The Posterior Condylar Cartilage Affects Rotational Alignment of the Femoral Component in Varus Knee Osteoarthritis

Hamada, Daisuke; Wada, Keizo; Mikami, Hiroshi; Toki, Shunichi; Goto, Tomohiro; Tsutsui, Takahiko; Takasago, Tomoya; Nagamachi, Akihiro; Sairyo, Koichi

doi:10.2152/jmi.64.24

Cited by 11 publications

(12 citation statements)

References 23 publications

(18 reference statements)

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“…Furthermore, anatomical variability among patients, especially the degree of osteoarthritis, may impede correct measurement [ 17 ]. It is difficult to match the TEA observed on the radiograph with that seen intraoperatively [ 12 ]. For this reason, the PCA is used as a reference to find the TEA axis in the surgery using mechanical alignment.…”

Section: Discussionmentioning

confidence: 99%

“…In most osteoarthritic knees, the medial and lateral cartilages of the posterior condyle have different thicknesses because of asymmetric cartilage wear [ 10 ]. Previous studies using MRI have shown that posterior cartilage loss alters the apparent femoral condylar twist angle [ 11 , 12 ]. These studies have proved that the angle of the TEA relative to the PCA is significantly greater in the presence of cartilage than in the absence of cartilage [ 11 , 12 ].…”

Section: Introductionmentioning

confidence: 99%

“…Previous studies using MRI have shown that posterior cartilage loss alters the apparent femoral condylar twist angle [ 11 , 12 ]. These studies have proved that the angle of the TEA relative to the PCA is significantly greater in the presence of cartilage than in the absence of cartilage [ 11 , 12 ]. However, in all these studies, the sample size was small, and the differences according to the mechanical axes and gender were not evaluated.…”

Section: Introductionmentioning

confidence: 99%

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Effect of the presence of the articular cartilage on the femoral component rotation in total knee arthroplasty in female and varus osteoarthritis knees

Nam

Koh

Kim³

et al. 2020

J Orthop Surg Res

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Purpose Surgical techniques for total knee arthroplasty (TKA) require femoral rotational corrections that alter the position of the surface of the posterior femoral joint especially in kinematic alignment. However, preoperative planning of TKA based on computed tomography (CT), without knowing the femoral cartilage thickness, may cause post-surgery failures in femoral rotation. Therefore, this study aimed to evaluate the effects of posterior condyle cartilage thickness on rotational alignment in the femoral component. Methods Three-dimensional magnetic resonance imaging (MRI) scans were obtained for 139 male and 531 female osteoarthritis patients. The angles defined by the femoral posterior condylar axis (PCA) and the surgical transepicondylar axis (TEA) were evaluated with respect to the presence of cartilage. Additionally, these effects were evaluated with respect to patient gender and varus/valgus condition. Results In all patients, the angle between the TEA and PCA was significantly greater in the presence of cartilage than in the absence of cartilage. This result was also seen in female patients. However, there was no difference in the TEA/PCA angle in male patients based on the presence of cartilage. The TEA/PCA angle was significantly greater in the presence of cartilage than in the absence of cartilage in the female varus group. However, there were no differences in the TEA/PCA angle based on the presence of cartilage in the male varus/valgus and female valgus groups. Cartilage thickness in the posterior femoral condyle was significantly greater on the lateral side than on the medial side in all and male patients. However, there was no difference between the genders regarding cartilage thickness. Conclusion Surgical planning for TKA based on CT does not consider articular cartilage and could lead to external malrotation of the femoral implant. Therefore, the effect of the remaining posterior condylar cartilage should be considered by surgeons to prevent over-rotation of the femoral component, especially in female varus knees.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Effect of the presence of the articular cartilage on the femoral component rotation in total knee arthroplasty in female and varus osteoarthritis knees

Nam

Koh

Kim³

et al. 2020

J Orthop Surg Res

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“…More external rotation of the femoral component with the measured resection technique can be attributed to cartilage wear of the medial condyle which has been reported by several researchers. 13,28 In the measured resection technique, the femoral component generally is placed in a condition of 3 or 5 degrees external rotation against the PCA using an instrument made by the implant manufacturer. However, Hamada et al 28 argued that wear of the medial cartilage can affect rotational alignment of the femoral component.…”

Section: Discussionmentioning

confidence: 99%

“…13,28 In the measured resection technique, the femoral component generally is placed in a condition of 3 or 5 degrees external rotation against the PCA using an instrument made by the implant manufacturer. However, Hamada et al 28 argued that wear of the medial cartilage can affect rotational alignment of the femoral component. They reported that the femoral component could be externally rotated more than the original target because of cartilage wear.…”

