Poor relationship between frontal tibiofemoral and trochlear anatomic parameters: Implications for designing a trochlea for kinematic alignment.
Aged
Arthroplasty, Replacement, Knee
/ methods
Biomechanical Phenomena
Female
Femur
/ diagnostic imaging
Humans
Imaging, Three-Dimensional
Knee Joint
/ diagnostic imaging
Knee Prosthesis
Male
Middle Aged
Osteoarthritis, Knee
/ diagnosis
Tibia
/ diagnostic imaging
Tomography, X-Ray Computed
/ methods
Implant design
Joint line orientation
Kinematic alignment
Knee replacement
Trochlea
Journal
The Knee
ISSN: 1873-5800
Titre abrégé: Knee
Pays: Netherlands
ID NLM: 9430798
Informations de publication
Date de publication:
Jan 2019
Jan 2019
Historique:
received:
02
08
2018
revised:
12
10
2018
accepted:
07
11
2018
pubmed:
14
12
2018
medline:
9
4
2019
entrez:
15
12
2018
Statut:
ppublish
Résumé
The kinematic alignment (KA) technique for total knee arthroplasty (TKA) is an emerging implant positioning philosophy that aims to restore constitutional knee anatomy to improve knee kinematics. At present, the KA technique aims to reconstruct native femorotibial (FT) joint alignment, however there is still insufficient consideration towards the inter-individual trochlear anatomy variability. Poor trochlear restoration may compromise clinical outcomes. Our study aimed at assessing the anatomical relationship between the native trochlea and other FT anatomical parameters. Fifty-eight preoperative CT scans of low-grade knee arthritic patients were segmented to create 3D bone models. The FT and the PF anatomical parameters were measured using in-house software. Values were compared between different groups of lower limb and FT joint line (JL) orientation, and correlations between FT and PF anatomical parameters were assessed. We were unable to detect any significant correlation between groove orientation (frontal and axial) or groove radius and either the hip-knee-ankle (HKA), or the lateral distal femoral (LDFA), or the medial proximal tibial (MPTA), or the FTJL-mechanical axis (FTJLMAA) Angles. When considering the correlation within sub-groups of limb or JL orientation, we only found a positive correlation (r = 0.464, p = 0.022) in the varus lower limb (HKA ≤ 180°) sub-group between groove frontal orientation and LDFA. Our study shows that the determination of several limb, knee, and JL parameters is of poor value to predict individual trochlea anatomy. This raises the issue of how to improve femoral component design to achieve individualised FT and PF anatomical restoration with KATKA. Level 1 - computational study.
Sections du résumé
BACKGROUND
BACKGROUND
The kinematic alignment (KA) technique for total knee arthroplasty (TKA) is an emerging implant positioning philosophy that aims to restore constitutional knee anatomy to improve knee kinematics. At present, the KA technique aims to reconstruct native femorotibial (FT) joint alignment, however there is still insufficient consideration towards the inter-individual trochlear anatomy variability. Poor trochlear restoration may compromise clinical outcomes. Our study aimed at assessing the anatomical relationship between the native trochlea and other FT anatomical parameters.
METHODS
METHODS
Fifty-eight preoperative CT scans of low-grade knee arthritic patients were segmented to create 3D bone models. The FT and the PF anatomical parameters were measured using in-house software. Values were compared between different groups of lower limb and FT joint line (JL) orientation, and correlations between FT and PF anatomical parameters were assessed.
RESULTS
RESULTS
We were unable to detect any significant correlation between groove orientation (frontal and axial) or groove radius and either the hip-knee-ankle (HKA), or the lateral distal femoral (LDFA), or the medial proximal tibial (MPTA), or the FTJL-mechanical axis (FTJLMAA) Angles. When considering the correlation within sub-groups of limb or JL orientation, we only found a positive correlation (r = 0.464, p = 0.022) in the varus lower limb (HKA ≤ 180°) sub-group between groove frontal orientation and LDFA.
CONCLUSION
CONCLUSIONS
Our study shows that the determination of several limb, knee, and JL parameters is of poor value to predict individual trochlea anatomy. This raises the issue of how to improve femoral component design to achieve individualised FT and PF anatomical restoration with KATKA.
LEVEL OF EVIDENCE
METHODS
Level 1 - computational study.
Identifiants
pubmed: 30545677
pii: S0968-0160(18)30634-3
doi: 10.1016/j.knee.2018.11.007
pii:
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
106-114Informations de copyright
Copyright © 2018 Elsevier B.V. All rights reserved.