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Cartilage assessment using preoperative planning MRI for femoral component rotational alignment

Published:August 22, 2022DOI:https://doi.org/10.1016/j.knee.2022.07.005

      Abstract

      Background

      Surgical planning of posterior referencing total knee arthroplasty (TKA) using computed tomography (CT) might lead to over-rotation of the femoral component because CT could not detect cartilage thickness of the posterior femoral condyle. The purpose of this study was to examine the rotational alignment difference of the femoral component between magnetic resonance imaging (MRI) and CT.

      Methods

      For elderly varus osteoarthritic patients, 66 varus osteoarthritic knee patients that underwent primary TKA were selected. Twenty-seven young patients who underwent primary anterior cruciate ligament reconstruction were selected as control. After the transepicondylar axis (CEA), the surgical epicondylar axis (SEA) and the posterior femoral condylar line (PCL) were drawn on CT and on MRI at the same angles as CT. Then, the practical PCL was drawn on MRI considering the cartilage thickness (the cartilage PCL). The angle between the SEA and the cartilage PCL (the cartilage posterior condylar angle (PCA)) was measured as preoperative planning. To investigate the accuracy of preoperative MRI measurement, the cartilage thickness on posterior femoral condyles was directly measured during TKA.

      Results

      The cartilage PCA for varus osteoarthritic patients averaged 1.3 ± 1.3°. The cartilage PCA was 1.8 ± 1.0° significantly smaller than the bone PCA (the PCA measured on CT). Meanwhile, the cartilage PCA was 0.2 ± 0.4° significantly larger than the bone PCA in young people. The preoperative angle measurement on MRI strongly correlated with the direct measurement of cartilage thickness during TKA.

      Conclusion

      There was 1.8° of divergence between MRI and CT in varus osteoarthritic patients due to cartilage degeneration of the medial femoral condyle. Cartilage assessment using MRI was useful for femoral component rotational alignment.

