Preoperative rotational assessment of the distal femur with CT may cause femoral component malrotation in TKA |
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| Institution: | 1. Department of Orthopaedic Surgery, Hallym University Kangnam Sacred Heart Hospital, 1, Singil-ro, Yeongdeungpo-gu, Seoul, South Korea;2. Department of Orthopaedic Surgery, Konkuk University Medical Center, 120-1, Neungdong-ro, Gwangjin-gu, Seoul, South Korea;1. Istanbul University–Cerrahpasa, Cerrahpasa Medical Faculty, Department of Orthopaedics and Traumatology, Istanbul, Turkey;2. Ortopediatri Kliniği, Istanbul, Turkey;1. Rehabilitation Unit, Kyoto University Hospital, Sakyo-ku, Kyoto, Japan;2. Department of Orthopedic Surgery, Faculty of Medicine, Kyoto University, Sakyo-ku, Kyoto, Japan;3. Department of Advanced Medicine for Rheumatic Diseases, Kyoto University, Sakyo-ku, Kyoto, Japan;2. Department of Orthopedic Surgery, Chaim Sheba Medical Center, Tel Hashomer and Sackler Faculty of Medicine, Derech Sheba 2, Ramat Gan, Israel;3. Montefiore Medical Center, 1250 Waters Place 11th Floor, Bronx, NY 10461, United States;4. Sports Medicine Institute, Hospital for Special Surgery, 535 E 70th St, New York, NY 10021, United States;1. Department of Kinesiology and Rehabilitation Sciences, University of Hawaii, Honolulu, Hawaii;2. Bone and Joint Clinic, Straub Medical Center, Honolulu, Hawaii;1. Department of Orthopedic Surgery, Nagoya University Graduate School and School of Medicine, Nagoya, Japan;2. Department of Rehabilitation, Nagoya University Hospital, Nagoya, Japan;3. Department of Orthopedic Surgery, Aichi Cancer Center Hospital, Nagoya, Japan |
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| Abstract: | BackgroundBefore total knee arthroplasty (TKA), rotational assessment of the distal femur can be performed using either magnetic resonance imaging (MRI) or computed tomography (CT). Until now, there has been no study comparing the two modalities regarding rotational assessment of the distal femur in the same patients.MethodsWe retrospectively reviewed the preoperative CT and MRI images of 110 knees in 110 patients who underwent TKA. In the axial planes of CT and MRI scan, the posterior condylar axis (PCA), anatomical transepicondylar axis (aTEA), and perpendicular line to anteroposterior axis (pAPA) were identified; the angles between these studied lines were calculated. During TKA, the angles measured on the preoperative CT and MRI were compared with the measurements obtained in the intraoperative field.ResultsThe mean aTEA-PCA angle was 6.2 ± 1.9° with CT and 5.1 ± 1.8° with MRI. The mean pAPA-PCA angle was 4.7 ± 2.1° with CT and 3.5 ± 2.0° with MRI. The mean aTEA-PCA (1.1 ± 1.3°, p = 0.001) and pAPA-PCA (1.2 ± 1.2°, p = 0.012) angles significantly differed between CT and MRI. Intra-operatively, the mean aTEA-PCA angle was 4.7 ± 1.1° and the mean pAPA-PCA angle was 3.2 ± 0.9°. Reliability analysis between the preoperative CT/MRI and the intraoperative measurements gave kappa values of 0.72 for aTEA-PCA and 0.66 for pAPA-PCA with CT, and 0.82 for aTEA-PCA and 0.84 for pAPA-PCA with MRI.ConclusionsPreoperative rotational assessment of the distal femur with CT may cause higher external rotation of femoral component in TKA. |
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| Keywords: | Total knee arthroplasty Femoral component Rotational assessment Computed tomography Magnetic resonance imaging |
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