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Erschienen in: Archives of Orthopaedic and Trauma Surgery 8/2011

01.08.2011 | Trauma Surgery

Influence of femoral malrotation on knee joint alignment and intra-articular contract pressures

verfasst von: Philipp Bretin, Padhraig F. O’Loughlin, Eduardo M. Suero, Daniel Kendoff, Sven Ostermeier, Tobias Hüfner, Christian Krettek, Musa Citak

Erschienen in: Archives of Orthopaedic and Trauma Surgery | Ausgabe 8/2011

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Abstract

Introduction

The standard treatment of femoral diaphyseal fractures is intramedullary nailing. Torsion error remains a largely unsolved problem. We hypothesized that femoral malrotation would change the coronal alignment of the lower extremity and the center of force (COF) in the tibiofemoral joint as compared to the native state.

Method

Ten cadaveric legs were used. Intraarticularly placed sensor foil was used to measure contact pressures for each condyle. The resultant pressure of this two-force measurement was calculated as the COF for the joint. Mechanical axis was defined by the navigation system. Two novel devices were used: (1) to simulate bodyweight with leg attachment and fixation to the anterior pelvis and (2) to fix the femur at various degrees of malrotation. A mid-diaphyseal osteotomy was performed and the distal fragment was rotated both internally and externally in 5° increments to a maximum of 25°. COF and axial alignment were assessed at each step with application of a half-bodyweight specific to each specimen.

Results

Internal rotation resulted in valgus deviation of the mechanical axis and a shift in COF towards the lateral condyle (P < 0.05). External rotation caused varus deviation and switched COF towards the medial condyle (P < 0.05). This study shows that femoral malrotation has a significant effect on mechanical axis alignment and force vectors within the knee. Correlation with clinical outcomes is necessary and further research into minimizing such errors of torsion is warranted.

