Relationship of the Posterior Condylar Line and the Transepicondylar Axis: A CT-Based Evaluation

Fitz, David W.; Johnson, Daniel J.; Hartwell, Matthew J.; Sullivan, Ryan; Keller, Tyler J.; Manning, David W.

doi:10.1055/s-0039-1685146

Cited by 6 publications

(7 citation statements)

References 46 publications

(38 reference statements)

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“…The sTEA was externally rotated 1.77°to the PCA with a range of 10°which was comparable to the 10°range in the sTEA-PCA angle found by Chalmers et al [25]. Similarly, several studies have found that the sTEA externally rotated to the PCA by about 2-3°on average [26,27]. Restrepo et al also noted that when the posterior cut is made at a fixed 3°external to the posterior condylar axis, there is a significantly greater chance of finding an outlier, which could lead to excessive external or internal rotation of the femoral component, resulting in knee instability and early failure [23].…”

Section: Discussionsupporting

confidence: 79%

A computed tomographic evaluation of femoral and tibial rotational reference axes in total knee arthroplasty

Panicker

Thilak

2023

SICOT-J

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Introduction: The surgical trans epicondylar axis (sTEA) is considered the gold standard for optimum rotation of the femoral component; however, no consensus exists on tibial component positioning. The objectives of this study were to determine the relationship of sTEA to various femoral and tibial reference axes in varus osteoarthritis (OA) knees and (ii) to study the intra-observer and inter-observer variability of the axis relationships. Materials and methods: The study was done on preoperative computerised tomogram (CT) scans of 110 varus knees to assess the rotational relationships respectively of femoral side sTEA with whitesides line (WSL), posterior condylar axis (PCA), clinical trans epicondylar axis (cTEA) and on the tibial side sTEA with posterior tibial margin (PTM), anterior condylar axis (ACA), Akagi’s line and line from the geometric centre of the tibial plateau to 1/3rd tibial tubercle (line GC 1/3rd TT). Results: On the femoral side the mean angles of sTEA with WSL, PCA, cTEA were 95.64° ± 2.85°, 1.77° ± 1.88°, 4.19° ± 0.99° respectively. On the tibial side, the mean angles of sTEA with, PTM, ACA, Akagi’s line, and line GC 1/3rd TT were 1.10° ± 4.69°, 11.98° ± 4.51°, 2.43° ± 4.35°, 16.04° ± 5.93° respectively. Conclusion: Contrary to the generalization, TEA has variable relationships. The surgical trans epicondylar axis was not at the assumed 3° of external rotation to PCA in 85% of knees, nor perpendicular to WSL in >95% of knees. Of the four tibial axes, Akagi’s line was the least variable with sTEA. Furthermore, surgeons should also be aware of the multiple reference axes and the range of deviation from sTEA to optimize the rotational alignment of components.

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Section: Discussionsupporting

confidence: 79%

A computed tomographic evaluation of femoral and tibial rotational reference axes in total knee arthroplasty

Panicker

Thilak

2023

SICOT-J

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“…Despite this, ra-TKA patients present with prolonged surgery time, the blood loss is significantly lower than during mTKA. The surgeon in the present study did not perform more than 15 procedures with NAVIO before enrollment of the patients, where Bell et al evidenced that learning curve was reached at 29 cases with NAVIO [ 37 , 38 ]. The increase in blood loss is not significant in the ra-TKA cohort and these results stands in the line with previously reported outcomes of avoiding of the intramedullary instrumentation [ 21 , 35 , 39 ].…”

Section: Discussionmentioning

confidence: 95%

Robotic-Assisted Total Knee Arthroplasty Utilizing NAVIO, CORI Imageless Systems and Manual TKA Accurately Restore Femoral Rotational Alignment and Yield Satisfactory Clinical Outcomes: A Randomized Controlled Trial

