Importance of Three-Dimensional Evaluation of Surgical Transepicondylar Axis in Total Knee Arthroplasty

Abstract

In total knee arthroplasty, the surgical transepicondylar axis (SEA) is one of the most reliable rotation axes for stabilizing of the patellofemoral joint. The SEA is identified with reference to the lateral epicondyle and the medial sulcus of the medial epicondyle. However, these two structures rarely appear on the same plane on computed tomography (CT), and it is necessary to take two points in separate images. Many surgeons measure the SEA on the same image (pseudo SEA) instead. We aimed to determine the difference between true SEAs and pseudo SEAs. A total of 31 normal knees and 24 varus knees were included in this study. Three-dimensional (3D) models of the femur were reconstructed from CT images, and a reconstructed plane was made using the International Society of Biomechanics coordinate system. Pseudo SEAs drawn in the plane passing through the lateral epicondyle and medial sulcus were defined as l-SEA and m-SEA, respectively. L-SEA, m-SEA, true SEA, and posterior condylar axis (PCA) were projected onto the International Society of Biomechanics coordinate plane and, “p l-SEA,” “p m-SEA,” “p true SEA,” and “p PCA” were obtained. The true SEA angle was defined as the angle between p true SEA and p PCA. The l-SEA angle or m-SEA angle was defined as the angle between the p l-SEA or p m-SEA and p PCA, respectively. There were no statistically significant differences between true SEA angle (2.64 ± 2.01 degrees) and pseudo SEA angle (l-SEA angle: 2.74 ± 2.07 degrees, m-SEA: 2.54 ± 2.19 degrees). Conversely, 12 knees in the normal group and 2 knees in the varus group had differences of more than 1 degree (p = 0.01). Among them, 6 knees in the normal group and 0 knees in the varus group had a difference of 2 degrees or more (p = 0.03). In most cases, pseudo SEA can be substituted for true SEA.

Keywords

total knee arthroplasty - true surgical transepicondylar axis - pseudo surgical transepicondylar axis