Conclusion

Torsion errors are not merely cosmetic issues, but may result in further morbidity, such as varus or valgus deformity and shifting of the COF, which may lead to joint arthrosis.
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Literatur
1.
Zurück zum Zitat Braten M, Terjesen T, Rossvoll I (1993) Torsional deformity after intramedullary nailing of femoral shaft fractures. Measurement of anteversion angles in 110 patients. J Bone Joint Surg Br 75:799–803 PubMed Braten M, Terjesen T, Rossvoll I (1993) Torsional deformity after intramedullary nailing of femoral shaft fractures. Measurement of anteversion angles in 110 patients. J Bone Joint Surg Br 75:799–803 PubMed
2.
Zurück zum Zitat Braten M, Terjesen T, Rossvoll I (1995) Femoral shaft fractures treated by intramedullary nailing. A follow-up study focusing on problems related to the method. Injury 26:379–383 PubMedCrossRef Braten M, Terjesen T, Rossvoll I (1995) Femoral shaft fractures treated by intramedullary nailing. A follow-up study focusing on problems related to the method. Injury 26:379–383 PubMedCrossRef
3.
Zurück zum Zitat Citak M, Gardner MJ, Citak M, Krettek C, Hufner T, Kendoff D (2008) Navigated femoral anteversion measurements: a new intraoperative technique. Injury 39:467–471 PubMedCrossRef Citak M, Gardner MJ, Citak M, Krettek C, Hufner T, Kendoff D (2008) Navigated femoral anteversion measurements: a new intraoperative technique. Injury 39:467–471 PubMedCrossRef
4.
Zurück zum Zitat Citak M, Kendoff D, Citak M, Gardner MJ, Oszwald M, Krettek C, Hufner T (2008) Femoral nail osteosynthesis. Mechanical factors influencing the femoral antetorsion. Unfallchirurg 111:240–246 PubMedCrossRef Citak M, Kendoff D, Citak M, Gardner MJ, Oszwald M, Krettek C, Hufner T (2008) Femoral nail osteosynthesis. Mechanical factors influencing the femoral antetorsion. Unfallchirurg 111:240–246 PubMedCrossRef
5.
Zurück zum Zitat Citak M, Kendoff D, Pearle AD, O’Loughlin PF, Krettek C, Hufner T, Citak M (2009) Navigated femoral anteversion measurements: general precision and registration options. Arch Orthop Trauma Surg 129:671–677 PubMedCrossRef Citak M, Kendoff D, Pearle AD, O’Loughlin PF, Krettek C, Hufner T, Citak M (2009) Navigated femoral anteversion measurements: general precision and registration options. Arch Orthop Trauma Surg 129:671–677 PubMedCrossRef
6.
7.
Zurück zum Zitat Eckhoff DG (1994) Effect of limb malrotation on malalignment and osteoarthritis. Orthop Clin North Am 25:405–414 PubMed Eckhoff DG (1994) Effect of limb malrotation on malalignment and osteoarthritis. Orthop Clin North Am 25:405–414 PubMed
8.
Zurück zum Zitat Gebhard F, Krettek C, Hufner T, Grutzner PA, Stockle U, Imhoff AB, Lorenz S, Ljungqvist J and Keppler P (2010) Reliability of computer-assisted surgery as an intraoperative ruler in navigated high tibial osteotomy. Arch Orthop Trauma Surg (in press) Gebhard F, Krettek C, Hufner T, Grutzner PA, Stockle U, Imhoff AB, Lorenz S, Ljungqvist J and Keppler P (2010) Reliability of computer-assisted surgery as an intraoperative ruler in navigated high tibial osteotomy. Arch Orthop Trauma Surg (in press)
9.
Zurück zum Zitat Gugenheim JJ, Probe RA, Brinker MR (2004) The effects of femoral shaft malrotation on lower extremity anatomy. J Orthop Trauma 18:658–664 PubMedCrossRef Gugenheim JJ, Probe RA, Brinker MR (2004) The effects of femoral shaft malrotation on lower extremity anatomy. J Orthop Trauma 18:658–664 PubMedCrossRef
10.
Zurück zum Zitat Hazel WA Jr, Rand JA, Morrey BF (1993) Results of meniscectomy in the knee with anterior cruciate ligament deficiency. Clin Orthop Relat Res 292:232–238 PubMed Hazel WA Jr, Rand JA, Morrey BF (1993) Results of meniscectomy in the knee with anterior cruciate ligament deficiency. Clin Orthop Relat Res 292:232–238 PubMed
11.
Zurück zum Zitat Hulet CH, Locker BG, Schiltz D, Texier A, Tallier E, Vielpeau CH (2001) Arthroscopic medial meniscectomy on stable knees. J Bone Joint Surg Br 83:29–32 PubMedCrossRef Hulet CH, Locker BG, Schiltz D, Texier A, Tallier E, Vielpeau CH (2001) Arthroscopic medial meniscectomy on stable knees. J Bone Joint Surg Br 83:29–32 PubMedCrossRef
12.
Zurück zum Zitat Jaarsma RL, Pakvis DF, Verdonschot N, Biert J, van Kampen A (2004) Rotational malalignment after intramedullary nailing of femoral fractures. J Orthop Trauma 18:403–409 PubMedCrossRef Jaarsma RL, Pakvis DF, Verdonschot N, Biert J, van Kampen A (2004) Rotational malalignment after intramedullary nailing of femoral fractures. J Orthop Trauma 18:403–409 PubMedCrossRef
13.
Zurück zum Zitat Janzing HM, Stockman B, Van Damme G, Rommens P, Broos PL (1998) The retrograde intramedullary nail: prospective experience in patients older than sixty-five years. J Orthop Trauma 12:330–333 PubMedCrossRef Janzing HM, Stockman B, Van Damme G, Rommens P, Broos PL (1998) The retrograde intramedullary nail: prospective experience in patients older than sixty-five years. J Orthop Trauma 12:330–333 PubMedCrossRef
14.
