Dorsal cortex line is more reliable than transepicondylar axis for rotation in revision total knee arthroplasty with severe bone loss
Aims: The transepicondylar axis is a well-established reference for the determination of femoral component rotation in total knee arthroplasty (TKA). However, when severe bone loss is present in the femoral condyles, rotational alignment can be more complicated. There is a lack of validated landmar...
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The British Editorial Society of Bone & Joint Surgery
2024-12-01
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| Series: | Bone & Joint Open |
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| Online Access: | https://online.boneandjoint.org.uk/doi/epdf/10.1302/2633-1462.512.BJO-2024-0140.R1 |
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| author | Mikhail Salzmann Ellen Kropp Robert Prill Nikolai Ramadanov Marco Adriani Roland Becker |
| author_facet | Mikhail Salzmann Ellen Kropp Robert Prill Nikolai Ramadanov Marco Adriani Roland Becker |
| author_sort | Mikhail Salzmann |
| collection | DOAJ |
| description | Aims: The transepicondylar axis is a well-established reference for the determination of femoral component rotation in total knee arthroplasty (TKA). However, when severe bone loss is present in the femoral condyles, rotational alignment can be more complicated. There is a lack of validated landmarks in the supracondylar region of the distal femur. Therefore, the aim of this study was to analyze the correlation between the surgical transepicondylar axis (sTEA) and the suggested dorsal cortex line (DCL) in the coronal plane and the inter- and intraobserver reliability of its CT scan measurement. Methods: A total of 75 randomly selected CT scans were measured by three experienced surgeons independently. The DCL was defined in the coronal plane as a tangent to the dorsal femoral cortex located 75 mm above the joint line in the frontal plane. The difference between sTEA and DCL was calculated. Descriptive statistics and angulation correlations were generated for the sTEA and DCL, as well as for the distribution of measurement error for intra- and inter-rater reliability. Results: The external rotation of the DCL to the sTEA was a mean of 9.47° (SD 3.06°), and a median of 9.2° (IQR 7.45° to 11.60°), with a minimum value of 1.7° and maximum of 16.3°. The measurements of the DCL demonstrated very good to excellent test-retest and inter-rater reliability coefficients (intraclass correlation coefficient 0.80 to 0.99). Conclusion: This study reveals a correlation between the sTEA and the DCL. Overall, 10° of external rotation of the dorsal femoral cortical bone to the sTEA may serve as a reliable landmark for initial position of the femoral component. Surgeons should be aware that there are outliers in this study in up to 17% of the measurements, which potentially could result in deviations of femoral component rotation. Cite this article: Bone Jt Open 2024;5(12):1067–1071. |
| format | Article |
| id | doaj-art-dfe5c88a199b41f69eb332c4ebbee85a |
| institution | Kabale University |
| issn | 2633-1462 |
| language | English |
| publishDate | 2024-12-01 |
| publisher | The British Editorial Society of Bone & Joint Surgery |
| record_format | Article |
| series | Bone & Joint Open |
| spelling | doaj-art-dfe5c88a199b41f69eb332c4ebbee85a2025-01-28T05:38:30ZengThe British Editorial Society of Bone & Joint SurgeryBone & Joint Open2633-14622024-12-015121067107110.1302/2633-1462.512.BJO-2024-0140.R1Dorsal cortex line is more reliable than transepicondylar axis for rotation in revision total knee arthroplasty with severe bone lossMikhail Salzmann0https://orcid.org/0009-0006-0957-2285Ellen Kropp1Robert Prill2Nikolai Ramadanov3https://orcid.org/0000-0003-4669-8187Marco Adriani4Roland Becker5Center or Orthopaedics and Traumatology, University Hospital Brandenburg/Havel, Brandenburg Medical School Theodor Fontane, Brandenburg, GermanyCenter or Orthopaedics and Traumatology, University Hospital Brandenburg/Havel, Brandenburg Medical School Theodor Fontane, Brandenburg, GermanyCenter