Skip to main content
Erschienen in: Knee Surgery, Sports Traumatology, Arthroscopy 3/2021

25.04.2020 | KNEE

Coronal shaft bowing of the femur affects varus inclination of the surgical transepicondylar axis in varus knee osteoarthritis

verfasst von: Shuntaro Nejima, Ken Kumagai, Hideo Kobayashi, Shunsuke Yamada, Tomotaka Akamatsu, Takahiro Ogino, Masaichi Sotozawa, Yutaka Inaba

Erschienen in: Knee Surgery, Sports Traumatology, Arthroscopy | Ausgabe 3/2021

Einloggen, um Zugang zu erhalten

Abstract

Purpose

This study investigated the relationship between femoral shaft bowing and the orientation of the surgical transepicondylar axis (TEA) in the coronal plane in varus knee osteoarthritis (OA).

Methods

A total of 82 knees scheduled to undergo total knee arthroplasty (TKA) for the treatment of varus knee OA were enrolled. The hip–knee-ankle angle (HKA) was measured preoperatively on anteroposterior whole-leg standing radiographs. The lateral angle between the TEA and the mechanical axis of the femur (MA-TEA) was measured in the coronal plane from preoperative computed tomography (CT) images. Femoral shaft bowing was measured on CT images. Pearson’s correlation coefficient was used to examine the correlation of the MA-TEA with the HKA and femoral shaft bowing.

Results

The MA-TEA correlated negatively with the HKA (r = − 0.321, P < 0.01) and positively with femoral shaft bowing (r = 0.415, P < 0.01).

Conclusions

The TEA changed to varus as femoral shaft bowing increased in patients with varus knee OA. This suggests that the TEA is not always the centre of the rotational axis of the femur after TKA. In addition, the TEA may not be useful as a consistent parameter in the coronal plane in patients with increasing femoral shaft bowing.

