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J Knee Surg 2020; 33(10): 971-977
DOI: 10.1055/s-0039-1688931
Original Article

Incidence of Femoral Component Malrotation Using Posterior Condylar Referencing in Total Knee Arthroplasty

Diana K. Lee
1   Department of Orthopaedic Surgery, Center for Hip and Knee Replacement (CHKR), NewYork-Presbyterian Hospital at Columbia University Medical Center, New York
,
Matthew J. Grosso
1   Department of Orthopaedic Surgery, Center for Hip and Knee Replacement (CHKR), NewYork-Presbyterian Hospital at Columbia University Medical Center, New York
,
David P. Trofa
1   Department of Orthopaedic Surgery, Center for Hip and Knee Replacement (CHKR), NewYork-Presbyterian Hospital at Columbia University Medical Center, New York
,
Julian J. Sonnenfeld
1   Department of Orthopaedic Surgery, Center for Hip and Knee Replacement (CHKR), NewYork-Presbyterian Hospital at Columbia University Medical Center, New York
,
H. John Cooper
1   Department of Orthopaedic Surgery, Center for Hip and Knee Replacement (CHKR), NewYork-Presbyterian Hospital at Columbia University Medical Center, New York
,
Roshan P. Shah
1   Department of Orthopaedic Surgery, Center for Hip and Knee Replacement (CHKR), NewYork-Presbyterian Hospital at Columbia University Medical Center, New York
,
Jeffrey A. Geller
1   Department of Orthopaedic Surgery, Center for Hip and Knee Replacement (CHKR), NewYork-Presbyterian Hospital at Columbia University Medical Center, New York
› Institutsangaben Funding None.
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Abstract

Proper femoral component rotation in total knee arthroplasty (TKA) is important, given the prognostic impact of a poorly positioned component. The purpose of this observational study was to determine the incidence of femoral component malrotation using posterior condylar axis (PCA) referencing. A total of 100 knees in 92 patients with varus gonarthritis of the knee undergoing primary TKA using a standard medial parapatellar approach were evaluated intraoperatively. After distal femoral resection, the standard femoral sizing guide referencing the posterior condylar axis was used to set femoral component rotation. This was then compared with both the transepicondylar (TEA) and trochlear anteroposterior axes (TRAx). Disparites were recorded and corrected in line with the epicondylar axis. Rotational adjustment for addition of further external rotation was made in 13 (13.0%) cases. In seven cases, the medial pin sites were raised between 1 and 3 mm, and in six cases, the lateral pin site was lowered between 1 and 3 mm (based on risk of notching the femoral cortex). It is critical to not rely exclusively on the PCA to confirm rotational positioning of the femoral component as predicted by posterior condylar referencing guides. Intraoperative adjustment and confirmation using the TEA and TRAx occurred in 13% of primary TKA cases, which might have, otherwise, had a significant effect on the clinical outcome.

Keywords

total knee arthroplasty - femoral component rotation - transepicondylar


Publikationsverlauf

Eingereicht: 01. Februar 2018

Angenommen: 05. April 2019

Artikel online veröffentlicht:
20. Mai 2019

© 2020. Thieme. All rights reserved.

Thieme Medical Publishers
333 Seventh Avenue, New York, NY 10001, USA.

 

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