Is radiographic measurement of distal femoral torsion reliable?

Viel, Timothée; Casin, Charles; Ducellier, Florian; Steiger, Vincent; Bigorre, N.; Bizot, Pascal

doi:10.1016/j.otsr.2013.02.009

Cited by 15 publications

(21 citation statements)

References 24 publications

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“…Variations in coronal and sagittal alignment have been widely documented. Variations in axial, or rotational, alignment have been indicated in several previous studies (Viel et al, 2013;Amaranath et al, 2014Loures et al, 2015;Jones et al, 2016). The advantage of this study is that it uses a more accurate technique for measuring the rotational alignment of the trochlear groove.…”

Section: Discussionmentioning

confidence: 86%

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: Discussionmentioning

confidence: 86%

Femoral rotational asymmetry is a common anatomical variant

2018

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“…We used the same radiographic technique described in the study by Viel et al 14 ; the patient was seated on a radio transparent table with the legs hanging over the edge (Fig. 2).…”

Section: Radiographic Assessment Protocolmentioning

confidence: 99%

“…3,4 Studies of different ethnic groups have shown a difference in the anatomical shapes of the distal femur and the proximal tibia, which may affect the choice of the implants and the optimum placement of the component, of these anthropometric measurements, the rotational profile of the distal femur which was studied in Indians, 5,6 Iranians, 7,8 Japanese, 9,10 Chinese, 11,12 and Caucasians. 13 Moreover, inter-individual variations were reported in a population of the same study, 5,14 which drove some authors to suggest the necessity of individualizing the femoral component rotation based on preoperative distal femoral torsion (DFT) measured values. 14,15 Computed tomography (CT) is considered as the standard imaging technique to evaluate the DFT of the native knee or component rotation of the replaced knee; however, routine CT use may not be feasible with the added risk of radiation exposure, and in some patients, detection of anatomical landmarks is difficult.…”

Section: Introductionmentioning

confidence: 99%

“…13 Moreover, inter-individual variations were reported in a population of the same study, 5,14 which drove some authors to suggest the necessity of individualizing the femoral component rotation based on preoperative distal femoral torsion (DFT) measured values. 14,15 Computed tomography (CT) is considered as the standard imaging technique to evaluate the DFT of the native knee or component rotation of the replaced knee; however, routine CT use may not be feasible with the added risk of radiation exposure, and in some patients, detection of anatomical landmarks is difficult. 14 To avoid the previously mentioned limitation, a specific radiographic view (seated PA view) was introduced as an alternative to CT for DFT and component rotation assessment; this technique's efficacy was confirmed in multiple studies, Takai et al 9 in 2003 then Kanekasu et al 10 in 2005 found that the DFT assessment values were similar to CT obtained values and in the study by Viel et al 14 in 2013, where they confirmed the inter-observer and test-retest reliability of this radiographic measurement technique.…”

Section: Introductionmentioning

confidence: 99%

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Evaluating distal femoral torsion and posterior condylar line reliability for adjusting femoral component rotation in TKA, Egyptian population radiographic study

Mahran

Khalifa

Ahmed

et al. 2021

Journal of Clinical Orthopaedics and Trauma

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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 À4.5 ± 2.4 (0 to À9 ), femoral component rotation significantly changed to a mean aPCA of À3.6 ± 2.3 (0 to À7 ) (p ¼ 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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“…The anterior-posterior radiologic incidence of the knee in flexion of 90 0 (seated view) shows the anatomic landmarks ( fig. 1.c): the medial and lateral epicondyle necessary to trace the trans-epicondylar axis (TEA) and the posterior condyles showing the posterior condylar line (PCL) [5,6]. The angle between the two axes calculates the torsion of the distal femoral (posterior condylar angle = PCA) with inter-individual variability.…”

Section: Experimental Partmentioning

confidence: 99%

Implantarea componentelor protetice axata pe planningul radiologic in diformitatile genunchiului in valgus

Savin¹,

Lupescu²,

Patrascu³

et al. 2017

Mat.Plast.

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The present study evaluates the radiologic particularities of deformities in valgus that are necessary for a correct positioning in frontal and rotational plane of the prosthetic components and for a long term life of the polyethylene and the prosthetic implant. Long leg X-ray performed in orthostatism can evaluate the type and degree of the deformity in frontal plane, it can establish the osteotomy cuts and the necessity of ligament release. The anterior-posterior radiologic incidence of the knee in flexion of 900 evaluates the individual rotational profile by calculating the torsion of the distal femoral. Although the frequency of deformity in valgus is more reduced, it presents important clinical and radiologic particularities for the surgical technique.

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Is radiographic measurement of distal femoral torsion reliable?

Abstract: Level IV, prospective cohort study.

Cited by 15 publications

References 24 publications

Femoral rotational asymmetry is a common anatomical variant

Femoral rotational asymmetry is a common anatomical variant

Evaluating distal femoral torsion and posterior condylar line reliability for adjusting femoral component rotation in TKA, Egyptian population radiographic study

Implantarea componentelor protetice axata pe planningul radiologic in diformitatile genunchiului in valgus

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