      Keywords

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      References

        • Akagi M.
        • Matsusue Y.
        • Mata T.
        • Asada Y.
        • Horiguchi M.
        • Iida H.
        • et al.
        Effect of rotational alignment on patellar tracking in total knee arthroplasty.
        Clin Orthop Relat Res. 1999; 366: 155-163
        • Berger R.A.
        • Crossett L.S.
        • Jacobs J.J.
        • Rubash H.E.
        Malrotation causing patellofemoral complications after total knee arthroplasty.
        Clin Orthop Relat Res. 1998; 1998: 144-153
        • Fehring T.K.
        Rotational malalignment of the femoral component in total knee arthroplasty.
        Clin Orthop Relat Res. 2000; 2000: 72-79
        • Merican A.M.
        • Ghosh K.M.
        • Iranpour F.
        • Deehan D.J.
        • Amis A.A.
        The effect of femoral component rotation on the kinematics of the tibiofemoral and patellofemoral joints after total knee arthroplasty.
        Knee Surg Sports Traumatol Arthrosc. 2011; 19: 1479-1487
        • Kawahara S.
        • Okazaki K.
        • Matsuda S.
        • Nakahara H.
        • Okamoto S.
        • Iwamoto Y.
        Internal rotation of femoral component affects functional activities after TKA – survey with the 2011 Knee Society Score.
        J Arthroplasty. 2014; 29: 2319-2323
        • Hanada H.
        • Whiteside L.A.
        • Steiger J.
        • Dyer P.
        • Naito M.
        Bone landmarks are more reliable than tensioned gaps in TKA component alignment.
        Clin Orthop Relat Res. 2007; 462: 137-142
        • Miller M.C.
        • Berger R.A.
        • Petrella A.J.
        • Karmas A.
        • Rubash H.E.
        Optimizing femoral component rotation in total knee arthroplasty.
        Clin Orthop Relat Res. 2001; 2001: 38-45
        • Bonnin M.P.
        • Saffarini M.
        • Nover L.
        • van der Maas J.
        • Haeberle C.
        • Hannink G.
        • et al.
        External rotation of the femoral component increases asymmetry of the posterior condyles.
        Bone Joint J. 2017; 99-b: 894-903
        • Berger R.A.
        • Rubash H.E.
        • Seel M.J.
        • Thompson W.H.
        • Crossett L.S.
        Determining the rotational alignment of the femoral component in total knee arthroplasty using the epicondylar axis.
        Clin Orthop Relat Res. 1993; 1993: 40-47
        • Griffin F.M.
        • Insall J.N.
        • Scuderi G.R.
        The posterior condylar angle in osteoarthritic knees.
        J Arthroplasty. 1998; 13: 812-815
        • Griffin F.M.
        • Math K.
        • Scuderi G.R.
        • Insall J.N.
        • Poilvache P.L.
        Anatomy of the epicondyles of the distal femur: MRI analysis of normal knees.
        J Arthroplasty. 2000; 15: 354-359
        • Skowronek P.
        • Arnold M.
        • Starke C.
        • Bartyzel A.
        • Moser L.B.
        • Hirschmann M.T.
        Intra- and postoperative assessment of femoral component rotation in total knee arthroplasty: An EKA knee expert group clinical review.
        Knee Surg Sports Traumatol Arthrosc. 2021; 29: 772-782
        • Asada S.
        • Akagi M.
        • Matsushita T.
        • Hashimoto K.
        • Mori S.
        • Hamanishi C.
        Effects of cartilage remnants of the posterior femoral condyles on femoral component rotation in varus knee osteoarthritis.
        Knee. 2012; 19: 185-189
        • Fujii T.
        • Kondo M.
        • Tomari K.
        • Kadoya Y.
        • Tanaka Y.
        Posterior condylar cartilage may distort rotational alignment of the femoral component based on posterior condylar axis in total knee arthroplasty.
        Surg Radiol Anat. 2012; 34: 633-638
        • Hamada D.
        • Wada K.
        • Mikami H.
        • Toki S.
        • Goto T.
        • Tsutsui T.
        • et al.
        The posterior condylar cartilage affects rotational alignment of the femoral component in varus knee osteoarthritis.
        J Med Invest. 2017; 64: 24-29
        • Tashiro Y.
        • Uemura M.
        • Matsuda S.
        • Okazaki K.
        • Kawahara S.
        • Hashizume M.
        • et al.
        Articular cartilage of the posterior condyle can affect rotational alignment in total knee arthroplasty.
        Knee Surg Sports Traumatol Arthrosc. 2012; 20: 1463-1469
        • Koo T.K.
        • Li M.Y.
        A guideline of selecting and reporting intraclass correlation coefficients for reliability research.
        J Chiropr Med. 2016; 15: 155-163
        • Arima J.
        • Whiteside L.A.
        • Martin J.W.
        • Miura H.
        • White S.E.
        • McCarthy D.S.
        Effect of partial release of the posterior cruciate ligament in total knee arthroplasty.
        Clin Orthop Relat Res. 1998; : 194-202
        • Ritter M.A.
        • Faris P.M.
        • Keating E.M.
        Posterior cruciate ligament balancing during total knee arthroplasty.
        J Arthroplasty. 1988; 3: 323-326
        • Baldini A.
        • Scuderi G.
        • Aglietti P.
        • Chalnick D.
        • Insall J.
        Flexion–extension gap changes during total knee arthroplasty: effect of posterior cruciate ligament and posterior osteophytes removal.
        J Knee Surg. 2004; 17: 69-72
        • In Y.
        • Kim J.-M.
        • Woo Y.-K.
        • Choi N.-Y.
        • Sohn J.-M.
        • Koh H.-S.
        Factors affecting flexion gap tightness in cruciate-retaining total knee arthroplasty.
        J Arthroplasty. 2009; 24: 317-321
        • Franceschini V.
        • Nodzo S.R.
        • Gonzalez Della Valle A.
        Femoral component rotation in total knee arthroplasty: A comparison between transepicondylar axis and posterior condylar line referencing.
        J Arthroplasty. 2016; 31: 2917-2921
        • Chin K.R.
        • Dalury D.F.
        • Zurakowski D.
        • Scott R.D.
        Intraoperative measurements of male and female distal femurs during primary total knee arthroplasty.
        J Knee Surg. 2002; 15: 213-217
        • Hitt K.
        • Shurman 2nd, J.R.
        • Greene K.
        • McCarthy J.
        • Moskal J.
        • Hoeman T.
        • et al.
        Anthropometric measurements of the human knee: correlation to the sizing of current knee arthroplasty systems.
        J Bone Joint Surg Am. 2003; 85-A: 115-122
        • Lonner J.H.
        • Jasko J.G.
        • Thomas B.S.
        Anthropomorphic differences between the distal femora of men and women.
        Clin Orthop Relat Res. 2008; 466: 2724-2729
        • Poilvache P.L.
        • Insall J.N.
        • Scuderi G.R.
        • Font-Rodriguez D.E.
        Rotational landmarks and sizing of the distal femur in total knee arthroplasty.
        Clin Orthop Relat Res. 1996; : 35-46
        • Dargel J.
        • Michael J.W.P.
        • Feiser J.
        • Ivo R.
        • Koebke J.
        Human knee joint anatomy revisited: morphometry in the light of sex-specific total knee arthroplasty.
        J Arthroplasty. 2011; 26: 346-353
        • Fehring T.K.
        • Odum S.M.
        • Hughes J.
        • Springer B.D.
        • Beaver W.B.
        Differences between the sexes in the anatomy of the anterior condyle of the knee.
        J Bone Joint Surg Am. 2009; 91: 2335-2341
        • Li K.
        • Langdale E.
        • Tashman S.
        • Harner C.
        • Zhang X.
        Gender and condylar differences in distal femur morphometry clarified by automated computer analyses.
        J Orthop Res. 2012; 30: 686-692
        • Voleti P.B.
        • Stephenson J.W.
        • Lotke P.A.
        • Lee G.C.
        No sex differences exist in posterior condylar offsets of the knee.
        Clin Orthop Relat Res. 2015; 473: 1425-1431