Publikationsverlauf

Eingereicht: 28. Dezember 2019

Angenommen: 31. März 2020

Artikel online veröffentlicht:
08. Juni 2020

• 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
• 2 Akagi M, Mori S, Nishimura S, Nishimura A, Asano T, Hamanishi C. Variability of extraarticular tibial rotation references for total knee arthroplasty. Clin Orthop Relat Res 2005; (436) 172-176
• 3 Berger RA, Rubash HE, Seel MJ, Thompson WH, Crossett LS. Determining the rotational alignment of the femoral component in total knee arthroplasty using the epicondylar axis. Clin Orthop Relat Res 1993; (286) 40-47
• 4 Dalury DF. Observations of the proximal tibia in total knee arthroplasty. Clin Orthop Relat Res 2001; (389) 150-155
• 5 Moreland JR. Mechanisms of failure in total knee arthroplasty. Clin Orthop Relat Res 1988; (226) 49-64
• 6 Yoshioka Y, Siu DW, Scudamore RA, Cooke TD. Tibial anatomy and functional axes. J Orthop Res 1989; 7 (01) 132-137
• 7 Akagi M, Oh M, Nonaka T, Tsujimoto H, Asano T, Hamanishi C. An anteroposterior axis of the tibia for total knee arthroplasty. Clin Orthop Relat Res 2004; (420) 213-219
• 8 Ohmori T, Kabata T, Kajino Y. et al. A proposed new rotating reference axis for the tibial component after proximal tibial resection in total knee arthroplasty. PLoS One 2018; 13 (12) e0209317
• 9 Bédard M, Vince KG, Redfern J, Collen SR. Internal rotation of the tibial component is frequent in stiff total knee arthroplasty. Clin Orthop Relat Res 2011; 469 (08) 2346-2355
• 10 Nicoll D, Rowley DI. Internal rotational error of the tibial component is a major cause of pain after total knee replacement. J Bone Joint Surg Br 2010; 92 (09) 1238-1244
• 11 Berger RA, Crossett LS, Jacobs JJ, Rubash HE. Malrotation causing patellofemoral complications after total knee arthroplasty. Clin Orthop Relat Res 1998; (356) 144-153
• 12 Olcott CW, Scott RD. The Ranawat Award. Femoral component rotation during total knee arthroplasty. Clin Orthop Relat Res 1999; (367) 39-42
• 13 Arima J, Whiteside LA, McCarthy DS, White SE. Femoral rotational alignment, based on the anteroposterior axis, in total knee arthroplasty in a valgus knee. A technical note. J Bone Joint Surg Am 1995; 77 (09) 1331-1334
• 14 Whiteside LA, Arima J. The anteroposterior axis for femoral rotational alignment in valgus total knee arthroplasty. Clin Orthop Relat Res 1995; (321) 168-172
• 15 Poilvache PL, Insall JN, Scuderi GR, Font-Rodriguez DE. Rotational landmarks and sizing of the distal femur in total knee arthroplasty. Clin Orthop Relat Res 1996; (331) 35-46
• 16 Saffarini M, Nover L, Tandogan R. et al. The original Akagi line is the most reliable: a systematic review of landmarks for rotational alignment of the tibial component in TKA. Knee Surg Sports Traumatol Arthrosc 2019; 27 (04) 1018-1027
• 17 Patel AR, Talati RK, Yaffe MA, McCoy BW, Stulberg SD. Femoral component rotation in total knee arthroplasty: an MRI-based evaluation of our options. J Arthroplasty 2014; 29 (08) 1666-1670
• 18 Eckhoff DG, Burke BJ, Dwyer TF, Pring ME, Spitzer VM, VanGerwen DP. The Ranawat Award. Sulcus morphology of the distal femur. Clin Orthop Relat Res 1996; (331) 23-28
• 19 Ohmori T, Kabata T, Kajino Y. et al. The accuracy of the “projected surgical transepicondylar axis” relative to the “true surgical transepicondylar axis” in total knee arthroplasty. Knee 2017; 24 (06) 1428-1434
• 20 Yau WP, Chiu KY, Tang WM. How precise is the determination of rotational alignment of the femoral prosthesis in total knee arthroplasty: an in vivo study. J Arthroplasty 2007; 22 (07) 1042-1048
• 21 Yoshino N, Takai S, Ohtsuki Y, Hirasawa Y. Computed tomography measurement of the surgical and clinical transepicondylar axis of the distal femur in osteoarthritic knees. J Arthroplasty 2001; 16 (04) 493-497
• 22 Griffin FM, Math K, Scuderi GR, Insall JN, Poilvache PL. Anatomy of the epicondyles of the distal femur: MRI analysis of normal knees. J Arthroplasty 2000; 15 (03) 354-359
• 23 Olcott CW, Scott RD. A comparison of 4 intraoperative methods to determine femoral component rotation during total knee arthroplasty. J Arthroplasty 2000; 15 (01) 22-26
• 24 Griffin FM, Insall JN, Scuderi GR. The posterior condylar angle in osteoarthritic knees. J Arthroplasty 1998; 13 (07) 812-815
• 25 Inui H, Taketomi S, Nakamura K, Sanada T, Tanaka S, Nakagawa T. An additional reference axis improves femoral rotation alignment in image-free computer navigation assisted total knee arthroplasty. J Arthroplasty 2013; 28 (05) 766-771
• 26 Kanekasu K, Kondo M, Kadoya Y. Axial radiography of the distal femur to assess rotational alignment in total knee arthroplasty. Clin Orthop Relat Res 2005; (434) 193-197
• 27 Tashiro Y, Uemura M, Matsuda S. et al. Articular cartilage of the posterior condyle can affect rotational alignment in total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 2012; 20 (08) 1463-1469
• 28 Ohmori T, Kabata T, Kajino Y. et al. Usefulness of the “grand-piano sign” for determining femoral rotational alignment in total knee arthroplasty. Knee 2018; 25 (01) 15-24
• 29 Watanabe H, Gejo R, Matsuda Y, Tatsumi I, Hirakawa K, Kimura T. Femoral anterior tangent line of the osteoarthritic knee for determining rotational alignment of the femoral component in total knee arthroplasty. J Arthroplasty 2011; 26 (02) 268-273
• 30 Watanabe H, Gejo R, Tokunaga A, Hirano N, Kimura T. Intraoperative measurements of femoral anterior tangent (FAT) line for determining the rotational alignment of femoral component of total knee arthroplasty. J Arthroplasty 2013; 28 (10) 1757-1759
• 31 Oshima Y, Iizawa N, Kataoka T, Majima T, Takai S. A computed-tomography-scan-based template to place the femoral component in accurate rotation with respect to the surgical epicondylar axis in total knee arthroplasty. Knee 2018; 25 (01) 195-202
• 32 Longstaff LM, Sloan K, Stamp N, Scaddan M, Beaver R. Good alignment after total knee arthroplasty leads to faster rehabilitation and better function. J Arthroplasty 2009; 24 (04) 570-578
• 33 Kingsley PC, Olmsted KL. A study to determine the angle of anteversion of the neck of the femur. J Bone Joint Surg Am 1948; 30A [phone]