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Patellar Medial-lateral Position can be Used to Correct the Effect of Leg Rotation on Preoperative Planning in Total Knee Arthroplasty for Varus Knees

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Patellar Medial-lateral Position can be Used to Correct the Effect of Leg Rotation on Preoperative Planning in Total Knee Arthroplasty for Varus Knees

Shinichiro Nakamura, MD, PhD, JAPAN Shota Takemoto, MD, JAPAN Shinichi Kuriyama, MD, PhD, JAPAN Kohei Nishitani, MD, PhD, JAPAN Hiromu Ito, MD, PhD, JAPAN Mutsumi Watanabe, MD, PhD, JAPAN Young Dong Song, MD, PhD, UNITED STATES Shuichi Matsuda, MD, PhD, JAPAN

Kyoto University, Kyoto, Kyoto, JAPAN

2023 Congress ePoster Presentation 2023 Congress Not yet rated

Anatomic Location

Knee

Anatomic Structure

Bones

Treatment / Technique

Arthroplasty

Summary: When the angle between the mechanical and anatomical axes of the femur is measured in a long leg radiograph, the method to correct the angle according to the patellar ML position can be used to reduce the measurement error, which reflects the proper angle in the true AP view.

Background

A long leg radiograph remains a gold standard during the preoperative planning for the femoral resection, and the angle between the mechanical and anatomical axes is applied to the cutting jig. Lower limb malrotation can be observed in long leg radiographs, affecting the measurement of the angle between the mechanical and anatomical axes. The purposes were to analyze the effect of limb rotation and to evaluate the accuracy of the corrected angle between the mechanical and anatomical axes based on the patellar medial-lateral (ML) position. The hypothesis was that the correction of the angle between the mechanical and anatomical axes according to the patellar ML position can reduce the error from the angle in the true antero-posterior (AP) view in most of the knees.

Materials And Methods

A total of 100 consecutive knees with varus deformity undergoing primary total knee arthroplasty were included. Computed tomography images were digitally reconstructed in the neutral position, and internally and externally rotated at 10° and 20° relative to the mechanical axis of the femur, connecting the center of the femoral head and knee joint, respectively. The patellar ML position relative to the medial (0%) and lateral (100%) epicondyles and the angle between the mechanical and anatomical axes of the femur were measured. The angle between the mechanical and anatomical axes of the femur was measured in each digitally reconstructed image. The corrected angle between the mechanical and anatomical axes was calculated using the averaged translational ratio.

Results

In the neutral position, the patellar center position was 56.1% (standard deviation [SD] = 4.7%), which was 31.4% (SD = 7.2%) and 80.2% (SD = 5.4%) in the 20° internal and external rotation, respectively. The angle between the mechanical and anatomical axes was 2.6° (SD = 2.0°) and 8.1° (SD = 2.1°) in the 20° internal and external rotation, respectively. On average, if the patellar center shifted 10%, the change of the angle between the mechanical and anatomical axes of the femur was 1.13°. The following equation was applied to calculate the corrected angle between the mechanical and anatomical axes of the femur.
z = (56.1 - x) × 0.113 + y
(x: patellar ML position (%), y: measured angle (degrees), z: corrected angle (degrees))
In the 20° external and internal rotations, approximately 40% of the knees showed a discrepancy of >3°. Applying the corrected angle, a discrepancy from the neutral position decreased.

Conclusion

The patellar ML center and the angle between the mechanical and anatomical axes are altered with limb rotation. When the angle between the mechanical and anatomical axes of the femur is measured in a long leg radiograph, the method to correct the angle according to the patellar ML position can be used to reduce the measurement error, which reflects the proper angle in the true AP view.

