The Effect of Femoral Component Position on the Kinematics of Total Knee Arthroplasty

Rhoads, Daniel D.; Noble, Philip C.; Reuben, Jeffrey D.; Tullós, Hugh S.

doi:10.1097/00003086-199301000-00019

Cited by 74 publications

(40 citation statements)

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“…In this study, we measured PCO using the transepicondylar axis (TEA) as a reference point to translate our results to the procedure of TKA and prosthesis design. Ideally, during TKA, the femoral component should be rotated parallel to the TEA of the femur to minimize patellar maltracking and instability [11,18]. However, most femoral components currently available are symmetric in terms of the AP dimension of the medial and lateral condyles.…”

Section: Discussionmentioning

confidence: 99%

“…1) and thus require surgeons to properly rotate the femoral component and perform the appropriate ligament releases [4,9,13,24]. Proper femoral component rotation has been shown to be important in minimizing patellar complications and knee instability after TKA [11,18]. Optimally, the femoral component should be rotated parallel to the transepicondylar axis of the femur.…”

Section: Introductionmentioning

confidence: 99%

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Plain Radiographs Underestimate the Asymmetry of the Posterior Condylar Offset of the Knee Compared With MRI

Voleti

Stephenson

Lotke

et al. 2014

Clinical Orthopaedics &Amp; Related Research

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Background Restoration of posterior condylar offset (PCO) during total knee arthroplasty is essential to maximize range of motion, prevent impingement, and minimize flexion instability. Previously, PCO was determined with lateral radiographs, which could not distinguish the asymmetries between the femoral condyles. MRI can independently measure both medial and lateral PCO. Questions/purposes The purpose of this study is to determine the normal PCO of the knee, to establish the differences in medial and lateral PCO, and to compare PCO measurements obtained from radiographs versus those obtained from MRI. Methods We identified 32 patients without a history of prior knee pathology who had both plain radiographs and MRI scans of the same knee performed. The PCO was measured on lateral radiographs and compared with MRI measurements using a novel three-dimensional protocol.Results By MRI, the mean medial PCO was 29 (± 3) mm and the mean lateral PCO was 26 (± 3) mm; both values were greater (p \ 0.001 and p = 0.03, respectively) than the mean radiographic PCO of 25 (± 2) mm. The medial PCO, as measured by MRI, was significantly greater than the lateral PCO (p \ 0.001). Conclusions Plain radiographs underestimate PCO as well as the asymmetry of the medial and lateral PCO compared with MRI. This discrepancy is the result of both articular cartilage thickness and the anatomic differences between medial and lateral condyles. Designers of knee prostheses and instrumentation should take these differences into account.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Plain Radiographs Underestimate the Asymmetry of the Posterior Condylar Offset of the Knee Compared With MRI

Voleti

Stephenson

Lotke

et al. 2014

Clinical Orthopaedics &Amp; Related Research

View full text Add to dashboard Cite

show abstract

“…Proper rotation of the femoral component is not only critical for flexion stability and kinematics, but it also plays a major role in patellar tracking [1,6,29,32,33]. The classic technique developed by Insall to determine femoral rotation uses flexion gap balancing combined with ligament releases [21,37].…”

Section: Discussionmentioning

confidence: 99%

Determining Femoral Component Position Using CAS and Measured Resection

Benjamin

2008

Clinical Orthopaedics &Amp; Related Research

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To evaluate the ability of computer-assisted surgery (CAS) to accurately size and determine rotational alignment of the femoral component in TKA, the author reviewed femoral component position after 50 consecutive primary TKAs using a femur-first, measured resection workflow. The computer software used allowed femoral rotation to be selected based on epicondylar axis, posterior condylar axis, or anteroposterior axis. The final femoral component size and position was determined by the surgeon to avoid anterior notching, match the posterior-medial condyle resection, and flexed to match the plane of the anterior femoral cortex. Femoral sizing was confirmed intraoperatively with a standard sizing guide. The femoral component was downsized in 52% of patients from the size recommended by the computer software. The posterior condylar axis matched the implanted rotational position of the femoral component to within 1°in 64% of patients in contrast to the epicondylar axis (32%) and anteroposterior axis (26%). CAS provides information to make surgical decisions but does not replace clinical judgment. Landmark referencing may be compromised by limited surgical exposures leading to variation in implant positioning by computer software. A clear understanding of the principles of TKA is critical when using CAS to optimize implant sizing and position.

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“…Thus, it is important to place the femoral component in the proper position. It has been suggested that lateral deviation of the femoral component will facilitate patellofemoral tracking (Rhoads et al 1990(Rhoads et al , 1993 ponent in primary TKA with a cruciate retaining type of prosthesis. The rationale was based on several studies reporting that the average midline of the natural femoral sulcus is about 5 mm lateral to the midline of the femoral condyles .…”

Section: Discussionmentioning

confidence: 99%

The native femoral sulcus as the guide for the medial/lateral position of the femoral component in knee arthroplasty: Normal patellar tracking in 690/700 knees—a prospective evaluation

Chiu

2006

Acta Orthopaedica

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The Effect of Femoral Component Position on the Kinematics of Total Knee Arthroplasty

Cited by 74 publications

References 0 publications

Plain Radiographs Underestimate the Asymmetry of the Posterior Condylar Offset of the Knee Compared With MRI

Plain Radiographs Underestimate the Asymmetry of the Posterior Condylar Offset of the Knee Compared With MRI

Determining Femoral Component Position Using CAS and Measured Resection

The native femoral sulcus as the guide for the medial/lateral position of the femoral component in knee arthroplasty: Normal patellar tracking in 690/700 knees—a prospective evaluation

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