Malrotation Causing Patellofemoral Complications After Total Knee Arthroplasty

Berger, Richard A.; Crossett, Lawrence S.; Jacobs, Joshua J.; Rubash, Harry E.

doi:10.1097/00003086-199811000-00021

Cited by 938 publications

(742 citation statements)

References 9 publications

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“…In particular we found no increase in the rate of patellofemoral complications in the KA group, similar to previous series using the KA technique [14,15,22,24,25]. The patellofemoral articulation is relevant because currently there is no implant specifically designed for use with KA; therefore, the relative internal rotation of the femoral component in KA versus the MA technique theoretically may adversely affect patellofemoral tracking [9,10].…”

Section: Discussionsupporting

confidence: 86%

The Chitranjan S. Ranawat Award

Young

Walker

Bayan

et al. 2017

Clinical Orthopaedics &Amp; Related Research

192

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Background Neutral mechanical alignment (MA) in total knee arthroplasty (TKA) aims to position femoral and tibial components perpendicular to the mechanical axis of the limb. In contrast, kinematic alignment (KA) attempts to match implant position to the prearthritic anatomy of the individual patient with the aim of improving functional outcome. However, comparative data between the two techniques are lacking.Questions/purposes In this randomized trial, we asked: (1) Are 2-year patient-reported outcome scores enhanced in patients with KA compared with an MA technique? (2) How does postoperative component alignment differ between the techniques? (3) Is the proportion of patients undergoing reoperation at 2 years different between the techniques? Methods Ninety-nine primary TKAs in 95 patients were randomized to either MA (n = 50) or KA (n = 49) groups. A pilot study of 20 TKAs was performed before this trial using the same patient-specific guides positioning in kinematic alignment. In the KA group, patient-specific cutting blocks were manufactured using individual preoperative MRI data. In the MA group, computer navigation was used to ensure neutral mechanical alignment accuracy. Postoperative alignment was assessed with CT scan, and functional scores (including the Oxford Knee Score, WOMAC, and the Forgotten Joint Score) were assessed preoperatively and at 6 weeks, 6 months, and 1 and 2 years postoperatively. No patients were lost to followup. We set sample size at a minimum of 45 patients per treatment arm based on a 5-point improvement in the mean Oxford Knee Score (OKS; the previously reported minimum clinically significant difference for the OKS in TKA), a pooled SD of 8.3, 80% power, and a two-sided significance level of 5%. Results We observed no difference in 2-year change scores (postoperative minus preoperative score) in KA versus MA The institution of one or more of the authors (SWY, MLW, AB, BF) has received, during the study period, funding from Stryker (Kalamazoo, MI, USA) One or more of the authors (AB, MLW, BF) or a member of his or her immediate family, has or may receive payments or benefits, during the study period, an amount of less than USD 10,000 from Stryker. All ICMJE Conflict of Interest Forms for authors and Clinical Orthopaedics and Related Research 1 editors and board members are on file with the publication and can be viewed on request. Clinical Orthopaedics and Related Research 1 neither advocates nor endorses the use of any treatment, drug, or device. Readers are encouraged to always seek additional information, including FDAapproval status, of any drug or device prior to clinical use. Each author certifies that his or her institution approved the human protocol for this investigation, that all investigations were conducted in conformity with ethical principles of research, and that informed consent for participation in the study was obtained. This work was performed at the Department of Orthopaedics, North Shore Hospital, Auckland, New Zealand. Postoperative hipknee-ankle a...

