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KMID : 0359620100220010046
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Journal of Korean Knee Society
2010 Volume.22 No. 1 p.46 ~ p.55
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Anatomical Assessment of the Distal Femur and Tibia for Optimal Femoral Rotational Alignment in Total Knee Arthroplasty
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Chang Jong-Bum
Seong Sang-Cheol
Lee Sang-Hoon
Lee Myung-Chul
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Abstract
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Purpose: This study aimed 1) to identify the rotational axis of the femur that provides a balanced 90˚ flexion space in TKA, 2) to assess the changes in the flexion space in deep flexion, and 3) to assess the changes in rotational alignment, with using the posterior condylar axis (PCA) as a guide, and as the changes are related to asymmetric cartilage erosion of the posterior condyle.
Materials and Methods: The axial MR images of the distal femur in knee extension and the coronal images of the distal femur and the entire tibia at 90 and 130˚ were examined in 40 healthy adults.
Results: The clinical transepicondylar axis (TEA) provides a balanced 90˚ flexion space on average. The balanced flexion space in 90˚ became an asymmetrical space with relative narrowing of the medial side in 130˚. Every 1 mm of asymmetrical cartilage erosion between the posterior condyles changed the femoral rotation by approximately 1˚ when using the PCA as a guide.
Conclusion: This study suggests that the clinical TEA is the rotational reference that provides a balanced flexion space. When using the PCA as a rotational reference, a surgeon should consider the potential change in the rotational angle that is caused by asymmetrical cartilage erosion.
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KEYWORD
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Total knee arthroplasty, Femoral component rotation, 90 degree flexion gap, 130 degree flexion gap, Asymmetrical cartilage erosion
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