The shape and orientation of the trochlea run more parallel to the posterior condylar line than generally believed

Vercruysse, Christophe; Vandenneucker, Hilde; Bellemans, Johan; Scheys, Lennart; Luyckx, Thomas

doi:10.1007/s00167-017-4685-5

Cited by 7 publications

(4 citation statements)

References 31 publications

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“…However, our findings are consistent with the current literature analyzing the native knee anatomy. Vercruysse et al described a broad variability between the anterior trochlea line and the TEA, with internal rotation on average [ 23 ].…”

Section: Discussionmentioning

confidence: 99%

True Kinematic Alignment Is Applicable in 44% of Patients Applying Restrictive Indication Criteria—A Retrospective Analysis of 111 TKA Using Robotic Assistance

Huber¹,

Christen²,

Calliess

et al. 2021

JPM

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Introduction: Image-based robotic assistance appears to be a promising tool for individualizing alignment in total knee arthroplasty (TKA). The patient-specific model of the knee enables a preoperative 3D planning of component position. Adjustments to the individual soft-tissue situation can be done intraoperatively. Based on this, we have established a standardized workflow to implement the idea of kinematic alignment (KA) for robotic-assisted TKA. In addition, we have defined limits for its use. If these limits are reached, we switch to a restricted KA (rKA). The aim of the study was to evaluate (1) in what percentage of patients a true KA or an rKA is applicable, (2) whether there were differences regarding knee phenotypes, and (3) what the differences of philosophies in terms of component position, joint stability, and early patient outcome were. Methods: The study included a retrospective analysis of 111 robotic-assisted primary TKAs. Based on preoperative long leg standing radiographs, the patients were categorized into a varus, valgus, or neutral subgroup. Initially, all patients were planned for KA TKA. When the defined safe zone had been exceeded, adjustments to an rKA were made. Intraoperatively, the alignment of the components and joint gaps were recorded by robotic software. Results and conclusion: With our indication for TKA and the defined boundaries, “only” 44% of the patients were suitable for a true KA with no adjustments or soft tissue releases. In the varus group, it was about 70%, whereas it was 0% in the valgus group and 25% in the neutral alignment group. Thus, significant differences with regard to knee morphotypes were evident. In the KA group, a more physiological knee balance reconstructing the trapezoidal flexion gap (+2 mm on average laterally) was seen as well as a closer reconstruction of the surface anatomy and joint line in all dimensions compared to rKA. This resulted in a higher improvement in the collected outcome scores in favor of KA in the very early postoperative phase.

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Section: Discussionmentioning

confidence: 99%

True Kinematic Alignment Is Applicable in 44% of Patients Applying Restrictive Indication Criteria—A Retrospective Analysis of 111 TKA Using Robotic Assistance

Huber¹,

Christen²,

Calliess

et al. 2021

JPM

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“…This is also believed to favour patellar tracking [10, 17, 21]. Yet, patellofemoral complications after TKA remain common, mainly due to femoral component malpositioning [27]. Newman et al [19] revealed high variability of trochlear rotation in 191 non‐arthritic knees and concluded that the classification of trochlear rotation could yield tailored positioning of the femoral component.…”

Section: Discussionmentioning

confidence: 99%

“…Moreover, performing TKA in knees of diferent ethnicities can result in considerable mismatches in trochlear parameters. Many surgical approaches for TKA orient the femoral component parallel to the surgical transepicondylar axis (sTEA) [10,17,21] to achieve a balanced lexion gap and externally rotate the posterior condylar axis [27]. This is also believed to favour patellar tracking [10,17,21].…”

Section: Discussionmentioning

confidence: 99%

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Sexual and ethnic polymorphism result in considerable mismatch between native trochlear geometry and off-the-shelf TKA prostheses