Level of evidence

III.
Literatur
1.
Zurück zum Zitat Akamatsu Y, Kobayashi H, Kusayama Y, Kumagai K, Saito T (2016) Femoral shaft bowing in the coronal and sagittal planes on reconstructed computed tomography in women with medial compartment knee osteoarthritis: a comparison with radiograph and its predictive factors. Arch Orthop Trauma Surg 136:1227–1232CrossRef Akamatsu Y, Kobayashi H, Kusayama Y, Kumagai K, Saito T (2016) Femoral shaft bowing in the coronal and sagittal planes on reconstructed computed tomography in women with medial compartment knee osteoarthritis: a comparison with radiograph and its predictive factors. Arch Orthop Trauma Surg 136:1227–1232CrossRef
2.
Zurück zum Zitat Berger RA, Rubash HE, Seel MJ, Thompson WH, Crossett LS (1993) Determining the rotational alignment of the femoral component in total knee arthroplasty using the epicondylar axis. Clin Orthop Relat Res 286:40–47 Berger RA, Rubash HE, Seel MJ, Thompson WH, Crossett LS (1993) Determining the rotational alignment of the femoral component in total knee arthroplasty using the epicondylar axis. Clin Orthop Relat Res 286:40–47
3.
Zurück zum Zitat Echhoff DG, Bach JM, Spitzer VM, Reinig KD, Bagur MM, Baldini TH, Rubinstein D, Humphries S (2003) Three-dimensional morphology and kinematics of the distal part of the femur viewed in virtual reality. J Bone Jt Surg Am 85:97–104CrossRef Echhoff DG, Bach JM, Spitzer VM, Reinig KD, Bagur MM, Baldini TH, Rubinstein D, Humphries S (2003) Three-dimensional morphology and kinematics of the distal part of the femur viewed in virtual reality. J Bone Jt Surg Am 85:97–104CrossRef
4.
Zurück zum Zitat Kim JM, Hong SH, Kim JM, Lee BS, Kim DE, Kim KA, Bin SI (2015) Femoral shaft bowing in the coronal plane has more significant effect on the coronal alignment of TKA than proximal or distal variations of femoral shape. Knee Surg Sports Traumatol Arthrosc 23:1936–1942CrossRef Kim JM, Hong SH, Kim JM, Lee BS, Kim DE, Kim KA, Bin SI (2015) Femoral shaft bowing in the coronal plane has more significant effect on the coronal alignment of TKA than proximal or distal variations of femoral shape. Knee Surg Sports Traumatol Arthrosc 23:1936–1942CrossRef
5.
Zurück zum Zitat Kobayashi H, Akamatsu Y, Kumagai K, Kusayama Y, Aratake M, Saito T (2015) Is the surgical epicondylar axis the center of rotation in the osteoarthritic knee? J Arthroplasty 30:479–483CrossRef Kobayashi H, Akamatsu Y, Kumagai K, Kusayama Y, Aratake M, Saito T (2015) Is the surgical epicondylar axis the center of rotation in the osteoarthritic knee? J Arthroplasty 30:479–483CrossRef
6.
Zurück zum Zitat Kobayashi H, Akamatsu Y, Kumagai K, Kusayama Y, Ishigatsubo R, Muramatsu S, Saito T (2014) The surgical epicondylar axis is a consistent reference of the distal femur in the coronal and axial planes. Knee Surg Sports Traumatol Arthrosc 22:2947–2953CrossRef Kobayashi H, Akamatsu Y, Kumagai K, Kusayama Y, Ishigatsubo R, Muramatsu S, Saito T (2014) The surgical epicondylar axis is a consistent reference of the distal femur in the coronal and axial planes. Knee Surg Sports Traumatol Arthrosc 22:2947–2953CrossRef
7.
Zurück zum Zitat Lasam MP, Lee KJ, Chang CB, Kang YG, Kim TK (2013) Femoral lateral bowing and varus condylar orientation are prevalent and affect axial alignment of TKA in Koreans. Clin Orthop Relat Res 471:1472–1483CrossRef Lasam MP, Lee KJ, Chang CB, Kang YG, Kim TK (2013) Femoral lateral bowing and varus condylar orientation are prevalent and affect axial alignment of TKA in Koreans. Clin Orthop Relat Res 471:1472–1483CrossRef
8.
Zurück zum Zitat Lustig S, Lavoie F, Selmi TA, Servien E, Neyret P (2008) Relationship between the surgical epicondylar axis and the articular surface of the distal femur: an anatomic study. Knee Surg Sports Traumatol Arthrosc 16:674–682CrossRef Lustig S, Lavoie F, Selmi TA, Servien E, Neyret P (2008) Relationship between the surgical epicondylar axis and the articular surface of the distal femur: an anatomic study. Knee Surg Sports Traumatol Arthrosc 16:674–682CrossRef
9.
Zurück zum Zitat Matsumoto T, Hashimura M, Takayama K, Ishida K, Kawakami Y, Matsuzaki T, Nakano N, Matsushita T, Kuroda R, Kurosaka M (2015) A radiographic analysis of alignment of the lower extremities—initiation and progression of varus type knee osteoarthritis. Osteoarthr Cartil 23:217–223CrossRef Matsumoto T, Hashimura M, Takayama K, Ishida K, Kawakami Y, Matsuzaki T, Nakano N, Matsushita T, Kuroda R, Kurosaka M (2015) A radiographic analysis of alignment of the lower extremities—initiation and progression of varus type knee osteoarthritis. Osteoarthr Cartil 23:217–223CrossRef
10.
Zurück zum Zitat Mochizuki T, Tanifuji O, Koga Y, Sato T, Kobayashi K, Nishino K, Watanabe S, Ariumi A, Fujii T, Yamagiwa H, Omori G, Endo N (2017) Sex differences in femoral deformity determined using three-dimensional assessment for osteoarthritic knees. Knee Surg Sports Traumatol Arthrosc 25:468–476CrossRef Mochizuki T, Tanifuji O, Koga Y, Sato T, Kobayashi K, Nishino K, Watanabe S, Ariumi A, Fujii T, Yamagiwa H, Omori G, Endo N (2017) Sex differences in femoral deformity determined using three-dimensional assessment for osteoarthritic knees. Knee Surg Sports Traumatol Arthrosc 25:468–476CrossRef
11.
Zurück zum Zitat Mullaji AB, Marawar SV, Mittal V (2009) A comparison of coronal plane axial femoral relationships in Asian patients with varus osteoarthritic knees and healthy knees. J Arthroplasty 24:861–867CrossRef Mullaji AB, Marawar SV, Mittal V (2009) A comparison of coronal plane axial femoral relationships in Asian patients with varus osteoarthritic knees and healthy knees. J Arthroplasty 24:861–867CrossRef
12.
Zurück zum Zitat Palanisami D, Iyyampillai G, Shanmugam S, Natesan R (2016) Individualised distal femoral cut improves femoral component placement and limb alignment during total knee replacement in knees with moderate and severe varus deformity. Int Orthop 40:2049–2054CrossRef Palanisami D, Iyyampillai G, Shanmugam S, Natesan R (2016) Individualised distal femoral cut improves femoral component placement and limb alignment during total knee replacement in knees with moderate and severe varus deformity. Int Orthop 40:2049–2054CrossRef
13.
Zurück zum Zitat Yau WP, Chiu KY, Tang WM, Ng TP (2007) Coronal bowing of the femur and tibia in Chinese: its incidence and effects on total knee arthroplasty planning. J Orthop Surg (Hong Kong) 15:32–36CrossRef Yau WP, Chiu KY, Tang WM, Ng TP (2007) Coronal bowing of the femur and tibia in Chinese: its incidence and effects on total knee arthroplasty planning. J Orthop Surg (Hong Kong) 15:32–36CrossRef
14.
Zurück zum Zitat Zhang Y, Wang X, Shao Y, Xia Q (2018) The orientation of the surgical epicondylar axis varies in varus and non-varus knees in the coronal plane. Knee Surg Sports Traumatol Arthrosc 26:2580–2586CrossRef Zhang Y, Wang X, Shao Y, Xia Q (2018) The orientation of the surgical epicondylar axis varies in varus and non-varus knees in the coronal plane. Knee Surg Sports Traumatol Arthrosc 26:2580–2586CrossRef
Metadaten
Titel
Coronal shaft bowing of the femur affects varus inclination of the surgical transepicondylar axis in varus knee osteoarthritis
verfasst von
Shuntaro Nejima
Ken Kumagai
Hideo Kobayashi
Shunsuke Yamada
Tomotaka Akamatsu
Takahiro Ogino
Masaichi Sotozawa
Yutaka Inaba
Publikationsdatum
25.04.2020
Verlag
Springer Berlin Heidelberg
Erschienen in
Knee Surgery, Sports Traumatology, Arthroscopy / Ausgabe 3/2021
Print ISSN: 0942-2056
Elektronische ISSN: 1433-7347
DOI
https://doi.org/10.1007/s00167-020-06025-1

