Impact of posterior femoral condylar cartilage and posterior intercondylar distance on rotation of femoral component in total knee arthroplasty
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 use...
| Main Authors: | , , , , , |
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| Format: | Article |
| Language: | English |
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BMC
2020-07-01
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| Series: | BMC Musculoskeletal Disorders |
| Subjects: | |
| Online Access: | http://link.springer.com/article/10.1186/s12891-020-03537-2 |
| _version_ | 1819068010164387840 |
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| author | Teruyuki Miyasaka Mitsuru Saito Daisaburo Kurosaka Ryo Ikeda Shoki Yamanaka Keishi Marumo |
| author_facet | Teruyuki Miyasaka Mitsuru Saito Daisaburo Kurosaka Ryo Ikeda Shoki Yamanaka Keishi Marumo |
| author_sort | Teruyuki Miyasaka |
| collection | DOAJ |
| description | 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. |
| first_indexed | 2024-12-21T16:27:21Z |
| format | Article |
| id | doaj.art-51517a7cb9684c06ac9fa188bfa1d304 |
| institution | Directory Open Access Journal |
| issn | 1471-2474 |
| language | English |
| last_indexed | 2024-12-21T16:27:21Z |
| publishDate | 2020-07-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Musculoskeletal Disorders |
| spelling | doaj.art-51517a7cb9684c06ac9fa188bfa1d3042022-12-21T18:57:25ZengBMCBMC Musculoskeletal Disorders1471-24742020-07-012111810.1186/s12891-020-03537-2Impact of posterior femoral condylar cartilage and posterior intercondylar distance on rotation of femoral component in total knee arthroplastyTeruyuki Miyasaka0Mitsuru Saito1Daisaburo Kurosaka2Ryo Ikeda3Shoki Yamanaka4Keishi Marumo5Department of Orthopaedic Surgery, Toshima HospitalDepartment of Orthopaedic Surgery, Jikei University School of MedicineDepartment of Orthopaedic Surgery, Jikei University School of MedicineDepartment of Orthopaedic Surgery, Jikei University School of MedicineDepartment of Orthopaedic Surgery, Toshima HospitalDepartment of Orthopaedic Surgery, Jikei University School of MedicineAbstract 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.http://link.springer.com/article/10.1186/s12891-020-03537-2Femoral componentRotational alignmentArticular cartilageTotal knee arthroplastyRadiographsPosterior condyle |
| spellingShingle | Teruyuki Miyasaka Mitsuru Saito Daisaburo Kurosaka Ryo Ikeda Shoki Yamanaka Keishi Marumo Impact of posterior femoral condylar cartilage and posterior intercondylar distance on rotation of femoral component in total knee arthroplasty BMC Musculoskeletal Disorders Femoral component Rotational alignment Articular cartilage Total knee arthroplasty Radiographs Posterior condyle |
| title | Impact of posterior femoral condylar cartilage and posterior intercondylar distance on rotation of femoral component in total knee arthroplasty |
| title_full | Impact of posterior femoral condylar cartilage and posterior intercondylar distance on rotation of femoral component in total knee arthroplasty |
| title_fullStr | Impact of posterior femoral condylar cartilage and posterior intercondylar distance on rotation of femoral component in total knee arthroplasty |
| title_full_unstemmed | Impact of posterior femoral condylar cartilage and posterior intercondylar distance on rotation of femoral component in total knee arthroplasty |
| title_short | Impact of posterior femoral condylar cartilage and posterior intercondylar distance on rotation of femoral component in total knee arthroplasty |
| title_sort | impact of posterior femoral condylar cartilage and posterior intercondylar distance on rotation of femoral component in total knee arthroplasty |
| topic | Femoral component Rotational alignment Articular cartilage Total knee arthroplasty Radiographs Posterior condyle |
| url | http://link.springer.com/article/10.1186/s12891-020-03537-2 |
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