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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
  • Published:
Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Purpose

The aim of this study was to determine (1) variations in the shape of the proximal, middle, and distal femur in a series of Korean patients who had undergone total knee arthroplasty (TKA), (2) the preoperative relationship between these three parameters and the distal valgus cutting angle referenced off the femoral intramedullary guide, and (3) whether there was any relationship between femoral bowing and variations in the shape of the proximal or distal femur in the coronal plane.

Methods

The preoperative long-standing anteroposterior radiographs of 316 consecutive osteoarthritis patients who underwent primary TKA from 2009 to 2011 were examined. The femoral neck shaft angle, the femoral shaft bowing angle, and the mechanical lateral distal femoral angle were measured to assess the shape of the proximal, middle, and distal femur, respectively. The valgus cutting angle of the femur was defined as the angle between the distal anatomical and mechanical axes of the femur.

Results

The study population showed large variations in femoral shape. The mean femoral intramedullary guide angle was 6.5° ± 1.3° (range: 4°–13°). The femoral shaft bowing angle was the factor that showed the strongest correlation with this angle (P < 0.001). The mechanical lateral distal femoral angle showed only a weak correlation (P = 0.001), and the femoral neck shaft angle showed no correlation (n.s.). The femoral shaft bowing angle showed a weak correlation with the mechanical lateral distal femoral angle (P = 0.001), but was not significantly correlated with the femoral neck shaft angle (n.s.). Apparent femoral bowing (>3° of lateral or medial bowing) was found in 42 (13.3 %) of cases (37 cases of lateral bowing and five of medial bowing). Cases with lateral apparent femoral bowing >3° had a distal cutting angle of 8.6° ± 2.2° relative to the femoral intramedullary guide.

Conclusion

The femoral intramedullary guide angle was mainly influenced by femoral shaft bowing among femoral deformities in the coronal plane. Therefore, to increase the accuracy of distal femoral cut during TKA, it is necessary to confirm femoral deformities and to measure the femoral intramedullary guide angle preoperatively from coronal radiographs covering the whole femur.

Level of evidence

IV.

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Acknowledgments

This research was supported by Basic Science Research Program through the National Research Foundation of Korea (NRF) funded by the Ministry of Education, Science and Technology (2012-0000479), and by a grant of the Korea Healthcare Technology R&D Project, Ministry of Health and Welfare, Republic of Korea (A100054).

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Authors and Affiliations

  1. Department of Orthopaedic Surgery, Kosin Gospel Hospital, College of Medicine, Kosin University, 34, Amnam-dong, Seo-gu, Busan, 602-702, South Korea

    Jong-Min Kim

  2. Department of Orthopaedic Surgery, Asan Medical Center, College of Medicine, Ulsan University, 388-1, Pungnap-2-dong, Songpa-gu, Seoul, 138-736, South Korea

    Soo-Heon Hong, Jong-Min Kim, Dong-Eun Kim & Seong-Il Bin

  3. Department of Orthopaedic Surgery, Incheon St. Mary’s Hospital, College of Medicine, Catholic University, Bupyeong 6-dong, Bupyeong-gu, Inchon, 403-720, South Korea

    Bum-Sik Lee

  4. Department of Biomedical Engineering, College of Medicine, Chungbuk National University, Gaesin-dong, Heungdeok-gu, Cheongju-si, Chungcheongbuk-do, 361-763, South Korea

    Kyung-Ah Kim

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Correspondence to Seong-Il Bin.

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Kim, JM., Hong, SH., Kim, JM. et al. 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, 1936–1942 (2015). https://doi.org/10.1007/s00167-014-3006-5

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