Total knee arthroplasty using trochlear groove as guide for position of femoral component in severe knee osteoarthritis

Abstract

BackgroundApart from transepicondylar axis, the native femoral sulcus was also reported to be used as a guide for the femoral component position in total knee arthroplasty (TKA). However, it was not shown in patients with severe knee osteoarthritis. This study was conducted to compare the position of trochlear groove in patients with and without osteoarthritis, and to assess whether trochlear groove could be used as a guide for position of femoral component in TKA for severe knee osteoarthritis.MethodsTotal 50 severe knee osteoarthritis patients (Kellgren Lawrence grade 3 or 4) who underwent TKA were included. Meanwhile, 50 patients who underwent arthroscopic surgery without osteoarthritis were included as control. The distance from trochlear groove to the midpoint of a virtual anterior condyle osteotomy line (parallel to the posterior condyle line) (a–b) was recorded by radiological and surgical measurements. Midpoint of transepicondylar axis and trochlear groove were used as guide for placing prosthesis model in TKA, respectively. No-thumb test was performed to assess the patellar tracking. The position of femoral component was finally performed using trochlear groove as guide in TKA.ResultsValue of “a–b” was significantly different between osteoarthritic and control knees (P = 0.008). During the placement of prosthesis model, similar patellar tracking was detected between using midpoint of transepicondylar axis and trochlear groove as guide (P > 0.05). After placing femoral component using trochlear groove as guide, most patients obtained good patellofemoral congruence with pneumatic tourniquet inflated (n = 43) or deflated (n = 5), and good patellofemoral congruence was also obtained by lateral patellar retinaculum release in two patients.ConclusionDespite the shifting of trochlear groove caused by severe knee osteoarthritis, trochlear groove can be used as a guide for position of femoral component, with equivalent patellar tracking compared with transepicondylar axis.

HURWA robotic-assisted total knee arthroplasty improves component positioning and alignment – A prospective randomized and multicenter study

“…Although new prosthesis and surgical instruments with more perfect design are constantly coming out, and the surgical technology of the operator is also improving year by year, TKA has not yet become a perfect operation, and its postoperative dissatisfaction rate is as high as 20% [ 39 , 40 ]. The main cause is that TKA has high requirements on the position of prosthesis placement, reconstruction of lower limb force line and maintenance of postoperative stability, while manual operation is difficult to ensure the accuracy and consistency of surgical operation [ [41] , [42] , [43] ]. Therefore, poor prosthesis position and poor alignment of lower limb occur from time to time, which seriously affects the stability of knee joint and recovery of motor function and the long-term survival rate and postoperative satisfaction of patients were reduced.…”

The shape and orientation of the trochlea run more parallel to the posterior condylar line than generally believed

“…Aside from the ATL, previous studies proposed the trochlear groove as an additional rotational landmark by stating that the native femoral sulcus could be used as a guide for the femoral component position in TKA surgery [8, 9, 27, 28]. Recently, Huang et al [13] confirmed this role of the native femoral sulcus in patients with severe osteoarthritis. In addition, Talbot et al [28] reported that the sulcus line of the trochlear groove is more accurate than Whiteside's line in determining femoral component rotation.…”

Effect of knee joint function training on joint functional rehabilitation after knee replacement

“…[ 10 ] The preferred treatment option for treating such condition is knee joint replacement (KJR). [ 11 – 13 ] However, some patients still suffer from severe knee pain and poor quality of life after KJR. [ 14 , 15 ]…”