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Section: Discussionsupporting

confidence: 86%

The Chitranjan S. Ranawat Award

Young

Walker

Bayan

et al. 2017

Clinical Orthopaedics &Amp; Related Research

192

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“…Proper rotational alignment of the component is one of the most important factors for successful total knee arthroplasty [ 1, 4,14]. Previous studies recommended that the femoral component should be inserted parallel to the transepicondylar axis [5,8] or to the AP axis [3].…”

Section: Discussionmentioning

confidence: 99%

“…In performing total knee arthroplasty for a valgus knee, 3" of external rotation from the posterior condyles results in internal rotation of the femoral component relative to the transepicondylar axis by 8.5". This amount of malrotation of the femoral component could cause patellofemoral joint complications [ 1,4,14]. The surgeon should take deformity of the lateral condyle into account, and the angle between the transepicondylar axis and the posterior condylar tangent should be measured using MRI (or computed tomography) before surgery.…”

Section: Discussionmentioning

confidence: 99%

Anatomical analysis of the femoral condyle in normal and osteoarthritic knees

Matsuda

Miura

Nagamine

et al. 2004

Journal Orthopaedic Research

130

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It is important to understand anatomical feature of the distal femoral condyle for treatment of osteoarthritic knees. Detailed measurement of the femoral condyle geometry, however, has not been available in osteoarthritic knees including valgus deformity. This study evaluated femoral condyle geometry in 30 normal knees, 30 osteoarthritic knees with varus deformity, and 30 osteoarthritic knees with valgus deformity using radiographs and magnetic resonance imaging (MRI). In radiographic analysis in the coronal plane, the femoral joint angle (lateral angle between the femoral anatomic axis and a tangent to femoral condyles) was 83.3" in the normal knees, 83.8" in the varus knees, and 80.7" in the valgus knees. In MRI analysis in the axial plane, the posterior condylar tangent showed 6.4" of internal rotation relative to the transepicondylar axis in the normal knees, 6.1 O in the varus knees, and 11.5" in the valgus knees. These results suggested that there was no hypoplasia of the medial condyle in the varus knees, but the lateral condyle in the valgus knees was severely distorted. Surgeons should take this deformity of the lateral femoral condyle into account when total knee arthroplasty is performed for a valgus knee.

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“…The success of TKA depends on correct implantation of the prosthesis and proper ligament balance of the deformed knee [8,18]. Restoration of the neutral mechanical alignment of the lower limb in the coronal plane and the correct rotational alignment in the axial plane are considered as two of the most important issues during prosthesis implantation [1,2,6,8].…”

Section: Introductionmentioning

confidence: 99%

Distal Femur Rotation Relates to Joint Obliquity in ACL-deficient Chinese

Yau

Chiu

Fok

et al. 2013

Clinical Orthopaedics &Amp; Related Research

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Background The lower limb osteometry of Chinese differs from that of whites. The joint line of the knee in the coronal plane in Chinese is more medially inclined and the posterior condylar angle of the distal femur in the axial plane is larger. However, it is unclear whether there is any direct association between the coronal plane and axial plane osteometry. Questions/purposes We asked whether the joint line obliquity of the knee is related to the posterior condylar angle of the distal femur in young Chinese subjects. Methods Ninety-nine young Chinese patients with anterior cruciate ligament injuries were recruited. The lower limb alignment and joint line obliquity were measured using standing long radiographs of the whole lower limb.The rotational alignment of the distal femur was assessed in the axial cuts of the MRI. Results The distal femur rotational alignment was associated with the obliquity of the knee in Chinese. The posterior condylar angle was 5°± 2°. The knee was 5°± 3°medially inclined. Conclusions The joint line of the knee in a group of young Chinese patients was more medially inclined than that of whites. The posterior condylar angle of the distal femur was larger. The presence of an association between distal femur rotational alignment and joint line obliquity in this group of young Chinese patients suggests a possible developmental cause explaining the difference in osteometry between races.

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Malrotation Causing Patellofemoral Complications After Total Knee Arthroplasty

Cited by 938 publications

References 9 publications

The Chitranjan S. Ranawat Award

The Chitranjan S. Ranawat Award

Anatomical analysis of the femoral condyle in normal and osteoarthritic knees

Distal Femur Rotation Relates to Joint Obliquity in ACL-deficient Chinese

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