Weitere Artikel der Ausgabe 3/2021

Knee Surgery, Sports Traumatology, Arthroscopy 3/2021 Zur Ausgabe

Arthropedia

Grundlagenwissen der Arthroskopie und Gelenkchirurgie. Erweitert durch Fallbeispiele, Videos und Abbildungen. 
» Jetzt entdecken

Notfall-TEP der Hüfte ist auch bei 90-Jährigen machbar

26.04.2024 Hüft-TEP Nachrichten

Ob bei einer Notfalloperation nach Schenkelhalsfraktur eine Hemiarthroplastik oder eine totale Endoprothese (TEP) eingebaut wird, sollte nicht allein vom Alter der Patientinnen und Patienten abhängen. Auch über 90-Jährige können von der TEP profitieren.

Arthroskopie kann Knieprothese nicht hinauszögern

25.04.2024 Gonarthrose Nachrichten

Ein arthroskopischer Eingriff bei Kniearthrose macht im Hinblick darauf, ob und wann ein Gelenkersatz fällig wird, offenbar keinen Unterschied.

Therapiestart mit Blutdrucksenkern erhöht Frakturrisiko

25.04.2024 Hypertonie Nachrichten

Beginnen ältere Männer im Pflegeheim eine Antihypertensiva-Therapie, dann ist die Frakturrate in den folgenden 30 Tagen mehr als verdoppelt. Besonders häufig stürzen Demenzkranke und Männer, die erstmals Blutdrucksenker nehmen. Dafür spricht eine Analyse unter US-Veteranen.

Ärztliche Empathie hilft gegen Rückenschmerzen

23.04.2024 Leitsymptom Rückenschmerzen Nachrichten

Personen mit chronischen Rückenschmerzen, die von einfühlsamen Ärzten und Ärztinnen betreut werden, berichten über weniger Beschwerden und eine bessere Lebensqualität.

Update Orthopädie und Unfallchirurgie

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.