Native femoral sulcus as a guide for the position of the femoral component in primary total knee arthroplasty

Abstract

A prospective randomized study was conducted to evaluate the effects of using the native femoral sulcus as a guide for the positioning of the femoral component in primary total knee arthroplasty (TKA), especially for patellar tracking. Between 2000 and 2002, 420 cases of primary TKA were collected. All the TKAs were performed with the same approach. The cases were randomly separated into two groups. In group 1 (consisting of 202 knees), the femoral insertion of the posterior cruciate ligament and the midline of the lateral-medial femoral condyles were used as a guide for the midline position of the femoral component; while in group 2 (consisting of 218 knees), the native femoral sulcus was used as the guide for the femoral component. Intraoperatively, no thumb technique was used to check the patellar tracking. In group 1, 16 knees (7.9%) received lateral retinacular releases, while none received lateral retinacular release in group 2 (P<0.0001). The average (range) follow-up period was 40 (30-56) months. In postoperative radiographic evaluation, two knees (1%) of lateral tilting of the patella were noted in group 1; while two knees (0.91%) of lateral tilting of the patella were noted in group 2 (P=0.751). In conclusion, native femoral sulcus could be a very effective and simple guide for the medial-lateral position of the femoral component, especially for patellar tracking. The prostheses used in this series were all Nexgen LPS-FLEX PCL Substituting (Zimmer, Warsaw) prostheses.

The femoral sulcus in total knee arthroplasty

“…The lateral location of the sulcus relative to the midline of the intact femoral condyles has been reported previously [5][6][7][8]. Eckhoff et al found the sulcus to lie about 5 mm lateral to the midline, with the midline being defined as the perpendicular bisector of a baseline connecting the most posterior points of the medial and lateral femoral condyles [7,8].…”

“…At surgery, the line marking the native femoral sulcus is identical to Whiteside's line or the anteroposterior axis of the distal femur [2,[4][5][6]14]. The marked line was used to determine the rotational alignment of the femoral component, by cutting the anterior aspect of the femoral condyles perpendicular to it [2].…”

“…The femoral sulcus was meticulously identified using a technique which involved gradually sliding the thumb along the trochlear groove to identify the low point by palpation and marking it with the diathermy. At surgery, the line marking the native femoral sulcus is identical to Whiteside's line or the anteroposterior axis of the distal femur [2,[4][5][6]14]. The marked line was used to determine the rotational alignment of the femoral component, by cutting the anterior aspect of the femoral condyles perpendicular to it [2].…”

Total knee arthroplasty using trochlear groove as guide for position of femoral component in severe knee osteoarthritis

“…Previous studies have found that the operative technique, prosthetic design, axial malalignment and malrotation as well as poor patellar tracking contributed to the patellofemoral complications [ 4 – 7 ]. Besides, femoral component designs and position were also reported as the main causes of poor patellar tracking in TKA [ 8 – 10 ].…”

“…Recently, previous studies have reported that native femoral sulcus could be used as a guide for the femoral component position in TKA [ 8 , 18 ]. However, it was not known yet whether trochlear groove was shifting with line of force in severe osteoarthritic knee, and whether the positioning of the femoral component using trochlear groove as reference contributed to the reconstruction of patellar tracking in patients with severe knee osteoarthritis.…”