Semin Musculoskelet Radiol 2018; 22(04): 435-443
DOI: 10.1055/s-0038-1667118
Review Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Assessment of Loosening and Rotational Malalignment Following Knee Endoprosthesis or Other Surgical Components

Ioan N. Gemescu
1   Department of Radiology and Medical Imaging, University Emergency Hospital Bucharest, Bucharest, Romania
,
Marc-André Weber
2   Institute of Diagnostic and Interventional Radiology, University Medical Center Rostock, Rostock, Germany
,
Christoph Rehnitz
3   Diagnostic and Interventional Radiology, Heidelberg University Hospital, Heidelberg, Germany
,
Wolfram Mittelmeier
4   Department of Orthopaedics, Biomechanics and Implant Technology Research Laboratory Rostock, University Medicine Rostock, Germany
,
John A. Carrino
5   Department of Radiology and Imaging, Hospital for Special Surgery, New York, New York
,
Kolja M. Thierfelder
2   Institute of Diagnostic and Interventional Radiology, University Medical Center Rostock, Rostock, Germany
› Author Affiliations
Further Information

Publication History

Publication Date:
22 August 2018 (online)

Abstract

Total knee arthroplasty (TKA) has significant medical and economic implications. The correct placement of the femoral and tibial components is vital to ensure a functional knee and also low failure and revision surgery rates. This article provides the most relevant information regarding knee endoprosthesis from a radiologic point of view. Basic information on the recommended alignment of the femoral and tibial components in TKA and how to measure them are discussed. We then present the most important axial plane rotational references for the femoral and the tibial components. The optimal coronal alignment, illustrating the axes of the lower limb, and loosening as the major complication are also discussed. Finally, we offer a detailed example of rotational assessment.

