In vivo relationship between the clinical epicondylar axis and the anterior pelvic plane in normal subjects

Abstract

Background: Several researchers consider the clinical epicondylar axis (CEA) as the functional flexion-extension axis of the knee. The anterior pelvic plane (APP) is commonly used as an anatomical reference plane of the pelvis. However, no study has investigated the relationship of the APP with the CEA and PCA. In this study, we aimed to investigate the relationship of the APP with the CEA and posterior condylar axis (PCA) in the standing and supine positions. Methods: We recruited 77 healthy Japanese subjects for this study, and carried out measurements using the Hip CAS?system, a 3D system used for the assessment of lower extremity alignment. Results: The mean femoral neck anteversion was 16.33°. There was an approximate discrepancy of 6° between the male and the female in anatomy (15.73° and 21.15° in the male and female subjects, respectively). The mean condylar twist angle (CTA) was 6.86° and the mean APP-PCA value in the standing position was ﹣6.88°. The mean APP-CEA value in the standing position was 0.02°, and the discrepancy between males and females was only 0.21° (0.09° and ﹣0.13° for the male and female subjects, respectively). This meant that Xp axis of APP and CEA were almost parallel. On the other hand, the mean APP-CEA value in the supine position was 7.07° (male subjects = 9.48°; female subjects = 5.62°). Here, the CEA was approximately parallel to the horizontal axis of the APP, which was compatible with the neutral position of the knee and hip joint, and anatomically and kinesiologically justified in normal subjects. Conclusion: CEA was approximately parallel to the horizontal axis of the APP. These results are compatible with regard to the neutral position of the knee and hip joints, and anatomically and kinesiologically justified in normal subjects. Moreover, CEA is a potential reference axis for the insertion of the femoral component in THA.

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Imai, N. , Ito, T. , Takahashi, Y. , Horigome, Y. , Suda, K. , Miyasaka, D. , Minato, I. and Endo, N. (2013) In vivo relationship between the clinical epicondylar axis and the anterior pelvic plane in normal subjects. Journal of Biomedical Science and Engineering, 6, 863-868. doi: 10.4236/jbise.2013.69105.

Conflicts of Interest

The authors declare no conflicts of interest.

