Articular cartilage of the posterior condyle can affect rotational alignment in total knee arthroplasty

Tashiro, Yasutaka; Uemura, Munenori; Matsuda, Shuichi; Okazaki, Ken; Kawahara, Shinya; Hashizume, Makoto; Iwamoto, Yukihide

doi:10.1007/s00167-011-1691-x

Cited by 48 publications

(55 citation statements)

References 27 publications

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“…, respectively (12). Our measurement method differs entirely from previously reported methods, although the differences between these CTAs in other reports were very close to our findings (13,14).…”

Section: The Journal Of Medical Investigation Vol 64 February 2017supporting

confidence: 84%

The Posterior Condylar Cartilage Affects Rotational Alignment of the Femoral Component in Varus Knee Osteoarthritis

et al. 2017

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: Rotational alignment of the femoral component in total knee arthroplasty (TKA) is important for patellar tracking and ligament balance. Preoperative planning based on radiography might have a potential risk for over-rotation because these X-ray based measurements can not detect asymmetric cartilage wear on posterior condyle. The purpose of this study is to evaluate the effect of the posterior condylar cartilage of varus osteoarthritic knee on rotational alignment of the femoral component in TKA. We established two different condylar twist angles (CTA) from intraoperative multiplanar reconstruction (MPR) images and intraoperative information of navigation system. The CTA measured by a navigation system that includes the cartilage (4.8 2.0 ) was smaller than those measured by MPR images, which does not include the cartilage (6.6 2.1 ) (p 0.05). The difference between these two angles that corresponds to the remaining posterior condylar cartilage was 1.7 1.2 . This result demonstrated that the posterior condylar cartilage might lead to over-rotational of the femoral component in varus osteoarthritic knee. Therefore, when determining rotational alignment of the femoral component, surgeons should consider the effect of the remaining posterior condylar cartilage to avoid the over-rotation of the femoral component, especially in severe varus knees.

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Section: The Journal Of Medical Investigation Vol 64 February 2017supporting

confidence: 84%

The Posterior Condylar Cartilage Affects Rotational Alignment of the Femoral Component in Varus Knee Osteoarthritis

et al. 2017

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“…Given the consistency of the MRI measurements in our study with cadaveric measurements in their study, validation for the use of MRI as a measurement tool for articular cartilage thickness is provided. Tashiro et al [19] showed that the articular cartilage thickness of the posterior condyles can affect rotational alignment in TKA. In their study, failure to account for articular cartilage of the posterior condyles led to excessive external rotation of the femoral components [19].…”

Section: Discussionmentioning

confidence: 99%

“…Tashiro et al [19] showed that the articular cartilage thickness of the posterior condyles can affect rotational alignment in TKA. In their study, failure to account for articular cartilage of the posterior condyles led to excessive external rotation of the femoral components [19]. Consequently, instrumentation and prosthetic knee designs should be based on MRI rather than CT to provide the most accurate anatomic relationships.…”

Section: Discussionmentioning

confidence: 99%

No Sex Differences Exist in Posterior Condylar Offsets of the Knee

Voleti

Stephenson

Lotke

et al. 2015

Clinical Orthopaedics &Amp; Related Research

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Background Restoration of posterior condylar offset during TKA is believed to be important to improving knee kinematics, maximizing ROM, and minimizing flexion instability. However, controversy exists regarding whether there are important anatomic differences between sexes and whether a unisex knee prosthesis can restore the anatomy of knees in males and females. Questions/purposes The purposes of our study were to determine if sex differences exist in (1) absolute posterior condylar offset size, (2) relative posterior condylar offset size in relation to total condylar height, and (3) posterior condylar articular cartilage thickness.Methods We identified 100 patients (50 men and 50 women) without a history of arthritis, deformity, dysplasia, osteochondral defect, fracture, or surgery about the knee who had MRI of the knee performed. All MR images were ordered by primary care medical physicians for evaluation of nonspecific knee pain. Using a previously described three-dimensional MRI protocol, we measured posterior condylar offset, total condylar height, and articular cartilage thickness at the medial and lateral femoral condyles and compared values to evaluate for potential sex differences. We performed an a priori power calculation using a 2-mm posterior condylar offset difference as the minimum clinically important difference; with 2n = 100, our power to detect such a difference was 99.8%.

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“…One report quantified that the cartilage depicted in MRI showed almost the same thickness as the actual specimens cut intraoperatively, indicating the superior precision that MRI provides when examining the axial anatomy of the distal femur. 27 Nonetheless, there are several limitations to our study. We focused on biomechanical and radiographic outcomes, and it was out of the scope of this project to correlate the predicted rotation from the PSI scan with the actual postoperative femoral rotation or clinical outcomes.…”

Section: Discussionmentioning

confidence: 91%

The Relationships between the Rotational Axes of the Distal Femur in the Arthritic Caucasian Knee: A Magnetic Resonance Imaging Analysis

et al. 2020

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Four distal femoral axes have been described to aid in the accuracy of transverse plane component alignment in total knee arthroplasty (TKA). These include the surgical epicondylar axis (SEA), the posterior condylar axis (PCA), and the anteroposterior (AP) axis. Therefore, the primary purpose of this study is to identify the axial femoral relationship with the least variation in a Caucasian population awaiting TKA for osteoarthritis. Secondarily, we further plan to determine if these femoral axis relationships differ with respect to sex or preoperative coronal alignment. These anatomic relationships were measured using preoperative magnetic resonance imaging, which was performed within 2 months of the planned operation date for patient specific instrumentation templating. In terms of our primary outcome, the mean SEA/AP angle was 92.8 degrees (standard deviation [SD]: 2.5 degrees), the mean PCA/AP angle was 95.7 degrees (SD: 2.8 degrees), and the mean PCA/SEA angle was 3.4 degrees (SD: 1.8 degrees). Overall, the PCA/SEA relationship had the smallest variance, while the PCA/AP had the most variance for all comparisons. In terms of our secondary outcome, there was no statistical difference between femoral axis relationships based on preoperative coronal plane alignment. In terms of sex differences, the PCA/SEA was significantly higher in female knees compared with males. Females had a PCA/SEA relationship of 4.7 degrees (SD: 1.3 degrees) compared with 2.6 degrees (SD: 1.2 degrees) for males (p < 0.05). By using the PCA/AP axes, the AP axis was externally rotated by 96.7 degrees (SD: 2.3 degrees) in females, compared with 93.2 degrees (SD: 2.1 degrees) in males, from the PCA. In conclusion, our results demonstrate that the PCA/SEA relationship should be used to determine axial rotation in TKA as it shows the least variation. When using the PCA, approximately 5 degrees of external rotation for Caucasian women and 3 degrees of external rotation for the Caucasian men should be dialed into the femoral cutting block to restore anatomic axial rotation. Further evaluation is needed to determine to role of preoperative coronal alignment on distal femoral axial alignment.

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Articular cartilage of the posterior condyle can affect rotational alignment in total knee arthroplasty

Abstract: II.

Cited by 48 publications

References 27 publications

The Posterior Condylar Cartilage Affects Rotational Alignment of the Femoral Component in Varus Knee Osteoarthritis

The Posterior Condylar Cartilage Affects Rotational Alignment of the Femoral Component in Varus Knee Osteoarthritis

No Sex Differences Exist in Posterior Condylar Offsets of the Knee

The Relationships between the Rotational Axes of the Distal Femur in the Arthritic Caucasian Knee: A Magnetic Resonance Imaging Analysis

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