The sagittal geometry of the trochlear groove could be described as a circle: an intraoperative assessment with navigation.

Abstract

The aim of this study was to describe the sagittal geometry of the trochlear groove in patients who underwent primary TKA, based on intraoperative data acquired with a navigation system. Intraoperative navigation data were collected from 110 patients. All operations were guided by a non-image-based navigation system (BLU-IGS, Orthokey Italia Srl). The trochlear groove has been described on the three anatomical planes; in particular, on the sagittal plane the hypothesis has been verified that the acquired points are referable to a circle. Using the data collected during intraoperative navigation, possible correlation between the radius of the trochlear groove and other femur dimension (length, AP dimension) was analyzed; the orientation of the trochlear sulcus with respect to the mechanical axis and the posterior condyle axis was analyzed too, searching for possible correlation between groove alignment (frontal and axial) or groove radius and the hip-knee-ankle (HKA). The average radius of curvature of the femoral trochlea was 25.5 ± 5.6mm; the difference was not statistically significant between the men and women (n.s. p value). No correlation was found between the trochlear groove radius and the femur length (r = - 0.02) or the HKA-phenotypes (r = 0.03) and between the groove alignment and HKA-phenotypes. On axial plane, the trochlear groove was 3.2° ± 4.3° externally rotated, with respect to the posterior condylar axis; on frontal plane, the trochlear groove was 3.9° ± 5.3° externally rotated, with respect to the mechanical axis. In both cases, no statistically significant differences were found between male and female and between left and right limb (p > 0.05). The present study shows that the sagittal plane geometry of the femoral trochlea in patients affected by osteoarthritis could be described accurately as a circle. The acquisition of the trochlear morphology intraoperatively can lead to more anatomically shape definition, to investigate deeper its radius of curvature and geometry. Trochlear shape could be used as landmarks for femoral component positioning, thus customizing the implant design, optimize the outcomes and improving anterior knee pain after TKA. IV.