Müller

Reina

et al. 2020

Knee Surg Sports Traumatol Arthrosc

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Purpose To determine if trochlear morphology in healthy knees depends on sex and ethnicity, and to compare it to of-theshelf TKA prostheses. Methods Three retrospective series of CT angiograms from France (female, 124; male, 135), China (female, 122; male, 137) and South Africa (female, 21; male, 62) were used to digitize osseous landmarks at the level of the femoral epicondyles. Sulcus angle, trochlear rotation, lateral trochlear inclination, trochlear asymmetry ratio, and trochlear depth index were quantiied for each knee and for 10 total knee arthroplasty (TKA) models. Univariable regression analyses were performed to determine associations of the ive trochlear parameters with sex and ethnicity. Interquartile ranges (IQR) of native trochlear parameters were compared to the trochlear parameters of 10 of-the-shelf TKA prostheses. Results Compared to French knees, Chinese knees had greater sulcus angle (β = 6.3°, p < 0.001), trochlear rotation (β = 0.8°, p = 0.004) and trochlear depth index (β = 1.60, p < 0.001). Conversely, South African knees had greater trochlear rotation (β = 1.9°, p < 0.001) and lateral trochlear inclination (β = 3.7°, p < 0.001). Female knees had smaller trochlear asymmetry ratios (β = − 0.03, p = 0.05) but greater trochlear rotation angles (β = 0.7, p = 0.005). Considerable mismatches in trochlear morphology were revealed between native knees and of-the-shelf TKA prostheses. Conclusions The indings suggest that thresholds used in the diagnosis of patellofemoral instability should be adapted to patient sex and ethnicity, and that standard of-the-shelf TKA may not restore native trochlear parameters in all patients. Level of evidence III, retrospective comparative.

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Individualised compared to off‐the‐shelf total knee arthroplasty results in lower and less variable patellar tilt

Beel,

Sappey‐Marinier,

Latifi

et al. 2024

Knee surg. sports traumatol. arthrosc.

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PurposeThe purpose of this study was to compare postoperative patellar tilt at 4 months follow‐up in a consecutive series of randomised patients that received individualised or off‐the‐shelf (OTS) primary total knee arthroplasty (TKA). The hypothesis was that patellar tilt would be lower and less variable in patients who received individualised TKA compared to patients who received OTS TKA.MethodsA consecutive series of 385 patients randomised (1:1) to receive either OTS TKA or individualised TKA were analysed. Pre‐ and postoperative radiographs at 4 months were obtained of weight‐bearing long leg, anterior–posterior and lateral knee views and a skyline view at 30° of flexion. Postoperative patellar tilt was measured between the anterior femoral line and patellar resection surface (β) and the anterior femoral line and mediolateral patellar axis (σ). Postoperative patellar tilt (absolute value) was compared between the individualised and OTS TKA groups based on preoperative phenotypes of their femoral mechanical angle, tibial mechanical angle and hip–knee–ankle angle. Variability in postoperative patellar tilt was compared using the 95% confidence intervals (CIs).ResultsComparisons of baseline patient characteristics revealed no difference between the individualised and OTS TKA groups. Comparison of absolute postoperative patellar tilt revealed significant differences between individualised and OTS TKA (|β|, 1.0° ± 1.0° and 2.5° ± 2.2°, respectively, p < 0.001; |σ|, 1.7° ± 1.6° and 2.8° ± 2.3°, respectively, p < 0.001). The 95% CI of postoperative patellar tilt (|β|) was narrower in patients that received individualised compared to OTS TKA (0.0° to 3.8° and 0.1° to 8.3°, respectively), irrespective of their preoperative phenotype.ConclusionPatients who underwent individualised TKA had lower and less variable postoperative patellar tilt than those with OTS TKA, irrespective of preoperative phenotype. Individualised TKA allows the decoupling of the tibiofemoral and patellofemoral joints, replicating anatomical trochlear orientation and improving patellar tilt, which could facilitate better clinical outcomes.Clinical Trial RegistrationThis study constitutes a part of a larger registered randomised controlled trial comparing patient satisfaction following OTS versus individualised TKA (NCT04460989).Level of EvidenceLevel II.

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The shape and orientation of the trochlea run more parallel to the posterior condylar line than generally believed

Abstract: III.

Cited by 7 publications

References 31 publications

True Kinematic Alignment Is Applicable in 44% of Patients Applying Restrictive Indication Criteria—A Retrospective Analysis of 111 TKA Using Robotic Assistance

True Kinematic Alignment Is Applicable in 44% of Patients Applying Restrictive Indication Criteria—A Retrospective Analysis of 111 TKA Using Robotic Assistance

Sexual and ethnic polymorphism result in considerable mismatch between native trochlear geometry and off-the-shelf TKA prostheses

Individualised compared to off‐the‐shelf total knee arthroplasty results in lower and less variable patellar tilt

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