Pre-operative radiological measurement of femoral rotation for prosthetic positioning in total knee arthroplasty

Savin, L. H.; Botez, Paul; Mihăilescu, Dan; Predescu, Vlad; Grierosu, Carmen

doi:10.1007/s00264-015-3110-2

Cited by 13 publications

(8 citation statements)

References 27 publications

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“…The sample size was calculated using G Power 3 software. According to femoral component malrotation incidence reported in previous study, 28 and expecting about 20% of our cases will have malrotation, with a power of 80% and type I error of 5%, a minimum of 86 knees were required.…”

Section: Discussionmentioning

confidence: 93%

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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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Section: Discussionmentioning

confidence: 93%

“…Understanding the preoperative DFT is essential when planning for TKA to accurately reproduce femoral component rotation on an individual basis. 6,15,28 Using a preoperative radiographic assessment can be an alternative to the preoperative CT assessment protocol suggested by Victor J. 15 and others.…”

Section: Discussionmentioning

confidence: 99%

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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“…Condylar Twist Angle (CTA) 11,60 In the kneeling view, it is measured as the angle between the PCL and the aTEA (if aTEA cannot be identified, the sTEA can be used instead) (Figure 4B). It is used to determine the amount of preoperative distal femoral torsion of a native femur or the femoral component rotation after TKA.…”

Section: Axial (A) Plane Evaluation (Axial and Special View Radiographs) Patient Positioning And Film Criteriamentioning

confidence: 99%

A Protocol to Systematic Radiographic Assessment of Primary Total Knee Arthroplasty

Khalifa¹,

Mullaji²,

Mostafa³

et al. 2021

ORR

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Although total knee arthroplasty (TKA) is considered one of the most successful procedures, however, a subset of patients are unsatisfied with the results, even with the introduction of new technologies and implant designs. Radiological assessment of TKA is still considered the most prevalent imaging modality for evaluating the knee joint pre-and postoperatively. Assessment of various angles and indices which could be measured in different radiographic views of the knee provides valuable information about the alignment of the entire limb and the individual prosthetic components, more so in the light of recent nuanced concepts of technique, alignment, and balance. This review article aims to present a comprehensive yet systematic approach to the most useful radiographic parameters for assessing the knee preoperatively and post-TKA by explaining the tools and techniques used for measuring various angles, indices and ratios in the coronal, sagittal and axial planes for diagnosis, preoperative planning, postoperative assessment, and routine follow-up. The protocol we followed in this review entailed first reporting the possible applications and software which could help in measuring these variables, then we mentioned the required series of knee radiographs. For the desired variables, we divided the assessment according to each plane, and in each, we reported the optimum position of the desired radiographic view followed by determining the axis and lines which will later form the desired angles to be measured; finally, we collected all the measurements in a table with the native knee values and the most accepted values after TKA.

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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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Pre-operative radiological measurement of femoral rotation for prosthetic positioning in total knee arthroplasty

Abstract: The results are encouraging for the further use of this pre-operative view with the premises of increasing the accuracy of prosthetic positioning and reducing the mechanical complications.

Cited by 13 publications

References 27 publications

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

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

A Protocol to Systematic Radiographic Assessment of Primary Total Knee Arthroplasty

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

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