or Orthopaedics and Traumatology, University Hospital Brandenburg/Havel, Brandenburg Medical School Theodor Fontane, Brandenburg, GermanyCenter or Orthopaedics and Traumatology, University Hospital Brandenburg/Havel, Brandenburg Medical School Theodor Fontane, Brandenburg, GermanyDepartment of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, ItalyCenter or Orthopaedics and Traumatology, University Hospital Brandenburg/Havel, Brandenburg Medical School Theodor Fontane, Brandenburg, GermanyAims: The transepicondylar axis is a well-established reference for the determination of femoral component rotation in total knee arthroplasty (TKA). However, when severe bone loss is present in the femoral condyles, rotational alignment can be more complicated. There is a lack of validated landmarks in the supracondylar region of the distal femur. Therefore, the aim of this study was to analyze the correlation between the surgical transepicondylar axis (sTEA) and the suggested dorsal cortex line (DCL) in the coronal plane and the inter- and intraobserver reliability of its CT scan measurement. Methods: A total of 75 randomly selected CT scans were measured by three experienced surgeons independently. The DCL was defined in the coronal plane as a tangent to the dorsal femoral cortex located 75 mm above the joint line in the frontal plane. The difference between sTEA and DCL was calculated. Descriptive statistics and angulation correlations were generated for the sTEA and DCL, as well as for the distribution of measurement error for intra- and inter-rater reliability. Results: The external rotation of the DCL to the sTEA was a mean of 9.47° (SD 3.06°), and a median of 9.2° (IQR 7.45° to 11.60°), with a minimum value of 1.7° and maximum of 16.3°. The measurements of the DCL demonstrated very good to excellent test-retest and inter-rater reliability coefficients (intraclass correlation coefficient 0.80 to 0.99). Conclusion: This study reveals a correlation between the sTEA and the DCL. Overall, 10° of external rotation of the dorsal femoral cortical bone to the sTEA may serve as a reliable landmark for initial position of the femoral component. Surgeons should be aware that there are outliers in this study in up to 17% of the measurements, which potentially could result in deviations of femoral component rotation. Cite this article: Bone Jt Open 2024;5(12):1067–1071.https://online.boneandjoint.org.uk/doi/epdf/10.1302/2633-1462.512.BJO-2024-0140.R1revision total knee arthroplastyrevision tkaanatomical landmarks in revision tkadorsal cortex linedcl |
| spellingShingle | Mikhail Salzmann Ellen Kropp Robert Prill Nikolai Ramadanov Marco Adriani Roland Becker Dorsal cortex line is more reliable than transepicondylar axis for rotation in revision total knee arthroplasty with severe bone loss Bone & Joint Open revision total knee arthroplasty revision tka anatomical landmarks in revision tka dorsal cortex line dcl |
| title | Dorsal cortex line is more reliable than transepicondylar axis for rotation in revision total knee arthroplasty with severe bone loss |
| title_full | Dorsal cortex line is more reliable than transepicondylar axis for rotation in revision total knee arthroplasty with severe bone loss |
| title_fullStr | Dorsal cortex line is more reliable than transepicondylar axis for rotation in revision total knee arthroplasty with severe bone loss |
| title_full_unstemmed | Dorsal cortex line is more reliable than transepicondylar axis for rotation in revision total knee arthroplasty with severe bone loss |
| title_short | Dorsal cortex line is more reliable than transepicondylar axis for rotation in revision total knee arthroplasty with severe bone loss |
| title_sort | dorsal cortex line is more reliable than transepicondylar axis for rotation in revision total knee arthroplasty with severe bone loss |
| topic | revision total knee arthroplasty revision tka anatomical landmarks in revision tka dorsal cortex line dcl |
| url | https://online.boneandjoint.org.uk/doi/epdf/10.1302/2633-1462.512.BJO-2024-0140.R1 |
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