Zurück zum Zitat Kendoff D, Citak M, Gardner MJ, Gosling T, Krettek C, Hufner T (2007) Navigated femoral nailing using noninvasive registration of the contralateral intact femur to restore anteversion. Technique and clinical use. J Orthop Trauma 21:725–730 PubMedCrossRef Kendoff D, Citak M, Gardner MJ, Gosling T, Krettek C, Hufner T (2007) Navigated femoral nailing using noninvasive registration of the contralateral intact femur to restore anteversion. Technique and clinical use. J Orthop Trauma 21:725–730 PubMedCrossRef
15.
Zurück zum Zitat Kettelkamp DB, Hillberry BM, Murrish DE, Heck DA (1988) Degenerative arthritis of the knee secondary to fracture malunion. Clin Orthop Relat Res 234:159–169 PubMed Kettelkamp DB, Hillberry BM, Murrish DE, Heck DA (1988) Degenerative arthritis of the knee secondary to fracture malunion. Clin Orthop Relat Res 234:159–169 PubMed
16.
Zurück zum Zitat Koch M (1993) Measuring plantar pressure in conventional shoes with the TEKSCAN sensory system. Biomed Tech (Berl) 38:243–248 CrossRef Koch M (1993) Measuring plantar pressure in conventional shoes with the TEKSCAN sensory system. Biomed Tech (Berl) 38:243–248 CrossRef
17.
Zurück zum Zitat Krettek C, Miclau T, Blauth M, Lindsey RW, Donow C, Tscherne H (1997) Recurrent rotational deformity of the femur after static locking of intramedullary nails: case reports. J Bone Joint Surg Br 79:4–8 PubMedCrossRef Krettek C, Miclau T, Blauth M, Lindsey RW, Donow C, Tscherne H (1997) Recurrent rotational deformity of the femur after static locking of intramedullary nails: case reports. J Bone Joint Surg Br 79:4–8 PubMedCrossRef
18.
Zurück zum Zitat Maier DG, Reisig R, Keppler P, Kinzl L, Gebhard F (2005) Post-traumatic torsional differences and functional tests following antegrade or retrograde intramedullary nailing of the distal femoral diaphysis. Unfallchirurg 108:109–117 PubMedCrossRef Maier DG, Reisig R, Keppler P, Kinzl L, Gebhard F (2005) Post-traumatic torsional differences and functional tests following antegrade or retrograde intramedullary nailing of the distal femoral diaphysis. Unfallchirurg 108:109–117 PubMedCrossRef
19.
Zurück zum Zitat Ostrum RF, Agarwal A, Lakatos R, Poka A (2000) Prospective comparison of retrograde and antegrade femoral intramedullary nailing. J Orthop Trauma 14:496–501 PubMedCrossRef Ostrum RF, Agarwal A, Lakatos R, Poka A (2000) Prospective comparison of retrograde and antegrade femoral intramedullary nailing. J Orthop Trauma 14:496–501 PubMedCrossRef
20.
Zurück zum Zitat Paley D, Tetsworth K (1992) Mechanical axis deviation of the lower limbs. Preoperative planning of uniapical angular deformities of the tibia or femur. Clin Orthop Relat Res 280:48–64 PubMed Paley D, Tetsworth K (1992) Mechanical axis deviation of the lower limbs. Preoperative planning of uniapical angular deformities of the tibia or femur. Clin Orthop Relat Res 280:48–64 PubMed
21.
Zurück zum Zitat Pena E, Calvo B, Martinez MA, Palanca D, Doblare M (2006) Why lateral meniscectomy is more dangerous than medial meniscectomy. A finite element study. J Orthop Res 24:1001–1010 PubMedCrossRef Pena E, Calvo B, Martinez MA, Palanca D, Doblare M (2006) Why lateral meniscectomy is more dangerous than medial meniscectomy. A finite element study. J Orthop Res 24:1001–1010 PubMedCrossRef
22.
Zurück zum Zitat Ricci WM, Bellabarba C, Lewis R, Evanoff B, Herscovici D, Dipasquale T, Sanders R (2001) Angular malalignment after intramedullary nailing of femoral shaft fractures. J Orthop Trauma 15:90–95 PubMedCrossRef Ricci WM, Bellabarba C, Lewis R, Evanoff B, Herscovici D, Dipasquale T, Sanders R (2001) Angular malalignment after intramedullary nailing of femoral shaft fractures. J Orthop Trauma 15:90–95 PubMedCrossRef
23.
Zurück zum Zitat Stindel E, Briard JL, Merloz P, Plaweski S, Dubrana F, Lefevre C, Troccaz J (2002) Bone morphing: 3D morphological data for total knee arthroplasty. Comput Aided Surg 7:156–168 PubMedCrossRef Stindel E, Briard JL, Merloz P, Plaweski S, Dubrana F, Lefevre C, Troccaz J (2002) Bone morphing: 3D morphological data for total knee arthroplasty. Comput Aided Surg 7:156–168 PubMedCrossRef
24.
Zurück zum Zitat van Joost MC, Gastkemper RJ (1972) Malrotation after femoral shaft fractures. Arch Chir Neerl 24:101–115 PubMed van Joost MC, Gastkemper RJ (1972) Malrotation after femoral shaft fractures. Arch Chir Neerl 24:101–115 PubMed
25.
Zurück zum Zitat Wirz D, Becker R, Li SF, Friederich NF, Muller W (2002) Validation of the Tekscan system for statistic and dynamic pressure measurements of the human femorotibial joint. Biomed Tech (Berl) 47:195–201 CrossRef Wirz D, Becker R, Li SF, Friederich NF, Muller W (2002) Validation of the Tekscan system for statistic and dynamic pressure measurements of the human femorotibial joint. Biomed Tech (Berl) 47:195–201 CrossRef
Metadaten
Titel
Influence of femoral malrotation on knee joint alignment and intra-articular contract pressures
verfasst von
Philipp Bretin
Padhraig F. O’Loughlin
Eduardo M. Suero
Daniel Kendoff
Sven Ostermeier
Tobias Hüfner
Christian Krettek
Musa Citak
Publikationsdatum
01.08.2011
Verlag
Springer-Verlag
Erschienen in
Archives of Orthopaedic and Trauma Surgery / Ausgabe 8/2011
Print ISSN: 0936-8051
Elektronische ISSN: 1434-3916
DOI
https://doi.org/10.1007/s00402-010-1210-4

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