Is the Surgical Epicondylar Axis the Center of Rotation in the Osteoarthritic Knee?

Kobayashi, Hideo; Akamatsu, Yasushi; Kumagai, Ken; Kusayama, Yoshihiro; Aratake, Masato; Saito, T.

doi:10.1016/j.arth.2014.10.024

Cited by 28 publications

(24 citation statements)

References 28 publications

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“…3,9 The SEA has been reported to be the most reliable landmark for rotational alignment. 8,[10][11][12] However, the SEA cannot be easily achieved during surgery. With the technology of threedimensional (3D) reconstruction of human femurs, we can locate the SEA more precisely and measure its relationship to the posterior condyle in Chinese TKA candidates.…”

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confidence: 99%

Highly Variable Femoral Morphology in Osteoarthritic Chinese: Are Prostheses Today Sufficiently Suitable?

Zhang

Wang

et al. 2017

J Knee Surg

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We aimed to retrospectively investigate the morphology of the resected surfaces of femurs in Chinese patients who underwent total knee arthroplasty (TKA) and to assess the suitability of contemporary femoral components. Measurements on three-dimensional reconstruction after virtual bone cutting were performed on 142 knees from Chinese TKA candidates. The anteroposterior (AP) and mediolateral (ML) dimensions, aspect ratio (ML/AP), and posterior condylar angle (PCA) were measured in the axial plane; the height and length of medial and lateral anterior condyles and the maximal width of the anterior condyles were measured in the frontal plane. Femurs were matched to the prosthesis with the closest AP size. The ML dimensions of femurs were compared with the ML dimensions of the prosthesis. The AP and ML dimensions were significantly larger in male knees ( < 0.01), whereas the difference of aspect ratios was not found to be significantly different between genders ( = 0.26). Both medial and lateral heights of the anterior condyles were significantly higher in men after normalization by AP ( < 0.01 and < 0.05, respectively). The mean PCA averaged 3.8 degrees for Chinese subjects. The overall prevalence of clinically significant overhang was 6.4% in males and 4.8% in females. The design of femoral prosthesis with alternative ML dimensions of the femoral component is a solution to sufficiently avoid overhang while retaining ideal coverage when dealing with a high variation. Chinese men had higher anterior condyles than women after normalization by AP dimension. The mean PCA was 3.8 degrees for all patients with high variability.

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Highly Variable Femoral Morphology in Osteoarthritic Chinese: Are Prostheses Today Sufficiently Suitable?

Zhang

Wang

et al. 2017

J Knee Surg

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“… 10 , 19 , 22 , 26 - 28 However, others have concluded that the epicondyles are reliable and easily identifiable intra-operative bony landmarks in TKA. 22 , 23 , 29 The superficial soft tissues covering the epicondyles can be dissected up to the collateral ligaments as a part of standard surgical exposure and debridement. In revision TKA surgery, dissection of the distal femur is usually more extensive than in primary TKA cases, allowing easy identification of the medial and lateral epicondyles.…”

Section: Discussionmentioning

confidence: 99%

The medial and lateral epicondyle as a reliable landmark for intra-operative joint line determination in revision knee arthroplasty

Özkurt

Sen

Çankaya

et al. 2016

Bone & Joint Research

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ObjectivesThe purpose of this study was to develop an accurate, reliable and easily applicable method for determining the anatomical location of the joint line during revision knee arthroplasty.MethodsThe transepicondylar width (TEW), the perpendicular distance between the medial and lateral epicondyles and the distal articular surfaces (DMAD, DLAD) and the distance between the medial and lateral epicondyles and the posterior articular surfaces (PMAD, DLAD) were measured in 40 knees from 20 formalin-fixed adult cadavers (11 male and nine female; mean age at death 56.9 years, sd 9.4; 34 to 69). The ratios of the DMAD, PMAD, DLAD and PLAD to TEW were calculated.ResultsThe mean TEW, DMAD, PMAD, DLAD and PLAD were 82.76 mm (standard deviation (sd) 7.74), 28.95 mm (sd 3.3), 28.57 mm (sd 3), 23.97 mm (sd 3.27) and 24.42 mm (sd 3.14), respectively. The ratios between the TEW and the articular distances (DMAD/TEW, DLAD/TEW, PMAD/TEW and PLAD/TEW) were calculated and their means were 0.35 (sd 0.02), 0.34 (sd 0.02), 0.28 (sd 0.03) and 0.29 (sd 0.03), respectively.ConclusionThis method provides a simple, reproducible and reliable technique enabling accurate anatomical joint line restoration during revision total knee arthroplasty.Cite this article: B. Ozkurt, T. Sen, D. Cankaya, S. Kendir, K. Basarır, Y. Tabak. The medial and lateral epicondyle as a reliable landmark for intra-operative joint line determination in revision knee arthroplasty. Bone Joint Res 2016;5:280–286. DOI: 10.1302/2046-3758.57.BJR-2016-0002.R1.

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“…Inaccurate track of the patellofemoral joint induced by the wrong femoral rotational alignment is one of the main reasons causing unsatisfied outcomes and limited range of knee motion after TKA surgery. [ 12 , 13 ] Although the surgical epicondylar axis is considered the axis of rotation in the knee with osteoarthritis, [ 14 ] the bone cut of femoral posterior condyle and the positioning of femoral rotational alignment are mainly according to the posterior condyle line due to easy access. The surgical instruments and prosthesis are also designed by the same approach.…”

Section: Discussionmentioning

confidence: 99%

Morphologic features of the distal femur and tibia plateau in Southeastern Chinese population

Fan

et al. 2017

Medicine

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Is the Surgical Epicondylar Axis the Center of Rotation in the Osteoarthritic Knee?

Cited by 28 publications

References 28 publications

Highly Variable Femoral Morphology in Osteoarthritic Chinese: Are Prostheses Today Sufficiently Suitable?

Highly Variable Femoral Morphology in Osteoarthritic Chinese: Are Prostheses Today Sufficiently Suitable?

The medial and lateral epicondyle as a reliable landmark for intra-operative joint line determination in revision knee arthroplasty

Morphologic features of the distal femur and tibia plateau in Southeastern Chinese population

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