Abstract
BackgroundFemoral component rotation (FCR) is one of the most important factors in total knee arthroplasty. In this prospective study, we used three different techniques for FCR and analyzed their accuracy with postoperative axial computed tomography (CT) images. We also evaluated effect of FCR to clinical outcome.MethodsOne hundred sixty-five patients were randomly allocated into three groups. In the measured resection group, FCR was set by externally rotating the axis 3° off the posterior femoral condylar axis. In the tensor group, a gap-tensioning device set at 20 lbf was used. In the block group, spacer blocks of various thicknesses were used. The FCR angle (FCRa) was measured on postoperative axial CT as an angle between the clinical transepicondylar and posterior condylar axes of the femoral component. Outliers were defined as FCRas deviated more than 3° either internally or externally. Postoperative 2 year clinical scores and knee range of motion were checked.ResultsThe tensor group had significantly better positioning of the femoral component to the neutral position compared with the measured resection group and the block group (mean FCRa: internal rotation 1.79, 0.43 and 2.63°, respectively, p < 0.001). The outliers were also least frequent in the tensor group (35, 16 and 40%, respectively, p = 0.02). There were no significant differences in postoperative 2 year clinical results among groups.ConclusionsGap technique with a 20-lbf tensor device was the most accurate and precise method for obtaining adequate FCR. Measured resection with 3° external rotation and gap technique with blocks could lead to internal rotation of the femoral component. Postoperative 2 year clinical results were not significantly different among groups with different techniques for FCR.Trial registrationThe study was registered in the Clinical Research information Service (trial number: KCT0000129) in Korea. Registration date is 23rd of June, 2011.
Highlights
Femoral component rotation (FCR) is one of the most important factors in total knee arthroplasty
The tensor group had significantly better positioning of the femoral component to the neutral position compared with the measured resection and block groups (p < 0.001)
The outliers were least frequent in the tensor group (35, 16 and 40% in the measured resection, tensor and block groups, respectively, p = 0.02)
Summary
Femoral component rotation (FCR) is one of the most important factors in total knee arthroplasty. In this prospective study, we used three different techniques for FCR and analyzed their accuracy with postoperative axial computed tomography (CT) images. Establishing adequate femoral component rotation (FCR) is important in total knee arthroplasty (TKA), and it is widely accepted through many studies. An external rotation of 3° off the posterior femoral condylar axis is considered to be satisfactory and generally accepted in the measured resection technique [8, 9]. Two methods are used to determine the flexion gap and femoral component position in axial plane in the gap technique. Gap blocks of various thickness can be used to perform the gap technique
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