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Knee Surgery, Sports Traumatology, Arthroscopy
Published in: Knee Surgery, Sports Traumatology, Arthroscopy 10/2012

01-10-2012 | Knee

Relationship between the tibial anteroposterior axis and the surgical epicondylar axis in varus and valgus knees

Authors: Shinya Kawahara, Shuichi Matsuda, Ken Okazaki, Yasutaka Tashiro, Hiroaki Mitsuyasu, Hiroyuki Nakahara, Yukihide Iwamoto

Published in: Knee Surgery, Sports Traumatology, Arthroscopy | Issue 10/2012

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Abstract

Purpose

Proper rotational alignment in total knee arthroplasty (TKA) is essential for successful outcomes. The surgical epicondylar axis (SEA) has been frequently used to determine the femoral rotational alignment, and the anteroposterior (AP) axis of the tibia described in previous study has been introduced as a line perpendicular to the SEA in healthy knees. However, the rotational relationship between the distal femur and the proximal tibia would vary between normal and osteoarthritic knees, and a question remains whether the rotational relationship between the SEA and the AP axis of the tibia would be the same between normal and osteoarthritic knees. This study aims to determine whether the AP axis of the tibia is actually perpendicular to the SEA and useful for the tibial rotational alignment also in osteoarthritic knees.

Methods

Preoperative computed tomography scans on 25 varus and 25 valgus knees undergoing TKA were studied. The SEA and the AP axis of the tibia were identified using a three-dimensional software, and the angle between the line perpendicular to the projected SEA and the AP axis was measured.

Results

The AP axis of the tibia was 1.7° ± 4.3° and 2.0° ± 4.0° internally rotated relative to the line perpendicular to the SEA in the varus and valgus groups, respectively.

Conclusions

The AP axis of the tibia was, on average, perpendicular to the SEA in both varus and valgus knees. The AP axis would be useful for setting the tibial component with minimal rotational mismatch.