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Efficacy of Functional Alignment Technique In Robotic-Arm Assisted Total Knee Arthroplasty ePoster Presentation Masashi Tamaki, MD, PhD, JAPAN Yuki Yamauchi, MD,PhD, JAPAN Seishiro Higa, MD, JAPAN Tomoyuki Shimakawa, MD, JAPAN Yuki Isobe, MD, JAPAN Teruya Ishibashi, MD,PhD, JAPAN Shoji Konda, PhD, JAPAN Tetsuya Tomita, M.D.,Ph.D , JAPAN
Three-Dimensional Evaluation of Distal Femoral Valgus Angle Using Whole Leg CT in Total Knee Arthroplasty ePoster Presentation Atsushi Sato, MD, PhD, JAPAN Jun Oike, MD, PhD, JAPAN Masataka Ota, MD, JAPAN Kanako Izukashi, MD, JAPAN Saki Yagura, MD, JAPAN Takayuki Okumo, MD, PhD, JAPAN Naoki Okuma, MD, JAPAN Takayuki Koya, MD, PhD, JAPAN Fumiyoshi Kawashima, MD, JAPAN Hiroshi Takagi, MD, PhD, JAPAN Koji Kanzaki, Prof., JAPAN
Combined Fixed-Bearing Unicompartmental Knee Arthroplasty and Anterior Cruciate Ligament Reconstruction ePoster Presentation Claudio Legnani, MD, ITALY Enrico Borgo, MD, ITALY Vittorio Macchi, MD, ITALY Alberto Ventura, MD, ITALY
Bilateral Simultaneous Unicompartimental Knee Arthroplasty. Midterm Results in 86 Arthroplasties with an Average Follow-Up Of 6.2 Years ePoster Presentation Stefano Gaggiotti, MD, ARGENTINA Gabriel Gaggiotti, MD, ARGENTINA Santino Gaggiotti, MD, ARGENTINA Julio Cesar Ringa
Modular Knee Arthrodesis as Definitive Treatment for Periprosthetic Infection, Bone Loss, and Failure of the Extensor Mechanism after Total Knee Arthroplasty ePoster Presentation Gloria Shoshana Coden, MD, UNITED STATES Maksym Bartashevskyy, BA, UNITED STATES Zachary Berliner, MD, UNITED STATES Ruijia Niu, MPH, UNITED STATES James V. Bono, MD, UNITED STATES Ayesha Abdeen, MD, UNITED STATES Eric L. Smith, MD, UNITED STATES
Is Surgeon Assessed Bone Quality During Total Knee Arthroplasty a Valid Tool To Diagnose Osteoporosis ? ePoster Presentation Adit Rajesh Maniar, MBBS, MS Orthopaedics, DNB Orthopaedics, INDIA Arpit Vasantbhai Bavaskar, MBBS, D.Orth., INDIA Vishal Raina, MS, INDIA Akshay Nayak, M.B.B.S, M.S , INDIA Ashwini Khokhar, MS, INDIA Rajesh Maniar, INDIA
Differences In Pain, Sleep Status And Functional Recovery Between TKA And UKA ePoster Presentation Takeo Mammoto, MD, JAPAN
Palliative Arthroscopic Debridement with Continuous Irrigation for the Infection TKA of High Mortality Risk Patients ePoster Presentation Yoon Sang Jeon, MD, KOREA, REPUBLIC OF Sung-Sahn Lee, MD., PhD., KOREA, REPUBLIC OF Yoon Cheol Nam, MD, KOREA, REPUBLIC OF Dong Jin Ryu, MD, PhD., KOREA, REPUBLIC OF
Treatment of Periprosthetic Infection after Total Knee Arthroplasty using an Ultrastatic Spacer ePoster Presentation Gloria Shoshana Coden, MD, UNITED STATES Suzanne Kent, MD, UNITED STATES Ruijia Niu, MPH, UNITED STATES Ayesha Abdeen, MD, UNITED STATES Eric L. Smith, MD, UNITED STATES
Central Sensitization is Associated with Persistent Postoperative Pain and Inferior Patient-Reported Outcomes in Patients Undergoing Unicompartmental Knee Arthroplasty ePoster Presentation Yong In, MD, PhD, KOREA, REPUBLIC OF Dongho Kwak, MD, KOREA, REPUBLIC OF Sungcheol Yang, MD, KOREA, REPUBLIC OF Hyukjin Jang, MD, KOREA, REPUBLIC OF Ryu Kyoung Cho, MD, KOREA, REPUBLIC OF Man-Soo Kim, MD, PhD, KOREA, REPUBLIC OF
Advanced Active Robotic Technology for Total Knee Arthroplasty: A Learning Curve of Operative Time and Alignment Accuracy ePoster Presentation Yong-Beom Park, MD, PhD, KOREA, REPUBLIC OF Young-Bong Ko, MD, KOREA, REPUBLIC OF Dong-Hoon Lee, MD, KOREA, REPUBLIC OF Hyun-Chul Nam, MD, KOREA, REPUBLIC OF Seong-Hwan Kim, MD,Ph.D, MStat, KOREA, REPUBLIC OF
Compliance and Outcome of Osteoporosis Treatment After Total Knee Arthroplasty ePoster Presentation Yun Seong Choi, MD, KOREA, REPUBLIC OF Seung Hoon Lee, MD, KOREA, REPUBLIC OF Jung Ro Yoon, MD, KOREA, REPUBLIC OF Young Bin Shin, MD, KOREA, REPUBLIC OF Tae Hyuk Yoon, MD, KOREA, REPUBLIC OF
How to Measure Physical Function in Clinical Trials on Patients Undergoing Total or Partial Knee Arthroplasty? A Systematic Review ePoster Presentation Marco Adriani, MD, ITALY Roland Becker, MD, PhD, Prof., GERMANY Aleksandra Krolikowska, PhD, Prof., POLAND Krzysztof Lachowski, MD, GERMANY Robert Prill, PhD, GERMANY

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Patellar Medial-lateral Position can be Used to Correct the Effect of Leg Rotation on Preoperative Planning in Total Knee Arthroplasty for Varus Knees

Patellar Medial-lateral Position can be Used to Correct the Effect of Leg Rotation on Preoperative Planning in Total Knee Arthroplasty for Varus Knees

Background

Materials And Methods

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Conclusion

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Patellar Medial-lateral Position can be Used to Correct the Effect of Leg Rotation on Preoperative Planning in Total Knee Arthroplasty for Varus Knees

Patellar Medial-lateral Position can be Used to Correct the Effect of Leg Rotation on Preoperative Planning in Total Knee Arthroplasty for Varus Knees

Background

Materials And Methods

Results

Conclusion

More 2023 ISAKOS Congress Content