What Factors Are Associated With Femoral Component Internal Rotation in TKA Using the Gap Balancing Technique?

Lee, Seung Yup; Lim, Hong Chul; Jang, Ki-Mo; Bae, Ji Hoon

doi:10.1007/s11999-017-5319-4

Cited by 20 publications

(13 citation statements)

References 42 publications

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“…We emphasize with the GB technique, the proximal tibial cut directly influences femoral component rotation. A source of error that can cause abnormal femoral rotation with the GB technique is a tilted tibial cut that is not perpendicular to the tibial mechanical axis [42]. For example, if the tibia is cut in varus, the medial flexion gap will be bigger with the GB technique, requiring a smaller medial femoral bone cut in flexion.…”

Section: Discussionmentioning

confidence: 99%

Comparison of Gap Balancing vs Measured Resection Technique in Patients Undergoing Simultaneous Bilateral Total Knee Arthroplasty: One Technique per Knee

Tapasvi¹,

Shekhar²,

Patil

et al. 2020

The Journal of Arthroplasty

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Section: Discussionmentioning

confidence: 99%

Comparison of Gap Balancing vs Measured Resection Technique in Patients Undergoing Simultaneous Bilateral Total Knee Arthroplasty: One Technique per Knee

Tapasvi¹,

Shekhar²,

Patil

et al. 2020

The Journal of Arthroplasty

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“…Before discussing the outlier incidence of each technique, we believed that references used to evaluate femoral component rotation deserve attention. Although several studies used cTEA 9,10,12,24 and others used sTEA for this evaluation, 29,30 it is not yet clear which of the two axes is closer to the flexionextension axis of the knee. 31 Hence, it is necessary to carefully choose between sTEA and cTEA when evaluating femoral component rotation in these two techniques using postoperative CT. Because cTEA is externally rotated against the PCA approximately 3 to 4 degrees more than sTEA, 32 outlier incidence can be different depending on the choice of reference.…”

Section: Discussionmentioning

confidence: 99%

“…In the gap balancing technique, rotation of the femoral component can differ according to the intensity of joint distraction force applied during flexion gap preparation, and the varus or valgus tibial resection can cause malrotation of the femoral component. [7][8][9][10] In the measured resection technique, previous studies have reported that accurately and consistently identifying the anatomical landmark is difficult in surgical fields. 5 The measured resection technique has been implemented in diverse ways in several studies.…”

mentioning

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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“…Every 1° increment with NaviLDFA induced a 0.668° decrement in FCR and a 1° increment with XrayLDFA induced a 0.714° decrement. In gap-technique TKA, the rotational alignment of the femoral component is adjusted on the basis of the mediolateral flexion gap difference [ 4 ]. In the present study, neither lateral soft tissue tightness (LGVS) nor mediolateral soft tissue tension difference (STSD) were significant predictors of FCR.…”

Section: Discussionmentioning

confidence: 99%

“…In gap-technique TKA, the tibia is resected in advance, and anterior and posterior cuts of the femur are performed parallel to the tibial cut. As a consequence of this procedure, the rotation of the femoral component can vary freely with the restriction of the soft tissue release [ 3 , 4 ]. Use of a gap technique-based navigation system allows surgeons to quantify femoral component rotation based on the posterior condylar axis ( Fig 1 ) [ 4 , 5 ].…”

Section: Introductionmentioning

confidence: 99%

Factors affecting femoral rotational angle based on the posterior condylar axis in gap-based navigation-assisted total knee arthroplasty for valgus knee

Lee

Kim

et al. 2018

PLoS ONE

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BackgroundAchieving proper rotational alignment of the femoral component in total knee arthroplasty (TKA) for valgus knee is challenging because of lateral condylar hypoplasia and lateral cartilage erosion. Gap-based navigation-assisted TKA enables surgeons to determine the angle of femoral component rotation (FCR) based on the posterior condylar axis. This study evaluated the possible factors that affect the rotational alignment of the femoral component based on the posterior condylar axis.Materials and methodsBetween 2008 and 2016, 28 knees were enrolled. The dependent variable for this study was FCR based on the posterior condylar axis, which was obtained from the navigation system archives. Multiple regression analysis was conducted to identify factors that might predict FCR, including body mass index (BMI), Kellgren-Lawrence grade (K-L grade), lateral distal femoral angles obtained from the navigation system and radiographs (NaviLDFA, XrayLDFA), hip-knee-ankle (HKA) axis, lateral gap under varus stress (LGVS), medial gap under valgus stress (MGVS), and side-to-side difference (STSD, MGVS − LGVS).ResultsThe mean FCR was 6.1° ± 2.0°. Of all the potentially predictive factors evaluated in this study, only NaviLDFA (β = −0.668) and XrayLDFA (β = −0.714) predicted significantly FCR.ConclusionsThe LDFAs, as determined using radiographs and the navigation system, were both predictive of the rotational alignment of the femoral component based on the posterior condylar axis in gap-based TKA for valgus knee. A 1° increment with NaviLDFA led to a 0.668° decrement in FCR, and a 1° increment with XrayLDFA led to a 0.714° decrement. This suggests that symmetrical lateral condylar hypoplasia of the posterior and distal side occurs in lateral compartment end-stage osteoarthritis with valgus deformity.

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What Factors Are Associated With Femoral Component Internal Rotation in TKA Using the Gap Balancing Technique?

Abstract: Level III, therapeutic study.

Cited by 20 publications

References 42 publications

Comparison of Gap Balancing vs Measured Resection Technique in Patients Undergoing Simultaneous Bilateral Total Knee Arthroplasty: One Technique per Knee

Comparison of Gap Balancing vs Measured Resection Technique in Patients Undergoing Simultaneous Bilateral Total Knee Arthroplasty: One Technique per Knee

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

Factors affecting femoral rotational angle based on the posterior condylar axis in gap-based navigation-assisted total knee arthroplasty for valgus knee

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