The anterior surface of the femur as a new landmark for femoral component rotation in total knee arthroplasty

Talbot, Simon; Bartlett, John R.

doi:10.1007/s00167-007-0421-x

Cited by 31 publications

(29 citation statements)

References 20 publications

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“…Previous studies have emphasised the difficulties surgeons face in this area. 31,32 The third level of error is related to the positioning and fixation of the cutting block and the execution of the cut with the saw. The subject of our study is at the first level, namely, the definition of the desired axis and its relation to the secondary surgical axis.…”

Section: Discussionmentioning

confidence: 99%

A common reference frame for describing rotation of the distal femur

Victor¹,

Doninck

Labey³

et al. 2009

The Journal of Bone and Joint Surgery. British volume

101

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The understanding of rotational alignment of the distal femur is essential in total knee replacement to ensure that there is correct placement of the femoral component. Many reference axes have been described, but there is still disagreement about their value and mutual angular relationship. Our aim was to validate a geometrically-defined reference axis against which the surface-derived axes could be compared in the axial plane. A total of 12 cadaver specimens underwent CT after rigid fixation of optical tracking devices to the femur and the tibia. Three-dimensional reconstructions were made to determine the anatomical surface points and geometrical references. The spatial relationships between the femur and tibia in full extension and in 90 degrees of flexion were examined by an optical infrared tracking system. After co-ordinate transformation of the described anatomical points and geometrical references, the projection of the relevant axes in the axial plane of the femur were mathematically achieved. Inter- and intra-observer variability in the three-dimensional CT reconstructions revealed angular errors ranging from 0.16 degrees to 1.15 degrees for all axes except for the trochlear axis which had an interobserver error of 2 degrees . With the knees in full extension, the femoral transverse axis, connecting the centres of the best matching spheres of the femoral condyles, almost coincided with the tibial transverse axis (mean difference -0.8 degrees , sd 2.05). At 90 degrees of flexion, this femoral transverse axis was orthogonal to the tibial mechanical axis (mean difference -0.77 degrees , sd 4.08). Of all the surface-derived axes, the surgical transepicondylar axis had the closest relationship to the femoral transverse axis after projection on to the axial plane of the femur (mean difference 0.21 degrees , sd 1.77). The posterior condylar line was the most consistent axis (range -2.96 degrees to -0.28 degrees , sd 0.77) and the trochlear anteroposterior axis the least consistent axis (range -10.62 degrees to +11.67 degrees , sd 6.12). The orientation of both the posterior condylar line and the trochlear anteroposterior axis (p = 0.001) showed a trend towards internal rotation with valgus coronal alignment.

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Section: Discussionmentioning

confidence: 99%

A common reference frame for describing rotation of the distal femur

Victor¹,

Doninck

Labey³

et al. 2009

The Journal of Bone and Joint Surgery. British volume

101

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“…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].…”

Section: Methodsmentioning

confidence: 99%

The femoral sulcus in total knee arthroplasty

Krishna¹,

Bartlett

2009

Knee Surg Sports Traumatol Arthrosc

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The position of the femoral sulcus relative to the midline of the distal femoral resection in total knee arthroplasty (TKA) was studied to determine if centralized placement of the femoral component on the distal femur was justified in terms of aligning the prosthetic sulcus with the native femoral sulcus. The location of the femoral sulcus was studied in 112 consecutive patients undergoing TKA. The mean sulcus position was 0.7 mm lateral to the midline of the distal femoral resection (SD 1.4, 95% CI, 0.5-1.0 mm). However, the variation in sulcus positions ranged from 4 mm medial to 4 mm lateral to the midline. The mean sulcus position in valgus knees was 1.0 mm lateral to the midline (SD 1.8), and that in varus knees was 0.7 mm lateral to the midline (SD 1.2) (P = 0.501). It appears prudent to centre the femoral component on the native sulcus rather than the midline of the distal femoral resection, so as to ensure accurate alignment of the prosthetic sulcus with the native sulcus and to encourage normal patella tracking.

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“…[15][16][17] However, A B in many cases the epicondyles cannot be reliably imaged as a result of considerable metal artifacts, so alternative osseous landmarks are necessary. 18 Talbot and Bartlett 13 were able to show that the anterior cortical bone has a close correlation to the epicondylar axis and thus, for the first time, they established an alternative to the direct visualization of the epicondylar axis.…”

Section: Discussionmentioning

confidence: 99%

Posterior Cortical Axis: A New Landmark to Control Femoral Component Rotation in Total Knee Arthroplasty

Matziolis¹,

Meiser²,

Sieber³

et al. 2017

Orthopedics

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Rotation errors of the femoral component are held responsible for occurrences such as instability in flexion and midflexion, patellar maltracking, and arthrofibrosis following total knee arthroplasty. However, in many cases, the epicondylar axis cannot be reliably identified due to bone defects or metal artifacts on computed tomography, so alternative landmarks are necessary to evaluate the femoral component rotation. The current study sought to determine the relationship of the posterior cortical bone and the anterior cortical bone in relation to the epicondylar axis. In this retrospective study, 398 consecutive patients who had undergone magnetic resonance imaging of the knee joint were included. The average angle between the posterior cortical bone and the epicondylar axis was 7.3°±3.3°. When the posterior cortical bone was used as the reference, the average absolute error was 2.6°±2.1°. In comparison, the average angle between the anterior cortical bone and epicondylar axis was 10.4°±4.5°. When this reference was used, the average absolute error was 3.6°±2.8°. The posterior cortical bone is a more consistent landmark than the anterior cortical bone is for intra- or postoperative approximation of the epicondylar axis. This appears to be due to the flat geometry of the posterior cortical bone compared with the elliptical form of the anterior cortical bone of the distal femur. In practice, an external rotation of the femoral component of 7° in relation to the posterior cortical bone is to be recommended. [Orthopedics. 2017; 40(3):188-190.].

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The anterior surface of the femur as a new landmark for femoral component rotation in total knee arthroplasty

Cited by 31 publications

References 20 publications

A common reference frame for describing rotation of the distal femur

A common reference frame for describing rotation of the distal femur

The femoral sulcus in total knee arthroplasty

Posterior Cortical Axis: A New Landmark to Control Femoral Component Rotation in Total Knee Arthroplasty

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