Abstract:
BACKGROUND:Greater accuracy is needed when determining the final femoral component (FC) rotation during total knee arthroplasty (TKA), because this parameter affects soft tissue balance during flexion and patellar tracking. Anatomical markers, such as the epicondylar axis, are typically used to determine the final FC rotation, although intraoperative confirmation may be challenging. Therefore, rotational position is frequently determined with the posterior condylar axis (PCA) as a landmark. However, the thickness of the posterior condylar cartilage has not been considered and may not be represented on preoperative images. We used plain X-rays to measure the thickness of the medial and lateral posterior condylar cartilage fragments postoperatively, and investigated the effects of differences in cartilage thickness on final FC rotation. METHODS:Fifty knees (19 men, 31 women) underwent primary TKA to treat medial knee osteoarthritis at our hospital between August 2015 and May 2017. All knees were treated using an Attune PS (DePuy Synthes, Inc., Warsaw, IN). We first measured the distance between the posterior femoral condyles, resected the posterior condyle, and measured the thickness of the resected cartilage fragments. We then took X-ray images from a direction tangential to the osteotomy surface, secured the cartilage fragments with digital calipers, and measured the thickness of the cartilage. We investigated the effects of differences in cartilage thickness on final FC rotation of the residual medial and lateral cartilage with a trigonometric function. RESULTS:Medial condylar cartilage thickness averaged 0.6 ± 0.5 mm and the lateral condylar thickness averaged 1.8 ± 0.6 mm; posterior intercondylar distance averaged 46.1 ± 3.3 mm and average impact on rotation of the cartilage remnant was 1.5 ± 0.9° (- 0.1-3.9°). There may be measurement error of up to 4° in the maximum values compared with the preoperative plan in cases with short intercondylar distance. CONCLUSIONS:In cases where the FC external rotation angle is determined using the posterior condyles as landmarks, this angle can be affected by the intercondylar distance, especially in Japanese women who have small physical stature. This angle can potentially be much larger, so caution is advised. Our results suggest that several anatomical landmarks should be referenced to achieve accurate FC rotation.
journal_name
BMC Musculoskelet Disordjournal_title
BMC musculoskeletal disordersauthors
Miyasaka T,Saito M,Kurosaka D,Ikeda R,Yamanaka S,Marumo Kdoi
10.1186/s12891-020-03537-2subject
Has Abstractpub_date
2020-07-28 00:00:00pages
498issue
1issn
1471-2474pii
10.1186/s12891-020-03537-2journal_volume
21pub_type
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journal_title:BMC musculoskeletal disorders
pub_type: 杂志文章
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pub_type: 杂志文章
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更新日期:2016-07-16 00:00:00
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journal_title:BMC musculoskeletal disorders
pub_type: 杂志文章
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pub_type: 杂志文章,随机对照试验
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更新日期:2009-04-23 00:00:00
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pub_type: 临床试验,杂志文章
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