et al. 2023

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Background and objectives: The introduction of novel techniques in total knee arthroplasty (TKA) aiming to enhance outcomes and satisfaction of the procedure is constantly ongoing. In order to evidence a priority of one, we have conducted a randomized controlled trial with the aim of comparing patient-reported functional outcomes, radiographic outcomes and intraoperative measures between imageless (NAVIO and CORI), robotic-assisted (ra)- TKA (ra-TKA) and manual TKA (mTKA) for primary knee osteoarthritis (KOA). Materials and Methods: A total of 215 patients with the diagnosis of KOA of the knee were randomly assigned to one of the three groups: NAVIO (76 patients) or CORI (71 patients) robotic-assisted TKA, or manual technique (68 patients) TKA. The primary outcome (Knee Injury and Osteoarthritis Outcome Study [KOOS]), Visual Analogue Scale (VAS), Range of motion (ROM), femoral component rotational alignment and the secondary outcomes (surgery time, blood loss, complications, and revision at 12 months after surgery) were compared between three groups. KOOS and VAS were collected at particular follow up visits from each patient individually and ROM in flexion and extension was assessed during the physical examination. Femoral component rotational alignment was measured on the CT scan performed postoperatively utilizing the Berger’s method. Statistical significance was set at p < 0.05. Results: Both the ra-TKA groups and mTKA group displayed significant improvements in the majority of the functional outcome scores at 12 months. Despite having more prominent surgery time (NAVIO: mean +44.5 min in comparison to mTKA and CORI: mean +38.5 min in comparison to mTKA), both NAVIO and CORI tend to achieve highly accurate femoral component rotational alignment with mean radiographic scores in NAVIO vs. CORI vs. mTKA of 1.48° vs. 1.33° vs. 3.15° and lower blood loss (NAVIO: 1.74; CORI: 1.51; mTKA: 2.32. Furthermore, the investigation revealed the significant difference in femoral component rotational alignment between mTKA—NAVIO and mTKA—CORI and significantly different KOOS scores in NAVIO vs. CORI vs. mTKA of 87.05 vs. 85.59 vs. 81.76. Furthermore, the KOOS analysis showed between group significant statistical differences, but did not reach minimal clinically significant difference. There were no differences in postoperative ROM and VAS. There were no differences in complications between groups. Conclusions: To achieve a successful TKA, the precise tool and individualised objective is of great importance. The results suggest satisfactory results after both ra-TKA methods and mTKA. Ra-TKA and mTKA stand for a safe and reliable treatment method for OA. Patients reported excellent alleviation in functional outcomes and the radiological results revealed that the better precision does not necessarily lead to a better outcome. Therefore, ra-TKA does not imply strong enough advantages in comparison to the manual method, especially in terms of cost-efficiency and surgical time.

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“…anatomical landmarks intraoperatively [2,4,22,29]. The largest computed tomography(CT) imaging study included approximately 100 patients [31], whereas cadaver studies generally use 20-50 specimens [8].…”

Section: Introductionmentioning

confidence: 99%

Gender differences exist in rotational anatomy of the distal femur in osteoarthritic knees using MRI

Koh

Nam

Chung

et al. 2019

Knee Surg Sports Traumatol Arthrosc

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Purpose Optimal rotational alignment of the femoral component is essential for total knee arthroplasty (TKA). The femoral transepicondylar axis (TEA), Whiteside's line (WSL), and posterior condylar axis (PCA) are various intra‐operative references that can be used to determine femoral rotation, and each has advantages and disadvantages. This study aimed to define the rotational anatomy of the distal femur and investigate its relationship with gender in osteoarthritic knees. Methods Magnetic resonance imaging (MRI) was obtained from 1522 patients (1298 females and 224 males) with end‐stage knee osteoarthritis prior to TKA. MRI was constructed into three‐dimensional models. The angles between the TEA and WSL, WSL and PCA, and TEA and PCA were calculated for each patient. In addition, gender differences in femoral rotation were evaluated. Results The PCA was 2.2° ± 1.0° internally rotated relative to the TEA. WSL was 1.2° ± 2.8° externally rotated relative to the TEA. The WSL to TEA relationship exhibited greater variability than the PCA to TEA relationship. PCA was more internally rotated and WSL was more externally rotated relative to TEA in female group than male group. Based on the standard reference rules of 3° external rotation from the PCA that has been conventionally used, 15.7% of patients showed external rotation lower 1° or greater than 5° external rotation from the PCA. In the mean external rotation of the TEA from the PCA (2.2°) from this population; however, the percentage of patients showing ± 2° from their TEA dropped to 5.1% of patients. Conclusion Gender difference and variability exist in distal femoral rotational anatomy. These data can be useful in consideration of femoral anatomy variability and gender difference. The same cutting angle may lead to malrotation of the femoral component. Level of evidence Consecutive patients, level III.

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Relationship of the Posterior Condylar Line and the Transepicondylar Axis: A CT-Based Evaluation

Cited by 6 publications

References 46 publications

A computed tomographic evaluation of femoral and tibial rotational reference axes in total knee arthroplasty

A computed tomographic evaluation of femoral and tibial rotational reference axes in total knee arthroplasty

Robotic-Assisted Total Knee Arthroplasty Utilizing NAVIO, CORI Imageless Systems and Manual TKA Accurately Restore Femoral Rotational Alignment and Yield Satisfactory Clinical Outcomes: A Randomized Controlled Trial

Gender differences exist in rotational anatomy of the distal femur in osteoarthritic knees using MRI

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