Level of evidence

IV.
Literature
1.
Aglietti P, Sensi L, Cuomo P, Ciardullo A (2008) Rotational position of femoral and tibial components in TKA using the femoral transepicondylar axis. Clin Orthop Relat Res 466:2751–2755PubMedCrossRef
2.
Akagi M, Matsusue Y, Mata T, Asada Y, Horiguchi M, Iida H, Nakamura T (1999) Effect of rotational alignment on patellar tracking in total knee arthroplasty. Clin Orthop Relat Res 366:155–163PubMedCrossRef
3.
Akagi M, Mori S, Nishimura S, Nishimura A, Asano T, Hamanishi C (2005) Variability of extraarticular tibial rotation references for total knee arthroplasty. Clin Orthop Relat Res 436:172–176PubMedCrossRef
4.
Akagi M, Oh M, Nonaka T, Tsujimoto H, Asano T, Hamanishi C (2004) An anteroposterior axis of the tibia for total knee arthroplasty. Clin Orthop Relat Res 420:213–219PubMedCrossRef
5.
Akagi M, Yamashita E, Nakagawa T, Asano T, Nakamura T (2001) Relationship between frontal knee alignment and reference axes in the distal femur. Clin Orthop Relat Res 388:147–156PubMedCrossRef
6.
Anouchi YS, Whiteside LA, Kaiser AD, Milliano MT (1993) The effects of axial rotational alignment of the femoral component on knee stability and patellar tracking in total knee arthroplasty demonstrated on autopsy specimens. Clin Orthop Relat Res 287:170–177PubMed
7.
Bauwens K, Matthes G, Wich M, Gebhard F, Hanson B, Ekkernkamp A, Stengel D (2007) Navigated total knee replacement. A meta-analysis. J Bone Joint Surg Am 89:261–269PubMedCrossRef
8.
Berger RA, Crossett LS, Jacobs JJ, Rubash HE (1998) Malrotation causing patellofemoral complications after total knee arthroplasty. Clin Orthop Relat Res 356:144–153PubMedCrossRef
9.
Berger RA, Rubash HE, Seel MJ, Thompson WH, Crossett LS (1993) Determining the rotational alignment of the femoral component in total knee arthroplasty using the epicondylar axis. Clin Orthop Relat Res 286:40–47PubMed
10.
Bruni D, Iacono F, Russo A, Zaffagnini S, Marcheggiani Muccioli GM, Bignozzi S, Bragonzoni L, Marcacci M (2010) Minimally invasive unicompartmental knee replacement: retrospective clinical and radiographic evaluation of 83 patients. Knee Surg Sports Traumatol Arthrosc 18:710–717PubMedCrossRef
11.
Casino D, Martelli S, Zaffagnini S, Lopomo N, Iacono F, Bignozzi S, Visani A, Marcacci M (2009) Knee stability before and after total and unicondylar knee replacement: in vivo kinematic evaluation utilizing navigation. J Orthop Res 27:202–207PubMedCrossRef
12.
Eckhoff DG, Johnston RJ, Stamm ER, Kilcoyne RF, Wiedel JD (1994) Version of the osteoarthritic knee. J Arthroplasty 9:73–79PubMedCrossRef
13.
Hovinga KR, Lerner AL (2009) Anatomic variations between Japanese and Caucasian populations in the healthy young adult knee joint. J Orthop Res 27:1191–1196PubMedCrossRef
14.
Insall JN, Easley ME (2001) Surgical techniques and instrumentation in total knee arthroplasty. In: Insall JN, Scott WN (eds) Surgery of the knee, 3rd edn. Churchill Livingstone, New York, pp 1553–1620
15.
Jeffery RS, Morris RW, Denham RA (1991) Coronal alignment after total knee replacement. J Bone Joint Surg Br 73:709–714PubMed
16.
Lewis P, Rorabeck CH, Bourne RB, Devane P (1994) Posteromedial tibial polyethylene failure in total knee replacements. Clin Orthop Relat Res 299:11–17PubMed
17.
Mantas JP, Bloebaum RD, Skedros JG, Hofmann AA (1992) Implications of reference axes used for rotational alignment of the femoral component in primary and revision knee arthroplasty. J Arthroplasty 7:531–535PubMedCrossRef
18.
Matsuda S, Miura H, Nagamine R, Mawatari T, Tokunaga M, Nabeyama R, Iwamoto Y (2004) Anatomical analysis of the femoral condyle in normal and osteoarthritic knees. J Orthop Res 22:104–109PubMedCrossRef
19.
Matsuda S, Miura H, Nagamine R, Urabe K, Hirata G, Iwamoto Y (2001) Effect of femoral and tibial component position on patellar tracking following total knee arthroplasty: 10-year follow-up of Miller-Galante I knees. Am J Knee Surg 14:152–156PubMed
20.
Miller MC, Berger RA, Petrella AJ, Karmas A, Rubash HE (2001) Optimizing femoral component rotation in total knee arthroplasty. Clin Orthop Relat Res 392:38–45PubMedCrossRef
21.
Moreland JR, Bassett LW, Hanker GJ (1987) Radiographic analysis of the axial alignment of the lower extremity. J Bone Joint Surg Am 69:745–749PubMed
22.
Nagamine R, Whiteside LA, White SE, McCarthy DS (1994) Patellar tracking after total knee arthroplasty. The effect of tibial tray malrotation and articular surface configuration. Clin Orthop Relat Res 304:262–271PubMed
23.
Su EP, Su SL, Della Valle AG (2010) Stiffness after TKR: how to avoid repeat surgery. Orthopedics 33:658PubMed
24.
Sun T, Lu H, Hong N, Wu J, Feng C (2009) Bony landmarks and rotational alignment in total knee arthroplasty for Chinese osteoarthritic knees with varus or valgus deformities. J Arthroplasty 24:427–431PubMedCrossRef
25.
Urabe K, Mahoney OM, Mabuchi K, Itoman M (2008) Morphologic differences of the distal femur between Caucasian and Japanese women. J Orthop Surg 16:312–315
26.
Verlinden C, Uvin P, Labey L, Luyckx JP, Bellemans J, Vandenneucker H (2010) The influence of malrotation of the femoral component in total knee replacement on the mechanics of patellofemoral contact during gait: an in vitro biomechanical study. J Bone Joint Surg Br 92:737–742PubMedCrossRef
27.
Wasielewski RC, Galante JO, Leighty RM, Natarajan RN, Rosenberg AG (1994) Wear patterns on retrieved polyethylene tibial inserts and their relationship to technical considerations during total knee arthroplasty. Clin Orthop Relat Res 299:31–43PubMed
28.
Yoshino N, Takai S, Ohtsuki Y, Hirasawa Y (2001) Computed tomography measurement of the surgical and clinical transepicondylar axis of the distal femur in osteoarthritic knees. J Arthroplasty 16:493–497PubMedCrossRef
29.
Yoshioka Y, Siu D, Cooke TD (1987) The anatomy and functional axes of the femur. J Bone Joint Surg Am 69:873–880PubMed
Metadata
Title
Relationship between the tibial anteroposterior axis and the surgical epicondylar axis in varus and valgus knees
Authors
Shinya Kawahara
Shuichi Matsuda
Ken Okazaki
Yasutaka Tashiro
Hiroaki Mitsuyasu
Hiroyuki Nakahara
Yukihide Iwamoto
Publication date
01-10-2012
Publisher
Springer-Verlag
Published in
Knee Surgery, Sports Traumatology, Arthroscopy / Issue 10/2012
Print ISSN: 0942-2056
Electronic ISSN: 1433-7347
DOI
https://doi.org/10.1007/s00167-011-1826-0

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