Top

Published in:

01-10-2016 | Original Article

Normal Femorotibial Rotational Alignment and Implications for Total Knee Arthroplasty: an MRI Analysis

Authors: Gregory C. Wernecke, MBBS (Hons), Ian A. Harrris, FRACS (Orth), Bradley G. Seeto, FRACS (Orth), Darren B. Chen, FRACS (Orth), Samuel J. MacDessi, FRACS (Orth)

Published in: HSS Journal ® | Issue 3/2016

Abstract

Background

Rotational alignment of prosthetic components in total knee arthroplasty (TKA) is important to successful outcomes. Component malrotation is a known cause of revision and understanding normal rotational alignment may help recreate normal joint kinematics. To date, no large MRI study assessing femorotibial rotational alignment in nonarthritic knees has been undertaken.

Questions/Purposes

Is Insall’s tibial axis a reliable rotational landmark against common femoral rotational axes in the nonarthritic patient population?

Methods

We reviewed 544 knee MRI scans performed for suspected soft tissue pathology and identified Insall’s tibial rotational axis as well as the femoral clinical trans-epicondylar axis (TEAc), femoral surgical trans-epicondylar axis (TEAs), posterior condylar articular axis (PCA), and a modified Eckhoff’s cylindrical axis. The perpendiculars of these axes were superimposed on Insall’s tibial axis, and the angular differences were measured.

Results

Insall’s axis was internally rotated to the TEAc by 1.4°, externally rotated to Eckhoff’s cylindrical axis by 1.8°, externally rotated to the TEAs by 2.7°, and externally rotated to the PCA by 3.5°. The mean deviation from 0° (optimal alignment for each femoral axis) was significantly greater for the PCA relative to all other femoral axis.

Conclusion

Insall’s axis is a reliable landmark for rotational positioning of the tibial component and may optimize femorotibial kinematics in fixed-bearing TKA.

Available only for authorised users

Abdel MP, Oussedik S, Parratte S, Lustig S. Coronal alignment in total knee replacement: historical review, contemporary analysis, and future direction. Bone Joint J. 2014; 96-B(7): 857-862.CrossRefPubMed

Aglietti P, Sensi L, Cuomo P, Ciardullo A. Rotational position of femoral and tibial components in TKA using the femoral transepicondylar axis. Clin Orthop Relat Res. 2008; 11: 2751-5.CrossRef

Akagi M, Matsusue Y, Mata T, et al. Effect of rotational alignment on patellar tracking in total knee arthroplasty. Clin Orthop Relat Res. 1999; 366: 155-63.CrossRefPubMed

Akagi M, Mori S, Nishimura S, Nishimura A, Asano T, Hamanishi C. Variability of extraarticular tibial rotation references for total knee arthroplasty. Clin Orthop Relat Res. 2005; 436: 172-76.CrossRefPubMed

Akagi M, Oh M, Nonaka T, Tsujimoto H, Asano T, Hamanishi C. An anteroposterior axis of the tibia for total knee arthroplasty. Clin Orthop Relat Res. 2004; 420: 213-219.CrossRefPubMed

Amaranath JE, Moopanar TR, Sorial RM. Defining distal femoral anatomy for rotational alignment in total knee arthroplasty: a magnetic resonance imaging-based study. ANZ J Surg. 2014. doi:10.1111/ans.12708.

Barrack RL, Schrader T, Bertot AJ, Wolfe MW, Myers L. Component rotation and anterior knee pain after total knee arthroplasty. Clin Orthop Relat Res. 2001; 392: 46-55.CrossRefPubMed

Bedard M, Vince KG, Redfern J, Collen SR. Internal rotation of the tibial component is frequent in stiff total knee arthroplasty. Clin Orthop Rela Res. 2011. Aug;469(8):2346–55

Berger RA, Crossett LS, Jacobs JJ, Rubash HE. Malrotation causing patellofemoral complications after total knee arthroplasty. Clin Orthop Rel Res. 1998; 356: 144-53.CrossRef

10.

Berger RA, Rubash HE, Seel MJ, Thompson WH, Crossett LS. Determining the rotational alignment of the femoral component in total knee arthroplasty using the epicondylar axis. Clin Orthop Relat Res. 1993; 286: 40-7.PubMed

11.

Bindelglass DF. Rotational alignment of the tibial component in total knee arthroplasty. Orthopedics. 2001; 24(11): 1049-1052.PubMed

12.

Bonnin MP, Saffarini M, Mercier PE, Laurent JR, Carrillon Y. Is the anterior tibial tuberosity a reliable rotational landmark for the tibial component in total knee arthroplasty? J Arthroplasty. 2011 Feb;26)2):260–7

13.

Eckhoff DG, Metzger RG, Vandewalle MV. Malrotation associated with implant alignment technique in total knee arthroplasty. Clin Orthop Relat Res. 1995; 321: 28-31.PubMed

14.

Fang DM, Ritter MA, Davis KE. Coronal alignment in total knee arthroplasty: just how important is it? J Arthroplasty. 2009; 24(6 Suppl): 39-34.CrossRefPubMed

15.