References

[1] Churchill, D.L., Incavo, S.J., Johnson, C.C. and Beynnon, B.D. (1998) The transepicondylar axis approximates the optimal flexion axis of the knee. Clinical Orthopaedics and Related Research, 56, 111-118. doi:10.1097/00003086-199811000-00016
[2] Johal, P., Williams, A., Wragg, P., Hunt, D. and Gedroyc, W. (2005) Tibio-femoral movement in the living knee. A study of weight bearing and non-weight bearing knee kinematics using “interventional” MRI. Journal of Biomechanics, 38, 269-276. doi:10.1016/j.jbiomech.2004.02.008
[3] Aglietti, P., Sensi, L., Cuomo, P. and Ciardullo, A. (2008) Rotational position of femoral and tibial components in TKA using the femoral transepicondylar axis. Clinical Orthopaedics and Related Research, 466, 2751-2755. doi:10.1007/s11999-008-0452-8
[4] Lewinnek, GE., Lewis, J.L., Tarr, R., Compere, C.L. and Zimmerman, J.R. (1978) Dislocations after total hip-replacement arthroplasties. The Journal of Bone & Joint Surgery, 60, 217-220.
[5] Nishihara, S., Sugano, N., Nishii, T., Ohzono, K. and Yoshikawa, H. (2003) Measurements of pelvic flexion angle using three-dimensional computed tomography. Clinical Orthopaedics and Related Research, 41, 140-151. doi:10.1097/01.blo.0000069891.31220.fd
[6] Jaramaz, B., DiGioia, A.M. 3rd, Blackwell, M. and Nikou, C. (1998) Computer assisted measurement of cup placement in total hip replacement. Clinical Orthopaedics and Related Research, 354, 70-81. doi:10.1097/00003086-199809000-00010
[7] Philippot, R., Wegrzyn, J., Farizon, F. and Fessy, M.H. (2009) Pelvic balance in sagittal and Lewinnek reference planes in the standing, supine and sitting positions. Orthopaedics & Traumatology: Surgery & Research, 95, 70-76.
[8] Sato, T., Koga, Y. and Omori, G. (2004) Three-dimensional lower extremity alignment assessment system: Application to evaluation of component position after total knee arthroplasty. The Journal of Arthroplasty, 19, 620-628. doi:10.1016/j.arth.2003.12.063
[9] Kobayashi, K., Sakamoto, M., Tanabe, Y., Ariumi, A., Sato, T., Omori, G. and Koga, Y. (2009) Automated image registration for assessing three-dimensional alignment of entire lower extremity and implant position using bi-plane radiography. Journal of Biomechanics, 42, 2818-2822. doi:10.1016/j.jbiomech.2009.08.022
[10] Ariumi, A., Sato, T., Kobayashi, K., Koga, Y., Omori, G., Minato, I. and Endo N. (2010) Three-dimensional lower extremity alignment in the weight-bearing standing position in healthy elderly subjects. Journal of Orthopaedic Science, 15, 64-70. doi:10.1007/s00776-009-1414-z
[11] Kingsley, P.C. and Olmsted, K.L. (1948) A study to determine the angle of anteversion of the neck of the femur. The Journal of Bone & Joint Surgery, 30, 745-751.
[12] Sugano, N., Noble, P.C. and Kamaric, E. (1998) A comparison of alternative methods of measuring femoral anteversion. Journal of Computer Assisted Tomography, 22, 610-614. doi:10.1097/00004728-199807000-00019
[13] Akagi, M., Mori, S., Nishimura, S., Asano, T. and Hamanishi, C. (2005) Variability of extraarticular tibial rotation references for total knee arthroplasty. Clinical Orthopaedics and Related Research, 436, 172-176. doi:10.1097/01.blo.0000160027.52481.32
[14] Stiehl, J.B. and Abbott, B.D. (1995) Morphology of the transepicondylar axis and its application in primary and revision total knee arthroplasty. The Journal of Arthroplasty, 10, 785-789. doi:10.1016/S0883-5403(05)80075-0
[15] Argenson, J.N., Flecher, X., Parratte, S. and Aubaniac, J. (2007) Anatomy of the dysplastic hip and consequences for total hip arthroplasty. Clinical Orthopaedics and Related Research, 465, 40-45.
[16] Babisch, J.W., Layher, F. and Amiot, L.P. (2008) The rationale for tilt-adjusted acetabular cup navigation. The Journal of Bone & Joint Surgery, 90, 357-365. doi:10.2106/JBJS.F.00628
[17] Pinoit, Y., May, O., Girard, J., Laffargue, P., Ala, Eddine, T. and Migaud, H. (2007) Low accuracy of the anterior pelvic plane to guide the position of the cup with imageless computer assistance: Variation of position in 106 patients. Revue de Chirurgie Orthopédique et Réparatrice de l’Appareil Moteur, 93, 455-460. doi:10.1016/S0035-1040(07)90327-X
[18] Wolf, A., Digioia, A.M. 3rd, Mor, A.B. and Jaramaz, B. (2005) A kinematic model for calculating cup alignment error during total hip arthroplasty. Journal of Biomechanics, 38, 2257-2265. doi:10.1016/S0035-1040(07)90327-X
[19] Blendea, S., Eckman, K., Jaramaz, B., Levison, T.J. and Digioia, A.M. 3rd (2005) Measurements of acetabular cup position and pelvic spatial orientation after total hip arthroplasty using computed tomography/radiography matching. Computer Aided Surgery, 10, 37-43.
[20] Wan, Z., Malik, A., Jaramaz, B., Chao, L. and Dorr, L.D. (2009) Imaging and navigation measurement of acetabular component position in THA. Clinical Orthopaedics and Related Research, 467, 32-42. doi:10.1007/s11999-008-0597-5
[21] Whittington, B., Silder, A., Heiderscheit, B. and Thelen, D.G. (2008) The contribution of passive-elastic mechanisms to lower extremity joint kinetics during human walking. Gait & Posture, 27, 628-634. doi:10.1007/s11999-008-0597-5
[22] Chumanov, E.S., Wall-Scheffler, C. and Heiderscheit, B.C. (2008) Gender differences in walking and running on level and inclined surfaces. Clinical Biomechanics, 23, 1260-1268. doi:10.1016/j.clinbiomech.2008.07.011
[23] Schache, A.G. and Baker, R. (2007) On the expression of joint moments during gait. Gait & Posture, 25, 440-452. doi:10.1016/j.gaitpost.2006.05.018
[24] Chan, C.W. and Rudins, A. (1994) Foot biomechanics during walking and running. Mayo Clinic Proceedings, 69, 448-461. doi:10.1016/S0025-6196(12)61642-5
[25] Guy, G. (2010) Kinesiology of walking. In: Neumann, D.A., Ed., Kinesiology of the Musculoskeletal System, 2nd Edition, Mosby Elsevier, Inc., St. Louis, 627-681.
[26] Yoshioka, Y., Siu, D.W., Scudamore, R.A. and Cooke, T.D. (1989) Tibial anatomy and functional axes. Journal of Orthopaedic Research, 7, 132-137. doi:10.1002/jor.1100070118

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