The posterior cortical axis as an alternative reference for femoral component placement in total knee arthroplasty
Abstract Background Although several reference axes have been established for determining femoral rotational alignment during total knee arthroplasty (TKA), the most accurate axis is undetermined. This study determines the relationship between the posterior cortical axis (PCA) and the trochlear ante...
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| Format: | Article |
| Language: | English |
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BMC
2020-12-01
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| Series: | Journal of Orthopaedic Surgery and Research |
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| Online Access: | https://doi.org/10.1186/s13018-020-02146-y |
| _version_ | 1817991879672725504 |
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| author | Ji-Hoon Nam Yong-Gon Koh Kiwon Kang Joon-Hee Park Kyoung-Tak Kang |
| author_facet | Ji-Hoon Nam Yong-Gon Koh Kiwon Kang Joon-Hee Park Kyoung-Tak Kang |
| author_sort | Ji-Hoon Nam |
| collection | DOAJ |
| description | Abstract Background Although several reference axes have been established for determining femoral rotational alignment during total knee arthroplasty (TKA), the most accurate axis is undetermined. This study determines the relationship between the posterior cortical axis (PCA) and the trochlear anterior line (TAL) of the femur in relation to the epicondylar axis. Methods A total of 341 patients who underwent TKA for osteoarthritis were enrolled. Patients who had undergone previous bony surgery or replacement that might have changed the femoral geometry were excluded. Finally, 336 patients (200 females and 136 males) were included in the study. The angles between the transepicondylar axis (TEA) and TAL and TEA and the femoral PCA (FPCA) were evaluated. We also assessed whether there was any significant differences in variance and gender in these two angles. Student’s t tests were used to determine the significance of coronal alignment and any gender-based differences. The variances between the TAL/TEA and FPCA/TEA angles were compared using F tests. Results The FPCA was externally rotated by 2.6° ± 3.6°, and the trochlear anterior line was internally rotated by 5.2° ± 5.5°, relative to the TEA. Gender-based differences were observed in the comparisons between anatomical references and TEA. Conclusions The FPCA is a more conservative landmark than the TAL for intraoperative or postoperative approximation of the TEA. When conventional reference axes, such as the posterior condylar axis and the anteroposterior axis, are inaccurate, surgeons can refer to this alternative reference. These findings demonstrate that the FPCA may be useful for determining the rotational alignment of the femoral component before and during TKA. |
| first_indexed | 2024-04-14T01:18:44Z |
| format | Article |
| id | doaj.art-dcf3f54ac9b64ed39377aea657da3ed5 |
| institution | Directory Open Access Journal |
| issn | 1749-799X |
| language | English |
| last_indexed | 2024-04-14T01:18:44Z |
| publishDate | 2020-12-01 |
| publisher | BMC |
| record_format | Article |
| series | Journal of Orthopaedic Surgery and Research |
| spelling | doaj.art-dcf3f54ac9b64ed39377aea657da3ed52022-12-22T02:20:45ZengBMCJournal of Orthopaedic Surgery and Research1749-799X2020-12-011511610.1186/s13018-020-02146-yThe posterior cortical axis as an alternative reference for femoral component placement in total knee arthroplastyJi-Hoon Nam0Yong-Gon Koh1Kiwon Kang2Joon-Hee Park3Kyoung-Tak Kang4Department of Mechanical Engineering, Yonsei UniversityJoint Reconstruction Center, Department of Orthopaedic Surgery, Yonsei Sarang HospitalOrthopaedic Clinic, Gaja Yonsei HospitalDepartment of Anesthesiology & Pain Medicine, Hallym University College of Medicine and Kangdong Sacred Heart HospitalDepartment of Mechanical Engineering, Yonsei UniversityAbstract Background Although several reference axes have been established for determining femoral rotational alignment during total knee arthroplasty (TKA), the most accurate axis is undetermined. This study determines the relationship between the posterior cortical axis (PCA) and the trochlear anterior line (TAL) of the femur in relation to the epicondylar axis. Methods A total of 341 patients who underwent TKA for osteoarthritis were enrolled. Patients who had undergone previous bony surgery or replacement that might have changed the femoral geometry were excluded. Finally, 336 patients (200 females and 136 males) were included in the study. The angles between the transepicondylar axis (TEA) and TAL and TEA and the femoral PCA (FPCA) were evaluated. We also assessed whether there was any significant differences in variance and gender in these two angles. Student’s t tests were used to determine the significance of coronal alignment and any gender-based differences. The variances between the TAL/TEA and FPCA/TEA angles were compared using F tests. Results The FPCA was externally rotated by 2.6° ± 3.6°, and the trochlear anterior line was internally rotated by 5.2° ± 5.5°, relative to the TEA. Gender-based differences were observed in the comparisons between anatomical references and TEA. Conclusions The FPCA is a more conservative landmark than the TAL for intraoperative or postoperative approximation of the TEA. When conventional reference axes, such as the posterior condylar axis and the anteroposterior axis, are inaccurate, surgeons can refer to this alternative reference. These findings demonstrate that the FPCA may be useful for determining the rotational alignment of the femoral component before and during TKA.https://doi.org/10.1186/s13018-020-02146-ySouth Korean patientsTrochlear anterior lineFemoral posterior cortical axisMorphometryTotal knee replacement |
| spellingShingle | Ji-Hoon Nam Yong-Gon Koh Kiwon Kang Joon-Hee Park Kyoung-Tak Kang The posterior cortical axis as an alternative reference for femoral component placement in total knee arthroplasty Journal of Orthopaedic Surgery and Research South Korean patients Trochlear anterior line Femoral posterior cortical axis Morphometry Total knee replacement |
| title | The posterior cortical axis as an alternative reference for femoral component placement in total knee arthroplasty |
| title_full | The posterior cortical axis as an alternative reference for femoral component placement in total knee arthroplasty |
| title_fullStr | The posterior cortical axis as an alternative reference for femoral component placement in total knee arthroplasty |
| title_full_unstemmed | The posterior cortical axis as an alternative reference for femoral component placement in total knee arthroplasty |
| title_short | The posterior cortical axis as an alternative reference for femoral component placement in total knee arthroplasty |
| title_sort | posterior cortical axis as an alternative reference for femoral component placement in total knee arthroplasty |
| topic | South Korean patients Trochlear anterior line Femoral posterior cortical axis Morphometry Total knee replacement |
| url | https://doi.org/10.1186/s13018-020-02146-y |
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