic analysis

The assessment of femoral shaft morphology in the sagittal plane in Chinese patients with osteoarthritis—a radiographic analysis

Clinical Faceoff: Do We Need Special Strategies for Asian Patients with TKA?

Optimal Sagittal Insertion Depth and Direction of Femoral Intramedullary Rod in Total Knee Arthroplasty in Chinese Osteoarthritis Patients

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