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Knee Surgery, Sports Traumatology, Arthroscopy
Published in: Knee Surgery, Sports Traumatology, Arthroscopy 9/2023

Open Access 16-09-2022 | Computed Tomography | KNEE

Excessive femoral torsion is not associated with patellofemoral pain or instability if TKA is functionally aligned and the patella denervated

Authors: Andreas Flury, Armando Hoch, Gabriele Cirigliano, Sandro Hodel, Nathalie Kühne, Stefan M. Zimmermann, Lazaros Vlachopoulos, Sandro F. Fucentese

Published in: Knee Surgery, Sports Traumatology, Arthroscopy | Issue 9/2023

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Abstract

Purpose

Recent data suggest that individual morphologic factors should be respected to restore preoperative patellofemoral alignment and thus reduce the likelihood of anterior knee pain. The goal of this study was to investigate the effect of excessive femoral torsion (FT) on clinical outcome of TKA.

Methods

Patients who underwent TKA and complete preoperative radiographic evaluation including a long-leg radiograph and CT scan were included. 51 patients showed increased FT of > 20° and were matched for age/sex to 51 controls (FT < 20°). Thirteen patients were lost to follow-up. Thirty-eight matched pairs were compared after a 2 year follow-up clinically (Kujala and patellofemoral score for TKA) and radiographically (FT, frontal leg axis, TT-TG, patellar thickness, patellar tilt, and lateral displacement of patella). Functional alignment of TKA was performed (hybrid-technique). All patellae were denervated but no patella was resurfaced.

Results

There was no significant difference between clinical scores two years after surgery between patients with normal and excessive FT (n.s.). Kujala score was 64.3 ± 16.7 versus 64.8 ± 14.4 (n.s.), and patellofemoral score for TKA was 74.3 ± 21 versus 78.5 ± 20.7 (n.s.) for increased FT group and control group, respectively. There was no correlation between preoperative FT and clinical scores. Other radiographic parameters were similar between both groups. No correlations between clinical outcomes and preoperative/postoperative frontal leg axis or total leg axis correction were found (n.s.).

Conclusion

If the leg axis deformity is corrected to a roughly neutral alignment during cemented TKA, including patellar denervation, then excessive FT was not associated with patellofemoral pain or instability.

Level of evidence.

Prospective comparative study, level II.
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Metadata
Title
Excessive femoral torsion is not associated with patellofemoral pain or instability if TKA is functionally aligned and the patella denervated
Authors
Andreas Flury
Armando Hoch
Gabriele Cirigliano
Sandro Hodel
Nathalie Kühne
Stefan M. Zimmermann
Lazaros Vlachopoulos
Sandro F. Fucentese
Publication date
16-09-2022
Publisher
Springer Berlin Heidelberg
Published in
Knee Surgery, Sports Traumatology, Arthroscopy / Issue 9/2023
Print ISSN: 0942-2056
Electronic ISSN: 1433-7347
DOI
https://doi.org/10.1007/s00167-022-07162-5

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