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J Knee Surg 2022; 35(03): 280-287
DOI: 10.1055/s-0040-1713733
Original Article

The Relationship of Transepicondylar Width with the Distal and Posterior Femoral Condyles and Its Clinical Implications: A Three-Dimensional Study

Merrill Lee 
1   Department of Orthopaedic Surgery, Singapore General Hospital, Singapore, Singapore
,
Jade Pei Yuik Ho
2   Department of Orthopaedic Surgery, National Orthopaedic Center of Excellence for Research and Learning, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
,
Jerry Yongqiang Chen
1   Department of Orthopaedic Surgery, Singapore General Hospital, Singapore, Singapore
,
Chung Kia Ng
2   Department of Orthopaedic Surgery, National Orthopaedic Center of Excellence for Research and Learning, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
,
Seng Jin Yeo
1   Department of Orthopaedic Surgery, Singapore General Hospital, Singapore, Singapore
,
Azhar M. Merican 
2   Department of Orthopaedic Surgery, National Orthopaedic Center of Excellence for Research and Learning, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
› Author Affiliations Funding None.
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Abstract

Background Restoration of the anatomical joint line, while important for clinical outcomes, is difficult to achieve in revision total knee arthroplasty (rTKA) due to distal femoral bone loss. The objective of this study was to determine a reliable method of restoring the anatomical joint line and posterior condylar offset in the setting of rTKA based on three-dimensional (3D) reconstruction of computed tomography (CT) images of the distal femur.

Methods CT scans of 50 lower limbs were analyzed. Key anatomical landmarks such as the medial epicondyle (ME), lateral epicondyle, and transepicondylar width (TEW) were determined on 3D models constructed from the CT images. Best-fit planes placed on the most distal and posterior loci of points on the femoral condyles were used to define the distal and posterior joint lines, respectively. Statistical analysis was performed to determine the relationships between the anatomical landmarks and the distal and posterior joint lines.

Results There was a strong correlation between the distance from the ME to the distal joint line of the medial condyle (MEDC) and the distance from the ME to the posterior joint line of the medial condyle (MEPC) (p < 0.001; r = 0.865). The mean ratio of MEPC to MEDC was 1.06 (standard deviation [SD]: 0.07; range: 0.88–1.27) and that of MEPC to TEW was 0.33 (SD: 0.03; range: 0.25–0.38).

Conclusions Our findings suggest that the fixed ratios of MEPC to TEW (0.33) and that of MEPC to MEDC (1.06) provide a reliable means for the surgeon to determine the anatomical joint line when used in combination.

Keywords

joint line - posterior condylar offset - distal femoral anatomy - revision knee arthroplasty


Publication History

Received: 21 November 2019

Accepted: 24 May 2020

Article published online:
06 July 2020

© 2020. Thieme. All rights reserved.

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