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J Knee Surg 2014; 27(04): 303-308
DOI: 10.1055/s-0033-1361950
Original Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Anterior Referencing versus Posterior Referencing in Total Knee Arthroplasty

Alexander A. Fokin
1   Department of Clinical Research, Heekin Institute for Orthopedic Research, Jacksonville, Florida
,
Richard D. Heekin
2   Department of Orthopedics, St. Vincent's Medical Center, Jacksonville, Florida
› Author Affiliations
Further Information

Publication History

21 May 2013

27 October 2013

Publication Date:
27 November 2013 (online)

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Abstract

Appropriate femoral component positioning and sizing is essential for proper kinematic function in total knee arthroplasty (TKA). Anterior or posterior referencing (AR or PR) are two major techniques for setting center of rotation and for balancing the sagittal plane of the arthroplasty. Both techniques have advantages and disadvantages. Minimally invasive surgical (MIS) TKA has added yet another aspect to intraoperative techniques and postoperative outcomes. A total of 100 consecutive patients undergoing unilateral MIS TKA were prospectively randomized to either AR or PR. Knee Society Scores, range of motion, SF-12, and strength testing by Cybex dynamometer were evaluated at standardized intervals postoperatively for 2 years. There were no statistically significant differences in surgical (incision length, surgical release, blood loss, surgical time, and length of stay) or clinical outcomes between two groups at all postoperative intervals (2 and 6 weeks, 3 and 6 months, and 1 and 2 years). Results demonstrate that both AR and PR are effective and can be used successfully during MIS TKA.