Section: Discussionmentioning

confidence: 99%

The Effects of Surgical Technique in Total Knee Arthroplasty for Varus Osteoarthritic Knee on the Rotational Alignment of Femoral Component: Gap Balancing Technique versus Measured Resection Technique

et al. 2019

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Few studies have compared the accuracy of femoral component rotation in the measured resection technique according to the preoperative computed tomography (CT) and gap balancing technique. The aim of this study was to evaluate whether there is a difference in accuracy and outlier incidence of femoral component rotation between gap balancing and measured resection techniques with or without preoperative CT and to evaluate the difference in patellofemoral alignment on simple radiographs and clinical outcomes. In this retrospective study, we evaluated femoral component rotation angle on the clinical and surgical transepicondylar axis (FCRA-cTEA and FCRA-sTEA, respectively), patellar tilt angle, lateral patellar displacement, and patient-reported outcomes in the gap balancing technique (Group 1) and in the measured resection technique without (Group 2) and with (Group 3) preoperative CT. A total of 163 total knee arthoplasty (TKA) replacements were included in this study. Average FCRA-cTEA was −3.4 ± 2.6, −2.8 ± 2.1, and −1.8 ± 2.3 degrees in groups 1 to 3, respectively (p = 0.002). Average FCRA-sTEA was −0.2 ± 2.7, 0.5 ± 2.4, and 1.5 ± 2.1 degrees, respectively (p = 0.001). In an outlier analysis that evaluated femoral component rotation using cTEA as reference, no significant difference was observed between the three groups (40.8, 37.3, and 23.7%, respectively, p = 0.133). When sTEA was used as a reference, groups 1 and 3 showed an outlier incidence of 8.2 and 8.5%, respectively, whereas this incidence was as high as 23.5% in group 2 (p = 0.030). No statistically significant group difference in patellofemoral alignment and patient-reported outcome was observed. In the measured resection technique with preoperative CT, the femoral component was externally rotated approximately 1 degree more than in the gap balancing or measured resection technique without preoperative CT. However, the difference in FCRA among the three techniques was not linked to the difference in patellofemoral alignment or patient-reported outcomes.

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Femoral cartilage thickness measured on MRI varies among individuals: Time to deepen one of the principles of kinematic alignment in total knee arthroplasty. A systematic review

Giurazza,

Caria,

Campi

et al. 2024

Knee surg. sports traumatol. arthrosc.

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PurposeKinematically aligned total knee arthroplasty (KA TKA), as a pure resurfacing procedure, is based on matching implant thickness with bone cut and kerf thickness, plus cartilage wear. However, the assumption of a consistent 2 mm femoral cartilage thickness remains unproven. This study aimed to systematically review the available literature concerning magnetic resonance imaging (MRI) assessment of femoral cartilage thickness in non‐arthritic patients. Our hypothesis was that cartilage thickness values would vary significantly among individuals, thereby challenging the established KA paradigm of ‘one‐cartilage‐fits‐all’.MethodsSystematic literature searches (Pubmed, Scopus and Cochrane Library) followed PRISMA guidelines. English‐language studies assessing distal and posterior femoral cartilage thickness using MRI in non‐arthritic adults were included. Studies lacking numerical cartilage thickness data, involving post‐operative MRI, considering total femoro‐tibial cartilage thickness, or failing to specify the compartment of the knee being studied were excluded.ResultsOverall, 27 studies comprising 8170 MRIs were analysed. Weighted mean femoral cartilage thicknesses were: 2.05 ± 0.62 mm (mean range 1.06–2.6) for the distal medial condyle, 1.95 ± 0.4 mm (mean range 1.15–2.5) for the distal lateral condyle, 2.44 ± 0.5 mm (mean range 1.37–2.6) for the posterior medial condyle and 2.27 ± 0.38 mm (mean range 1.48–2.5) for the posterior lateral condyle.DiscussionFemoral cartilage thickness varies significantly across patients. In KA TKA, relying on a fixed thickness of 2 mm may jeopardize the accurate restoration of individual anatomy, leading to errors in implant coronal and rotational alignment. An intraoperative assessment of cartilage thickness may be advisable to express the KA philosophy at its full potential.Level of EvidenceLevel IV.

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The Posterior Condylar Cartilage Affects Rotational Alignment of the Femoral Component in Varus Knee Osteoarthritis

Cited by 11 publications

References 23 publications

Effect of the presence of the articular cartilage on the femoral component rotation in total knee arthroplasty in female and varus osteoarthritis knees

Effect of the presence of the articular cartilage on the femoral component rotation in total knee arthroplasty in female and varus osteoarthritis knees

The Effects of Surgical Technique in Total Knee Arthroplasty for Varus Osteoarthritic Knee on the Rotational Alignment of Femoral Component: Gap Balancing Technique versus Measured Resection Technique

Femoral cartilage thickness measured on MRI varies among individuals: Time to deepen one of the principles of kinematic alignment in total knee arthroplasty. A systematic review

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