Effect of the presence of the articular cartilage on the femoral component rotation in total knee arthroplasty in female and varus osteoarthritis knees

Journal of Orthopaedic Surgery and Research

Joon-Hee Park¹  Kyoung-Tak Kang²  Ji-Hoon Nam²  Paul Shinil Kim³  Yong-Gon Koh⁴ 

[1] Department of Anesthesiology & Pain Medicine, Hallym University College of Medicine and Kangdong Sacred Heart Hospital, 150 Seongan-ro, Gangdong-gu, 05355, Seoul, Republic of Korea;Department of Mechanical Engineering, Yonsei University, 50 Yonsei-ro, Seodaemun-gu, 03722, Seoul, Republic of Korea;Department of Orthopaedic Surgery, The Bone Hospital, 67, Dongjak-daero, Dongjak-gu, Seoul, Republic of Korea;Joint Reconstruction Center, Department of Orthopaedic Surgery, Yonsei Sarang Hospital, 10 Hyoryeong-ro, Seocho-gu, 06698, Seoul, Republic of Korea;

关键词: Korean patients;    Articular cartilage;    Cartilage thickness;    Femoral rotation;    Varus knee;   

DOI  :  10.1186/s13018-020-02030-9

来源: Springer

【 摘 要 】

PurposeSurgical techniques for total knee arthroplasty (TKA) require femoral rotational corrections that alter the position of the surface of the posterior femoral joint especially in kinematic alignment. However, preoperative planning of TKA based on computed tomography (CT), without knowing the femoral cartilage thickness, may cause post-surgery failures in femoral rotation. Therefore, this study aimed to evaluate the effects of posterior condyle cartilage thickness on rotational alignment in the femoral component.MethodsThree-dimensional magnetic resonance imaging (MRI) scans were obtained for 139 male and 531 female osteoarthritis patients. The angles defined by the femoral posterior condylar axis (PCA) and the surgical transepicondylar axis (TEA) were evaluated with respect to the presence of cartilage. Additionally, these effects were evaluated with respect to patient gender and varus/valgus condition.ResultsIn all patients, the angle between the TEA and PCA was significantly greater in the presence of cartilage than in the absence of cartilage. This result was also seen in female patients. However, there was no difference in the TEA/PCA angle in male patients based on the presence of cartilage. The TEA/PCA angle was significantly greater in the presence of cartilage than in the absence of cartilage in the female varus group. However, there were no differences in the TEA/PCA angle based on the presence of cartilage in the male varus/valgus and female valgus groups. Cartilage thickness in the posterior femoral condyle was significantly greater on the lateral side than on the medial side in all and male patients. However, there was no difference between the genders regarding cartilage thickness.ConclusionSurgical planning for TKA based on CT does not consider articular cartilage and could lead to external malrotation of the femoral implant. Therefore, the effect of the remaining posterior condylar cartilage should be considered by surgeons to prevent over-rotation of the femoral component, especially in female varus knees.

【 授权许可】

CC BY