The Archives of Bone and Joint Surgery

The Archives of Bone and Joint Surgery

Evaluation of Distal Femoral Rotational Alignment with Spiral CT Scan before Total Knee Arthroplasty (A Study in Iranian Population)

Document Type : RESEARCH PAPER

Authors
Mahmoud Jabalameli 1
Amin Moradi 2
Abolfazl Bagherifard 1
Mehran Radi 1
Tahmineh Mokhtari 3
1 Shafa Orthopedic Hospital, Iran University of Medical Sciences, Tehran, Iran
2 Tabriz Shohada Hospital, Tabriz University of Medical Sciences, Tabriz, Iran
3 Tehran University of Medical Sciences, Tehran, Iran
10.22038/abjs.2016.6024
Abstract
 
 
Background: Evaluating the landmarks for rotation of the distal femur is a challenge for orthopedic surgeons. Although the posterior femoral condyle axis is a good landmark for surgeons, the surgical transepicondylar axis may be a better option with the help of preoperative CT scanning. The purpose of this study was to ascertain relationships among the axes’ guiding distal femur rotational alignment in preoperative CT scans of Iranian patients who were candidates for total knee arthroplasty and the effects of age, gender, and knee alignment on these relationships.
Methods: One hundred and eight cases who were admitted to two university hospitals for total knee arthroplasty were included in this study. The rotation of the distal femur was evaluated using single axial CT images through the femoral epicondyle. Four lines were drawn digitally in this view: anatomical and surgical transepicondylar axes, posterior condylar axis and the Whiteside anteroposterior line. The alignment of the extremity was evaluated in the standing alignment view. Then the angles were measured along these lines and their relationship was evaluated.
Results: The mean angle between the anatomical transepicondylar axis and posterior condylar axis and between the surgical transepicondylar axis and posterior condylar axis were 5.9 ± 1.6 degrees and 1.6±1.7 degrees respectively. The mean angle between the Whiteside’s anteroposterior line and the line perpendicular to the posterior condylar axis was 3.7±2.1 degrees. Significant differences existed between the two genders in these relationships. No significant correlation between the age of patients and angles of the distal femur was detected. The anatomical surgical transepicondylar axis was in 4.3 degrees external rotation in relation to the surgical transepicondylar axis.
Conclusion: Preoperative CT scanning can help accurately determine rotational landmarks of the distal femur. If one of the reference axes cannot be determined, other reference axes can be used because of the good correlation between these landmarks.
 
 
 
Keywords
Distal femur
Rotational alignment
Transepicondylar axis
Whiteside line
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The Archives of Bone and Joint Surgery
Volume 4, Issue 2 - Serial Number 2
April 2016
Pages 122-127

  • Receive Date 30 July 2015
  • Revise Date 23 November 2015
  • Accept Date 29 November 2015