Paweł Skowronek1, Markus Arnold2,3, Christian Starke4, Agnieszka Bartyzel5, Lukas B Moser6,3, Michael T Hirschmann6,3. 1. Department of Orthopaedic and Trauma Surgery, S. Żeromski Hospital, Os. Na Skarpie 66, 31-913, Kraków, Poland. pawelskowronek@interia.pl. 2. LEONARDO-Physicians for Orthopaedic and Traumatologic Surgery, Hirslanden Clinic Birshof, Münchenstein, Switzerland. 3. University of Basel, 4051, Basel, Switzerland. 4. Universitätsklinikum A. ö. R, Orthopädische Universitätsklinik, Bereich Kniechirurgie Und Sportorthopädie, Leipziger Str. 44, 39120, Magdeburg, Germany. 5. Department of Orthopaedic and Trauma Surgery, S. Żeromski Hospital, Os. Na Skarpie 66, 31-913, Kraków, Poland. 6. Department of Orthopaedic Surgery and Traumatology, Kantonsspital Baselland (Bruderholz, Liestal, Laufen), 4101, Bruderholz, Switzerland.
Abstract
PURPOSE: Malrotation of the femoral component after primary total knee arthroplasty (TKA) is one of the most important problems leading to painful TKA requiring revision surgery. METHODS: A comprehensive systematic review of the literature was performed to present current evidence on how to optimally place the femoral component in TKA. Several landmarks and techniques for intraoperative determination of femoral component placement and examination of their reliability were analyzed. RESULTS: 2806 articles were identified and 21 met the inclusion criteria. As there is no unquestioned gold standard, numerous approaches are possible which come along with specific advantages and disadvantages. In addition, imaging modalities and measurements regarding postoperative femoral component rotation were also investigated. Femoral component rotation measurements on three-dimensional (3D) reconstructed computerised tomography (CT) images displayed intraclass correlation coefficients (ICC) above 0.85, significantly better than those performed in radiographics or two-dimensional (2D) CT images. Thus, 3D CT images to accurately evaluate the femoral prosthetic component rotation are recommended, especially in unsatisfied patients after TKA. CONCLUSION: The EKA Femoral Rotation Focus Group has not identified a single best reference method to determine femoral component rotation, but surgeons mostly prefer the measured resection technique using at least two landmarks for cross-checking the rotation. LEVEL OF EVIDENCE: III.
PURPOSE: Malrotation of the femoral component after primary total knee arthroplasty (TKA) is one of the most important problems leading to painful TKA requiring revision surgery. METHODS: A comprehensive systematic review of the literature was performed to present current evidence on how to optimally place the femoral component in TKA. Several landmarks and techniques for intraoperative determination of femoral component placement and examination of their reliability were analyzed. RESULTS: 2806 articles were identified and 21 met the inclusion criteria. As there is no unquestioned gold standard, numerous approaches are possible which come along with specific advantages and disadvantages. In addition, imaging modalities and measurements regarding postoperative femoral component rotation were also investigated. Femoral component rotation measurements on three-dimensional (3D) reconstructed computerised tomography (CT) images displayed intraclass correlation coefficients (ICC) above 0.85, significantly better than those performed in radiographics or two-dimensional (2D) CT images. Thus, 3D CT images to accurately evaluate the femoral prosthetic component rotation are recommended, especially in unsatisfied patients after TKA. CONCLUSION: The EKA Femoral Rotation Focus Group has not identified a single best reference method to determine femoral component rotation, but surgeons mostly prefer the measured resection technique using at least two landmarks for cross-checking the rotation. LEVEL OF EVIDENCE: III.
Entities:
Keywords:
Anatomical landmarks; Clinical outcome; Femoral component rotation; Gap balance technique; Grand piano sign; Hybrid technique; Knee replacement; Measured resection technique; Postoperative CT; Total knee arthroplasty
Authors: Jessica L Churchill; Anton Khlopas; Assem A Sultan; Steven F Harwin; Michael A Mont Journal: J Knee Surg Date: 2017-11-27 Impact factor: 2.757
Authors: Sina Babazadeh; Michelle M Dowsey; Michael G Vasimalla; James D Stoney; Peter F M Choong Journal: J Arthroplasty Date: 2017-08-24 Impact factor: 4.757
Authors: Krishna R Cidambi; Nicholas Robertson; Camille Borges; Nader A Nassif; Steven L Barnett Journal: J Arthroplasty Date: 2018-02-17 Impact factor: 4.757
Authors: Roman Popescu; Stefan Cristea; Valentin Oleksik; Adrian Marius Pascu; Emil George Haritinian Journal: J Appl Biomed Date: 2021-09-20 Impact factor: 1.797
Authors: Emma L Robertson; Martin Hengherr; Felix Amsler; Michael T Hirschmann; Dominic T Mathis Journal: Skeletal Radiol Date: 2021-01-04 Impact factor: 2.199