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Knee Surgery, Sports Traumatology, Arthroscopy
Published in: Knee Surgery, Sports Traumatology, Arthroscopy 9/2020

01-09-2020 | Magnetic Resonance Imaging | KNEE

Gender differences exist in rotational anatomy of the distal femur in osteoarthritic knees using MRI

Authors: Yong-Gon Koh, Ji-Hoon Nam, Hyun-Seok Chung, Hyo-Jeong Kim, Hwa-Yong Lee, Kyoung-Tak Kang

Published in: Knee Surgery, Sports Traumatology, Arthroscopy | Issue 9/2020

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Abstract

Purpose

Optimal rotational alignment of the femoral component is essential for total knee arthroplasty (TKA). The femoral transepicondylar axis (TEA), Whiteside’s line (WSL), and posterior condylar axis (PCA) are various intra-operative references that can be used to determine femoral rotation, and each has advantages and disadvantages. This study aimed to define the rotational anatomy of the distal femur and investigate its relationship with gender in osteoarthritic knees.

Methods

Magnetic resonance imaging (MRI) was obtained from 1522 patients (1298 females and 224 males) with end-stage knee osteoarthritis prior to TKA. MRI was constructed into three-dimensional models. The angles between the TEA and WSL, WSL and PCA, and TEA and PCA were calculated for each patient. In addition, gender differences in femoral rotation were evaluated.

Results

The PCA was 2.2° ± 1.0° internally rotated relative to the TEA. WSL was 1.2° ± 2.8° externally rotated relative to the TEA. The WSL to TEA relationship exhibited greater variability than the PCA to TEA relationship. PCA was more internally rotated and WSL was more externally rotated relative to TEA in female group than male group. Based on the standard reference rules of 3° external rotation from the PCA that has been conventionally used, 15.7% of patients showed external rotation lower 1° or greater than 5° external rotation from the PCA. In the mean external rotation of the TEA from the PCA (2.2°) from this population; however, the percentage of patients showing ± 2° from their TEA dropped to 5.1% of patients.

Conclusion

Gender difference and variability exist in distal femoral rotational anatomy. These data can be useful in consideration of femoral anatomy variability and gender difference. The same cutting angle may lead to malrotation of the femoral component.

Level of evidence

Consecutive patients, level III.
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Metadata
Title
Gender differences exist in rotational anatomy of the distal femur in osteoarthritic knees using MRI
Authors
Yong-Gon Koh
Ji-Hoon Nam
Hyun-Seok Chung
Hyo-Jeong Kim
Hwa-Yong Lee
Kyoung-Tak Kang
Publication date
01-09-2020
Publisher
Springer Berlin Heidelberg
Published in
Knee Surgery, Sports Traumatology, Arthroscopy / Issue 9/2020
Print ISSN: 0942-2056
Electronic ISSN: 1433-7347
DOI
https://doi.org/10.1007/s00167-019-05730-w

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