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A computed tomographic evaluation of femoral and tibial rotational reference axes in total knee arthroplasty

Introduction: The surgical trans epicondylar axis (sTEA) is considered the gold standard for optimum rotation of the femoral component; however, no consensus exists on tibial component positioning. The objectives of this study were to determine the relationship of sTEA to various femoral and tibial...

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Autores principales: Panicker, Johncy, Thilak, Jai
Formato: Online Artículo Texto
Lenguaje:English
Publicado: EDP Sciences 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9878997/
https://www.ncbi.nlm.nih.gov/pubmed/36705527
http://dx.doi.org/10.1051/sicotj/2023002
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author Panicker, Johncy
Thilak, Jai
author_facet Panicker, Johncy
Thilak, Jai
author_sort Panicker, Johncy
collection PubMed
description Introduction: The surgical trans epicondylar axis (sTEA) is considered the gold standard for optimum rotation of the femoral component; however, no consensus exists on tibial component positioning. The objectives of this study were to determine the relationship of sTEA to various femoral and tibial reference axes in varus osteoarthritis (OA) knees and (ii) to study the intra-observer and inter-observer variability of the axis relationships. Materials and methods: The study was done on preoperative computerised tomogram (CT) scans of 110 varus knees to assess the rotational relationships respectively of femoral side sTEA with whitesides line (WSL), posterior condylar axis (PCA), clinical trans epicondylar axis (cTEA) and on the tibial side sTEA with posterior tibial margin (PTM), anterior condylar axis (ACA), Akagi’s line and line from the geometric centre of the tibial plateau to 1/3rd tibial tubercle (line GC 1/3rd TT). Results: On the femoral side the mean angles of sTEA with WSL, PCA, cTEA were 95.64° ± 2.85°, 1.77° ± 1.88°, 4.19° ± 0.99° respectively. On the tibial side, the mean angles of sTEA with, PTM, ACA, Akagi’s line, and line GC 1/3rd TT were 1.10° ± 4.69°, 11.98° ± 4.51°, 2.43° ± 4.35°, 16.04° ± 5.93° respectively. Conclusion: Contrary to the generalization, TEA has variable relationships. The surgical trans epicondylar axis was not at the assumed 3° of external rotation to PCA in 85% of knees, nor perpendicular to WSL in >95% of knees. Of the four tibial axes, Akagi’s line was the least variable with sTEA. Furthermore, surgeons should also be aware of the multiple reference axes and the range of deviation from sTEA to optimize the rotational alignment of components.
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spelling pubmed-98789972023-02-03 A computed tomographic evaluation of femoral and tibial rotational reference axes in total knee arthroplasty Panicker, Johncy Thilak, Jai SICOT J Original Article Introduction: The surgical trans epicondylar axis (sTEA) is considered the gold standard for optimum rotation of the femoral component; however, no consensus exists on tibial component positioning. The objectives of this study were to determine the relationship of sTEA to various femoral and tibial reference axes in varus osteoarthritis (OA) knees and (ii) to study the intra-observer and inter-observer variability of the axis relationships. Materials and methods: The study was done on preoperative computerised tomogram (CT) scans of 110 varus knees to assess the rotational relationships respectively of femoral side sTEA with whitesides line (WSL), posterior condylar axis (PCA), clinical trans epicondylar axis (cTEA) and on the tibial side sTEA with posterior tibial margin (PTM), anterior condylar axis (ACA), Akagi’s line and line from the geometric centre of the tibial plateau to 1/3rd tibial tubercle (line GC 1/3rd TT). Results: On the femoral side the mean angles of sTEA with WSL, PCA, cTEA were 95.64° ± 2.85°, 1.77° ± 1.88°, 4.19° ± 0.99° respectively. On the tibial side, the mean angles of sTEA with, PTM, ACA, Akagi’s line, and line GC 1/3rd TT were 1.10° ± 4.69°, 11.98° ± 4.51°, 2.43° ± 4.35°, 16.04° ± 5.93° respectively. Conclusion: Contrary to the generalization, TEA has variable relationships. The surgical trans epicondylar axis was not at the assumed 3° of external rotation to PCA in 85% of knees, nor perpendicular to WSL in >95% of knees. Of the four tibial axes, Akagi’s line was the least variable with sTEA. Furthermore, surgeons should also be aware of the multiple reference axes and the range of deviation from sTEA to optimize the rotational alignment of components. EDP Sciences 2023-01-27 /pmc/articles/PMC9878997/ /pubmed/36705527 http://dx.doi.org/10.1051/sicotj/2023002 Text en © The Authors, published by EDP Sciences, 2023 https://creativecommons.org/licenses/by/4.0/This is an Open Access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0 (https://creativecommons.org/licenses/by/4.0/) ), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
spellingShingle Original Article
Panicker, Johncy
Thilak, Jai
A computed tomographic evaluation of femoral and tibial rotational reference axes in total knee arthroplasty
title A computed tomographic evaluation of femoral and tibial rotational reference axes in total knee arthroplasty
title_full A computed tomographic evaluation of femoral and tibial rotational reference axes in total knee arthroplasty
title_fullStr A computed tomographic evaluation of femoral and tibial rotational reference axes in total knee arthroplasty
title_full_unstemmed A computed tomographic evaluation of femoral and tibial rotational reference axes in total knee arthroplasty
title_short A computed tomographic evaluation of femoral and tibial rotational reference axes in total knee arthroplasty
title_sort computed tomographic evaluation of femoral and tibial rotational reference axes in total knee arthroplasty
topic Original Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9878997/
https://www.ncbi.nlm.nih.gov/pubmed/36705527
http://dx.doi.org/10.1051/sicotj/2023002
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