JOURNAL ARTICLE

Rotational alignment of the distal femur: anthropometric measurements with CT-based patient-specific instruments planning show high variability of the posterior condylar angle

Emmanuel Thienpont, Pierre-Emmanuel Schwab, Frederic Paternostre, Peter Koch
Knee Surgery, Sports Traumatology, Arthroscopy: Official Journal of the ESSKA 2014, 22 (12): 2995-3002
24888223

PURPOSE: Finding the anatomical landmarks used for correct femoral axial alignment can be difficult. The posterior condylar line (PCL) is probably the easiest to find during surgery. The aim of this study was to analyse whether a predetermined fixed angle referencing of the PCL could help find the surgical epicondylar axis (SEA) and this based on a large CT database with enough Caucasian diversity to be representable.

METHODS: A total of 2,637 CT scans and 3D reconstructions from patients on four continents, executed for preoperative planning and creation of patient-specific instrumentation, were used to perform anthropometric measurements and to measure the posterior condylar angle (PCA) between the surgical epicondylar angle and the PCL.

RESULTS: The mean (SD) PCA was 4° (1.4°) of external rotation. A significant correlation was found between more external rotation of the SEA and more proximal varus of the tibia or more distal valgus of the femur. For 59% of the study population, 4° external rotation from the PCL would be the right amount of axial rotation to align the femoral component in line with the SEA. Nine per cent needs less, and 32% needs more than 4° of axial rotation. On 105 (4%) CT-based 3D models, external rotation between 7° and 11° was measured and 77 (73%) of those cases were in varus or neutral alignment. In 132 patients, bilateral measurements were available and 94 (71%) had rotation within 1° of the opposite side. This last finding underlines that there is even an intra-individual difference in distal femoral anatomy that can range from 1° to 5°.

CONCLUSIONS: This study was performed on a very large anthropometric CT and 3D models database and showed that there is a 41% risk of malalignment if a fixed PCA referenced of the PCL is used in total knee arthroplasty. The clinical importance of this study is the observation that femoral axial anatomy is individual and also that it is determined by the tibial anatomy. A group of patients needs more than the average external rotation because they have more distal femoral valgus with dysplastic condyles or more proximal tibial varus with a bigger medial condyle.

LEVEL OF EVIDENCE: III.

Full Text Links

Find Full Text Links for this Article

Discussion

You are not logged in. Sign Up or Log In to join the discussion.

Related Papers

Remove bar
Read by QxMD icon Read
24888223
×

Save your favorite articles in one place with a free QxMD account.

×

Search Tips

Use Boolean operators: AND/OR

diabetic AND foot
diabetes OR diabetic

Exclude a word using the 'minus' sign

Virchow -triad

Use Parentheses

water AND (cup OR glass)

Add an asterisk (*) at end of a word to include word stems

Neuro* will search for Neurology, Neuroscientist, Neurological, and so on

Use quotes to search for an exact phrase

"primary prevention of cancer"
(heart or cardiac or cardio*) AND arrest -"American Heart Association"