 
  • References

  • 1 Freeman MA, Pinskerova V. The movement of the knee studied by magnetic resonance imaging. Clin Orthop Relat Res 2003; (410) 35-43
  • 2 Hemmerich A, Brown H, Smith S, Marthandam SS, Wyss UP. Hip, knee, and ankle kinematics of high range of motion activities of daily living. J Orthop Res 2006; 24 (04) 770-781
  • 3 Walker PS, Haider H. Characterizing the motion of total knee replacements in laboratory tests. Clin Orthop Relat Res 2003; (410) 54-68
  • 4 Cyteval C. Imaging of knee implants and related complications. Diagn Interv Imaging 2016; 97 (7–8): 809-821
  • 5 Rees JL, Beard DJ, Price AJ. , et al. Real in vivo kinematic differences between mobile-bearing and fixed-bearing total knee arthroplasties. Clin Orthop Relat Res 2005; (432) 204-209
  • 6 Talbot S, Bartlett J. The anterior surface of the femur as a new landmark for femoral component rotation in total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 2008; 16 (03) 258-262
  • 7 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
  • 8 Churchill DL, Incavo SJ, Johnson CC, Beynnon BD. The transepicondylar axis approximates the optimal flexion axis of the knee. Clin Orthop Relat Res 1998; (356) 111-118
  • 9 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
  • 10 Victor J. Rotational alignment of the distal femur: a literature review. Orthop Traumatol Surg Res 2009; 95 (05) 365-372
  • 11 Whiteside LA, Arima J. The anteroposterior axis for femoral rotational alignment in valgus total knee arthroplasty. Clin Orthop Relat Res 1995; (321) 168-172
  • 12 Hanada H, Whiteside LA, Steiger J, Dyer P, Naito M. Bone landmarks are more reliable than tensioned gaps in TKA component alignment. Clin Orthop Relat Res 2007; 462 (462) 137-142
  • 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 Amaranath JE, Moopanar TR, Sorial RM. Defining distal femoral anatomy for rotational alignment in total knee arthroplasty: a magnetic resonance imaging-based study. ANZ J Surg 2014; 84 (11) 852-855
  • 15 Nagamine R, Miura H, Inoue Y. , et al. Reliability of the anteroposterior axis and the posterior condylar axis for determining rotational alignment of the femoral component in total knee arthroplasty. J Orthop Sci 1998; 3 (04) 194-198
  • 16 Middleton FR, Palmer SH. How accurate is Whiteside's line as a reference axis in total knee arthroplasty?. Knee 2007; 14 (03) 204-207
  • 17 Talbot S, Dimitriou P, Radic R, Zordan R, Bartlett J. The sulcus line of the trochlear groove is more accurate than Whiteside's line in determining femoral component rotation. Knee Surg Sports Traumatol Arthrosc 2015; 23 (11) 3306-3316
  • 18 Siston RA, Patel JJ, Goodman SB, Delp SL, Giori NJ. The variability of femoral rotational alignment in total knee arthroplasty. J Bone Joint Surg Am 2005; 87 (10) 2276-2280
  • 19 Olcott CW, Scott RD. The Ranawat Award. Femoral component rotation during total knee arthroplasty. Clin Orthop Relat Res 1999; (367) 39-42
  • 20 Akagi M, Yamashita E, Nakagawa T, Asano T, Nakamura T. Relationship between frontal knee alignment and reference axes in the distal femur. Clin Orthop Relat Res 2001; (388) 147-156
  • 21 Griffin FM, Insall JN, Scuderi GR. The posterior condylar angle in osteoarthritic knees. J Arthroplasty 1998; 13 (07) 812-815
  • 22 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 (03) 152-156
  • 23 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
  • 24 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
  • 25 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
  • 26 Victor J, Van Doninck D, Labey L, Innocenti B, Parizel PM, Bellemans J. How precise can bony landmarks be determined on a CT scan of the knee?. Knee 2009; 16 (05) 358-365
  • 27 Konigsberg B, Hess R, Hartman C, Smith L, Garvin KL. Inter- and intraobserver reliability of two-dimensional CT scan for total knee arthroplasty component malrotation. Clin Orthop Relat Res 2014; 472 (01) 212-217
  • 28 Cobb JP, Dixon H, Dandachli W, Iranpour F. The anatomical tibial axis: reliable rotational orientation in knee replacement. J Bone Joint Surg Br 2008; 90 (08) 1032-1038
  • 29 Bonnin MP, Saffarini M, Mercier PE, Laurent JR, Carrillon Y. Is the anterior tibial tuberosity a reliable rotational landmark for the tibial component in total knee arthroplasty?. J Arthroplasty 2011; 26 (02) 260-7.e1 , 2
  • 30 Page SR, Deakin AH, Payne AP, Picard F. Reliability of frames of reference used for tibial component rotation in total knee arthroplasty. Comput Aided Surg 2011; 16 (02) 86-92
  • 31 Uehara K, Kadoya Y, Kobayashi A, Ohashi H, Yamano Y. Bone anatomy and rotational alignment in total knee arthroplasty. Clin Orthop Relat Res 2002; (402) 196-201
  • 32 Incavo SJ, Coughlin KM, Pappas C, Beynnon BD. Anatomic rotational relationships of the proximal tibia, distal femur, and patella: implications for rotational alignment in total knee arthroplasty. J Arthroplasty 2003; 18 (05) 643-648
  • 33 Aglietti P, Sensi L, Cuomo P, Ciardullo A. Rotational position of femoral and tibial components in TKA using the femoral transepicondylar axis. Clin Orthop Relat Res 2008; 466 (11) 2751-2755
  • 34 Berger RA, Crossett LS, Jacobs JJ, Rubash HE. Malrotation causing patellofemoral complications after total knee arthroplasty. Clin Orthop Relat Res 1998; (356) 144-153
  • 35 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
  • 36 Sahin N, Atıcı T, Öztürk A, Özkaya G, Özkan Y, Avcu B. Accuracy of anatomical references used for rotational alignment of tibial component in total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 2012; 20 (03) 565-570
  • 37 Jeffery RS, Morris RW, Denham RA. Coronal alignment after total knee replacement. J Bone Joint Surg Br 1991; 73 (05) 709-714
  • 38 Kim YH, Kim JS, Choi Y, Kwon OR. Computer-assisted surgical navigation does not improve the alignment and orientation of the components in total knee arthroplasty. J Bone Joint Surg Am 2009; 91 (01) 14-19
  • 39 Lützner J, Krummenauer F, Wolf C, Günther KP, Kirschner S. Computer-assisted and conventional total knee replacement: a comparative, prospective, randomised study with radiological and CT evaluation. J Bone Joint Surg Br 2008; 90 (08) 1039-1044
  • 40 Hsu RW, Himeno S, Coventry MB, Chao EY. Normal axial alignment of the lower extremity and load-bearing distribution at the knee. Clin Orthop Relat Res 1990; (255) 215-227
  • 41 Hsu HP, Garg A, Walker PS, Spector M, Ewald FC. Effect of knee component alignment on tibial load distribution with clinical correlation. Clin Orthop Relat Res 1989; (248) 135-144
  • 42 Fang DM, Ritter MA, Davis KE. Coronal alignment in total knee arthroplasty: just how important is it?. J Arthroplasty 2009; 24 (6, Suppl): 39-43
  • 43 Insall JN, Binazzi R, Soudry M, Mestriner LA. Total knee arthroplasty. Clin Orthop Relat Res 1985; (192) 13-22
  • 44 Townley CO. The anatomic total knee resurfacing arthroplasty. Clin Orthop Relat Res 1985; (192) 82-96
  • 45 Mason JB, Fehring TK, Estok R, Banel D, Fahrbach K. Meta-analysis of alignment outcomes in computer-assisted total knee arthroplasty surgery. J Arthroplasty 2007; 22 (08) 1097-1106
  • 46 Cheng T, Zhang G, Zhang X. Imageless navigation system does not improve component rotational alignment in total knee arthroplasty. J Surg Res 2011; 171 (02) 590-600
  • 47 Nunley RM, Ellison BS, Zhu J, Ruh EL, Howell SM, Barrack RL. Do patient-specific guides improve coronal alignment in total knee arthroplasty?. Clin Orthop Relat Res 2012; 470 (03) 895-902
  • 48 Math KR, Zaidi SF, Petchprapa C, Harwin SF. Imaging of total knee arthroplasty. Semin Musculoskelet Radiol 2006; 10 (01) 47-63
  • 49 Miller TT. Imaging of knee arthroplasty. Eur J Radiol 2005; 54 (02) 164-177