Hancock CW, Winston MJ, Bach JM, Davidson BS, Eckhoff DG. Cylindrical axis, not epicondyles, approximates perpendicular to knee axes. Clin Orthop Relat Res. 2013; 471(7): 2278-83.CrossRefPubMedPubMedCentral

16.

Hill PF, Vedi V, Williams A, Iwaki H, Pinskerova V, Freeman MAR. Tibiofemoral movement 2: the loaded and unloaded living knee studied by MRI. J Bone Joint Surg (Br). 2000; 82-B: 1196-1198.CrossRef

17.

Incavo SJ, Coughlin KM, Pappas C, Beynnon BD. Anatomic rotational relationships of the proximal tibia, distal femur, and patella: implications for rotational alignment in total knee arthroplasty. J Arthroplasty. 2003; 18(5): 643-8.CrossRefPubMed

18.

Incavo SJ, Wild JJ, Coughlin KM, Beynnon BD. Early revision for component malrotation in total knee arthroplasty. Clin Orthop Relat Res. 2007. May;458:131–6

19.

Insall JN. Surgical technique and instrumentation in TKA. In:INsall JN, ed. Surgery of the Knee. New York NY: Churchill Livingstone: 1993;739–893

20.

KimYH PJW, Kim JS, Park SD. The relationship between the survival of total knee arthroplasty and postoperative coronal, sagittal and rotational alignment of knee prosthesis. Int Orthop. 2014; 38(2): 379-85.CrossRef

21.

Nakagawa S, Kadoya Y, Todo S, et al. Tibiofemoral movement 3: full flexion in the living knee studied by MRI. J Bone Joint Surg (Br). 2000; 82-B: 1199-1200.CrossRef

22.

Park IS, Ong A, Nam CH, et al. Transepicondylr axes for femoral component rotation might produce flexion asymmetry during total knee arthroplasty in knees with proximal tibia vara. Knee. 2014; 21(2): 369-73.CrossRefPubMed

23.

Patel AR et al. Femoral component rotation in total knee arthroplaty: an MRI-based evaluation of our options. J Athroplasty. 2014. doi:10.1016/j.arth.2014.02.033.

24.

Paternostre F, Schwab PE, Thienpont E. The combined Whiteside’s and posterior condylar line as a reliable reference to describe axial distal femoral anantomy in patient-specific instrument planning. Knee Surg Sports Traumatol Arthrosc. 2014. doi:10.1007/s00167-014-2836-5.

25.

Romero J, Stahelin T, Binkert C, Pfirrmann C, Hodler J, Kessler O. The clinical consequences of flexion gap asymmetry in total knee arthroplasty. J Arthroplasty. 2007; 22(2): 235-40.CrossRefPubMed

26.

Uehara K, Kadoya Y, Kobyashi A, Ohashi H, Yamona Y. Bone anatomy and rotational alignment in total knee arthroplasty. Clin Orthop Relat Res. 2002; 402: 196-201.CrossRefPubMed

27.

Wernecke GC, Harris IA, Houang M, Seeto BG, Chen DB, MacDessi SJ. Comparison of tibial bone coverage of 6 knee prostheses: a magnetic resonance imaging study with controlled rotation. J Orthop Surg. 2012; 20(2): 143-7.

Title: Normal Femorotibial Rotational Alignment and Implications for Total Knee Arthroplasty: an MRI Analysis
Authors: Gregory C. Wernecke, MBBS (Hons)
Ian A. Harrris, FRACS (Orth)
Bradley G. Seeto, FRACS (Orth)
Darren B. Chen, FRACS (Orth)
Samuel J. MacDessi, FRACS (Orth)
Publication date: 01-10-2016
Publisher: Springer US
Published in: HSS Journal ® / Issue 3/2016
Print ISSN: 1556-3316
Electronic ISSN: 1556-3324
DOI: https://doi.org/10.1007/s11420-016-9491-y

At a glance: The STEP trials

Springer Medicine

Normal Femorotibial Rotational Alignment and Implications for Total Knee Arthroplasty: an MRI Analysis

Abstract

Background

Questions/Purposes

Methods

Results

Conclusion

At a glance: The STEP trials

Springer Medicine

Abstract

Background

Questions/Purposes

Methods

Results

Conclusion

Please log in to get access to this content

Other articles of this Issue 3/2016

Association between Achilles tightness and lower extremity injury in children

ACL Damage and Deficiency is Associated with More Severe Preoperative Deformity, Lower Range of Motion at the Time of TKA

All-Arthroscopic Modified Rotator Interval Slide for Massive Anterosuperior Cuff Tears Using the Subdeltoid Space: Surgical Technique and Early Results

Phillip D. Wilson, Jr., MD: A Life Fulfilled

Handheld Navigation Device and Patient-Specific Cutting Guides Result in Similar Coronal Alignment for Primary Total Knee Arthroplasty: a Retrospective Matched Cohort Study

Rating a Sports Medicine Surgeon’s “Quality” in the Modern Era: an Analysis of Popular Physician Online Rating Websites