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The Journal of arthroplasty v.33 no.1, 2018년, pp.67 - 74   SCIE
본 등재정보는 저널의 등재정보를 참고하여 보여주는 베타서비스로 정확한 논문의 등재여부는 등재기관에 확인하시기 바랍니다.

Patient Variation Limits Use of Fixed References for Femoral Rotation Component Alignment in Total Knee Arthroplasty

Twiggs, Joshua G.    (Department of Biomedical Engineering, AMME, University of Sydney, Sydney, New South Wales, Australia   ); Dickison, David M.    (Peninsula Orthopaedics, Dee Why, New South Wales, Australia   ); Kolos, Elizabeth C.    (360 Knee Systems Pty Ltd, Pymble, New South Wales, Australia   ); Wilcox, Caitlin E.    (360 Knee Systems Pty Ltd, Pymble, New South Wales, Australia   ); Roe, Justin P.    (North Sydney Orthopaedic and Sports Medicine Centre, Wollstonecraft, New South Wales, Australia   ); Fritsch, Brett A.    (Sydney Orthopaedic Research Institute, Chatswood, New South Wales, Australia   ); McMahon, Stephen J.    (Malabar Orthopaedic Clinic, Windsor, Victoria, Australia   ); Miles, Brad P.    (360 Knee Systems Pty Ltd, Pymble, New South Wales, Australia   ); Ruys, Andrew J.    (Department of Biomedical Engineering, AMME, University of Sydney, Sydney, New South Wales, Australia  );
  • 초록  

    Abstract Background Optimal rotational alignment of the femoral component is a common goal during total knee arthroplasty. The posterior condylar axis (PCA) is thought to be the most reproducible reference in surgery, while the transepicondylar axis (TEA) seems to better approximate the native kinematic flexion axis. This study sought to determine if rules based on patient gender or coronal alignment could allow reliable reproduction of the TEA from the PCA. Methods Three-dimensional models based on preoperative computed tomography were made representing a patient's arthritic knee joint. The landmarks were defined and angular relationships determined. Results The population group of 726 patients contained large anatomic variation. When applying the standard reference rule of 3° external rotation from the PCA, 36.9% of patients would have a rotational target greater than ±2° from their TEA. When applying the mean external rotation of the TEA from the PCA (1.85°) from this population, this proportion dropped to 26.0% of patients. The use of statistically significant gender and coronal alignment relationships to define the femoral rotation did not reduce the proportion of patients in ±2° error. Conclusion This study shows that gender and coronal alignment relationships to the TEA to PCA angle are not clinically significant as a quarter of patients would still have a target for rotation greater than ±2° from the TEA using these relationships. Superior tools for orienting rotational cuts directly to the TEA in surgery or preoperative identification of relevant patient-specific angles might capture the proportion of patients for whom standard reference angles are not appropriate.


  • 주제어

    femoral .   rotational alignment .   transepicondylar axis .   posterior condylar axis .   AP sizers .   total knee arthroplasty.  

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