Radiographic measurement of the posterior femoral offset is not precise

Jenny, Jean–Yves; Honecker, Sophie; Chammai, Y.

doi:10.1007/s00167-015-3855-6

Cited by 5 publications

(7 citation statements)

References 27 publications

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“…First, the use of plain radiographs preoperatively fails to account for chondral thickness, which may underestimate both PCO and AP femoral dimension. [17][18][19] If the average posterior condyle chondral thickness is approximately 1.7 mm medially and 2.0 mm laterally, 20 this would mean that our group with a reduction in PCO would actually have had an even greater decrease in PCO, pushing the average reduction to approximately 5.5 mm yet without any notable effect on ROM or outcomes, leaving this conclusion accurate. In contrast, the group with increased PCO may not have had as large of an increase in PCO when factoring in chondral thickness.…”

Section: Discussionmentioning

confidence: 87%

Does Posterior Condylar Offset Affect Clinical Results following Total Knee Arthroplasty?

et al. 2017

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Total knee arthroplasty (TKA) is an effective, durable treatment for knee osteoarthritis. However, a subset of patients experiences incomplete pain relief and ongoing dysfunction. Posterior condylar offset (PCO) has previously been shown to be associated with postoperative range of motion (ROM) following TKA; however, an association with patient-reported outcome measures (PROMs) has not been established. The purpose of this study was to evaluate the association between PCO and postoperative ROM and PROMs. A retrospective review of 970 posterior-stabilized single design TKAs was performed. Preoperative and postoperative radiographs were analyzed to measure the change in PCO and anteroposterior (AP) femoral dimension. Clinical outcome measures, including Short Form-12 physical and mental component summaries, Western Ontario and McMaster Universities Arthritis Index, and Knee Society Score were reviewed to determine if these were influenced by changes in PCO and AP dimension. PCO was increased by more than 3 mm in 15.1%, maintained (within 3 mm) in 59.6%, and decreased by more than 3 mm in 25.3% of patients. Comparing between these groups, there were no significant differences in postoperative ROM or PROM. AP dimension increased in 24.4%, maintained in 47.8%, and decreased in 27.8%. Similarly, there were no significant differences in ROM or PROM between these groups. Spearman's correlation analyses failed to identify an association between PCO and ROM or PROMs. In conclusion, increasing or decreasing PCO or AP femoral dimension with this PS TKA design did not significantly affect postoperative ROM or PROM. Similarly, maintenance of PCO within one implant size with this system compared with optimal sizing had no deleterious effect on TKA outcomes.

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Section: Discussionmentioning

confidence: 87%

Does Posterior Condylar Offset Affect Clinical Results following Total Knee Arthroplasty?

et al. 2017

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“…ment was found to be greater in males than females in two of three anatomic studies. Hence, customized arthroplasties designed with attention to the offset were probably important to subsequent restoration of function in patients requiring surgery, and care was often taken to consider this factor in treatment planning [39].…”

Section: Discussionmentioning

confidence: 99%

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2019

Int J Sports Exerc Med

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Objective: To identify anatomic sex differences in the osseous and cartilage structures of the knee. Materials and methods:We performed a comprehensive review of imaging investigations of knee morphology comparing male and female subjects using PUBMED, with search terms for CT/MRI, knee anatomy, and gender. Inclusion criteria were primary imaging investigations of knee osseous/cartilage anatomy (minimum 15 subjects); exclusion criteria were studies of post-operative patients, those with comorbid orthopedic conditions, and review articles. Sex differences in osseous/cartilage anatomy were extracted and aggregated.Results: Of 1550 citations reviewed, 84 studies met inclusion criteria and fell into 5 categories: Bony axes of the knee (n = 21), morphology of the distal femur (n = 38), proximal tibia (n = 15) and patella (n = 8), and articular cartilage (n = 16). Knee axes studies suggested trochlear groove-tibial tuberosity distance and posterior tibial slope may be greater in females. Distal femur studies showed larger metrics in males, and narrower metrics in females with smaller intercondylar notch volumes. Regarding tibial morphology, females had smaller tibias (normalizing for height), with narrower tibial plateaus and deeper medial tibial plateaus. Female patellas were smaller and different enough in morphology to be accurate in predicting sex in forensic studies. Cartilage studies mostly suggested that articular cartilage thickness and volume were greater in males. Conclusion:Sex differences in anatomic structures of the knee have been reported. Given the increasing emphasis on individualized medicine, the emergence of sex-based diagnosis and treatment protocols, radiologists should be aware of anatomic sex differences.

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“…The authors concluded that conventional radiologic measurement is unreliable for both pre-and postoperative assessment. 15 van Lieshout et al 10 compared surgical techniques (flexion first balancer vs.…”

Section: León-muñoz Et Almentioning

confidence: 99%

“…The documentation of changes on plain conventional radiographs is questionable. 10,14,15 Only a few published studies comparing pre-and postoperative PCO consider cartilage thickness. 4,10,16 As shown in Figure 2, there is a discrepancy between the pre-(bones contours) and postoperative (prosthetic shapes) measurements.…”

Section: Introductionmentioning

confidence: 99%

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Reliability of the posterior condylar offset

León‐Muñoz

Parrinello

Galloni

et al. 2021

Journal Orthopaedic Research

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The posterior condylar offset (PCO) has been proposed as a determinant of a postoperative range of motion after total knee arthroplasty, although there is no consensus. This study aimed to demonstrate the error introduced by forcing the femoral rotation to overlap both condyles for the “true” lateral X‐ray projection for the PCO measurement. We hypothesize that the angular discrepancy between the posterior femoral cortical reference plane and the posterior condylar axis plane due to rotation invalidates the acquisition of reliable measurements on X‐rays. We have measured the PCO in 50 “true” lateral X‐rays and compared it with the medial and lateral condyles PCO's assessed on a computed tomography‐scan‐based three‐dimensional (3D) model of each knee. PCO based on the 3D imaging differed significantly between the medial (25.8 ± 3.67 mm) and lateral (16.59 ± 2.92 mm) condyle. Three‐dimensional PCO values differ significantly from those determined in the radiographic studies. Also, the mean values of the medial and lateral condyle PCO measurements differed significantly (p < 0.001) with all PCO measurements on radiographs. We have identified a difference between the posterior cortical plane and the posterior condylar axis projections, both on the axial plane with a mean value of 11.23° ± 3.64°. Our data show an interplane discrepancy angle between the posterior femoral diaphyseal cortical and the posterior condylar axis plane (due to the femur's necessary rotation to overlap both condyles) may invalidate the 2D X‐ray PCO assessment as a reliable measurement.

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Radiographic measurement of the posterior femoral offset is not precise

Abstract: Level IV.

Cited by 5 publications

References 27 publications

Does Posterior Condylar Offset Affect Clinical Results following Total Knee Arthroplasty?

Does Posterior Condylar Offset Affect Clinical Results following Total Knee Arthroplasty?

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Reliability of the posterior condylar offset

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