Keywords

anterior referencing - posterior referencing - knee arthroplasty
 

  • References

  • 1 Barrack RL, Schrader T, Bertot AJ, Wolfe MW, Myers L. Component rotation and anterior knee pain after total knee arthroplasty. Clin Orthop Relat Res 2001; (392) 46-55
    PubMedGoogle Scholar
  • 2 Kienapfel H, Springorum HP, Ziegler A, Klose KJ, Georg C, Griss P. -Effect of rotation of the femoral and tibial components on patellofemoral malalignment in knee arthroplasty-. Orthopade 2003; 32 (4) 312-318
    CrossrefPubMedGoogle Scholar
  • 3 Matsuda S, Miura H, Nagamine R, Urabe K, Hirata G, Iwamoto Y. Effect of femoral and tibial component position on patellar tracking following total knee arthroplasty: 10-year follow-up of Miller-Galante I knees. Am J Knee Surg 2001; 14 (3) 152-156
    PubMedGoogle Scholar
  • 4 D'Lima DD, Chen PC, Colwell Jr CW. Polyethylene contact stresses, articular congruity, and knee alignment. Clin Orthop Relat Res 2001; (392) 232-238
    PubMedGoogle Scholar
  • 5 Zhang Z, Zhu W, Gu B, Zhu L, Chen C. Mini-midvastus versus mini-medial parapatellar approach in total knee arthroplasty: a prospective, randomized study. Arch Orthop Trauma Surg 2013; 133 (3) 389-395
    CrossrefPubMedGoogle Scholar
  • 6 Haas SB, Macdessi SJ, Manitta MA. Mini-midvastus total knee arthroplasty. In: Scuderi GR, Tria AJ, , eds. Minimally Invasive Surgery in Orthopedics. New York: Springer; 2010: 293-300
    CrossrefGoogle Scholar
  • 7 Thienpont E. Faster recovery after minimally invasive surgery in total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 2013; 21 (10) 2412-2417
    CrossrefPubMedGoogle Scholar
  • 8 Bonutti PM, Zywiel MG, McGrath MS, Mont MA. Surgical techniques for minimally invasive exposures for total knee arthroplasty. Instr Course Lect 2010; 59: 83-91
    PubMedGoogle Scholar
  • 9 Manson TT, Khanuja HS, Jacobs MA, Hungerford MW. Sagittal plane balancing in the total knee arthroplasty. J Surg Orthop Adv 2009; 18 (2) 83-92
    PubMedGoogle Scholar
  • 10 Bellemans J, Banks S, Victor J, Vandenneucker H, Moemans A. Fluoroscopic analysis of the kinematics of deep flexion in total knee arthroplasty. Influence of posterior condylar offset. J Bone Joint Surg Br 2002; 84 (1) 50-53
    CrossrefPubMedGoogle Scholar
  • 11 Biasca N, Schneider TO, Bungartz M. Minimally invasive computer-navigated total knee arthroplasty. Orthop Clin North Am 2009; 40 (4) 537-563
    CrossrefPubMedGoogle Scholar
  • 12 Ng FY, Jiang XF, Zhou WZ, Chiu KY, Yan CH, Fok MW. The accuracy of sizing of the femoral component in total knee replacement. Knee Surg Sports Traumatol Arthrosc 2013; 21 (10) 2309-2313
    CrossrefPubMedGoogle Scholar
  • 13 Page SR, Pinzuti JB, Deakin AH, Payne AP, Picard F. Profile of the distal femur anterior cortex—a computer-assisted cadaveric study. Orthop Traumatol Surg Res 2011; 97 (8) 821-825
    CrossrefPubMedGoogle Scholar
  • 14 Cui WQ, Won YY, Baek MH, Kim KK, Cho JH. Variations of the 'grand-piano sign' during total knee replacement. A computer-simulation study. J Bone Joint Surg Br 2006; 88 (11) 1441-1447
    PubMedGoogle Scholar
  • 15 Middleton FR, Palmer SH. How accurate is Whiteside's line as a reference axis in total knee arthroplasty?. Knee 2007; 14 (3) 204-207
    CrossrefPubMedGoogle Scholar
  • 16 Callaghan JJ, O'rourke MR, Saleh KJ. Why knees fail: lessons learned. J Arthroplasty 2004; 19 (4) (Suppl. 01) 31-34
    CrossrefPubMedGoogle Scholar
  • 17 Laskin RS, Beksac B. Stiffness after total knee arthroplasty. J Arthroplasty 2004; 19 (4) (Suppl. 01) 41-46
    PubMedGoogle Scholar
  • 18 Hirsh DM, Bhalla S, Roffman M. Supracondylar fracture of the femur following total knee replacement. Report of four cases. J Bone Joint Surg Am 1981; 63 (1) 162-163
    PubMedGoogle Scholar
  • 19 Zalzal P, Backstein D, Gross AE, Papini M. Notching of the anterior femoral cortex during total knee arthroplasty characteristics that increase local stresses. J Arthroplasty 2006; 21 (5) 737-743
    CrossrefPubMedGoogle Scholar
  • 20 Lesh ML, Schneider DJ, Deol G, Davis B, Jacobs CR, Pellegrini Jr VD. The consequences of anterior femoral notching in total knee arthroplasty. A biomechanical study. J Bone Joint Surg Am 2000; 82-A (8) 1096-1101
    PubMedGoogle Scholar
  • 21 Culp RW, Schmidt RG, Hanks G, Mak A, Esterhai Jr JL, Heppenstall RB. Supracondylar fracture of the femur following prosthetic knee arthroplasty. Clin Orthop Relat Res 1987; (222) 212-222
    PubMedGoogle Scholar
  • 22 Ritter MA, Thong AE, Keating EM , et al. The effect of femoral notching during total knee arthroplasty on the prevalence of postoperative femoral fractures and on clinical outcome. J Bone Joint Surg Am 2005; 87 (11) 2411-2414
    CrossrefPubMedGoogle Scholar
  • 23 Merkel KD, Johnson Jr EW. Supracondylar fracture of the femur after total knee arthroplasty. J Bone Joint Surg Am 1986; 68 (1) 29-43
    PubMedGoogle Scholar