Open Access, Peer-reviewed
pISSN 1226-2102
eISSN 2005-8918
    J Korean Orthop Assoc. 2011 Aug;46(4):320-325. Korean.
    Published online Aug 31, 2011.
    https://doi.org/10.4055/jkoa.2011.46.4.320
    Copyright © 2011 by The Korean Orthopaedic Association
    Original Article

    Accuracy of Inter Femoral Head Center Distance Measurement and Evaluation for Coronal Alignment of Femoral Component during Total Knee Arthroplasty

    Woon Hwa Jung, M.D., Dong Hyun Kim, M.D., Chung Woo Chun, M.D., Jae Heon Jeong, M.D.,* Yong Chan Ha, M.D.,* and Jai Gon Seo, M.D.†
      • Department of Orthopedic Surgery, Murup Hospital, Changwon, Korea.
      • *Department of Orthopedic Surgery, Chung-Ang University College of Medicine, Seoul, Korea.
      • †Department of Orthopedic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
    • Correspondence to: Jae Heon Jeong, M.D. Department of Orthopedic Surgery, Chung-Ang University College of Medicine, 224-1, Heukseok-dong, Dongjak-gu, Seoul 156-755, Korea. TEL: +82-2-6299-1577, FAX: +82-2-822-1710, Email: osjjaeheon@naver.com
    Received August 31, 2010; Accepted February 08, 2011.

    This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

    Abstract

    Purpose

    Alignment is an important factor in the long-term success of total knee arthroplasty. In the total knee arthroplasty, the conventional extramedullary femoral alignment system has significant error in femoral coronal alignment, since it is difficult to find the femoral head center and it is time consuming to determine during the operation. The purpose of our study was to evaluate the accuracy of the newly-designed marker system for extramedullary femoral alignment that uses radiologic distance between the 2 femoral head centers.

    Materials and Methods

    Between July 2008 and July 2009, 90 patients (100 knees) with knee osteoarthritis underwent total knee arthroplasty using the femoral extramedullary femoral guide system. We measured the distance between the femoral head centers using the radiologic picture archiving and communication system (PACS, General Electric, Milwaukee, WI) system preoperatively, then plastic rods and metal pegs were used to simulate the inter femoral head center distance. By placing the center of the plastic rod after marking the inter femoral head center distance on the central body line, we could trace the coronal mechanical axis. We measured the angle between the femoral mechanical axis and the femoral component in standing long leg antero-posterior radiograph to assess radiologically the accuracy of coronal alignment postoperatively.

    Results

    The average femoral length in the study group was 402.5±16.2 mm. The mean distance between the femoral head and the center of the marker was 49.6±17.9 mm. The average error in estimation of the distance between the femoral head center and the metal peg of the marker was 3.78±3.14 mm. The positional error in alignment was 1° or less in 90% and 2° or less in 100% of knees. The average angle of femoral component to femoral mechanical axis was 89.9±1.5° (range 84.4-93.6°). The coronal alignment of the femoral components was within 90°±3° in -96% of cases.

    Conclusion

    Our results suggest that the clinical method reported here is a simple and reliable method to localize the center of the femoral head during total knee arthroplasty.

    Keywords
    total knee arthroplasty; mechanical axis; extramedullary femoral guide system; interfemoral head center distance

    Figures

    Figure 1
    (A) 100mm X-Ray Magnification Maker (B) X-ray shows calculation of the interfemoral head center distance. (C) The Mechanical Axis Marker is placed on the body center.

    Figure 2
    The Mechanical Axis Marker: the plastic rod and metal pegs were used to simulate the inter femoral head center distance.

    Figure 3
    A radiograph was taken after positioning of the patient before surgery. We measured horizontal distance from the peg to the perpendicular extending line through the line of the femoral head center.

    Figure 4
    Radiograph showing the mechanical axis in the coronal plane. The alignment of the coronal femoral components was measured by the intersection of a line drawn across the base of each component and the mechanical axis. FFA, frontal femoral angle.

    Figure 5
    Drawing shows the acceptable range of error in Mechanical Axis Marker placement.

    Tables

    Table 1
    Demographic Data

    References

      1. Andriacchi TP. Biomechanics and gait analysis in total knee replacement. Orthop Rev 1988;17:470–473.
      1. Laskin RS. Total knee arthroplasty using an uncemented, polyethylene tibial implant. A seven-year follow-up study. Clin Orthop Relat Res 1993;(288):270–276.
      1. Matsuda S, Miura H, Nagamine R, et al. Posterior tibial slope in the normal and varus knee. Am J Knee Surg 1999;12:165–168.
      1. Mihalko WM, Krackow KA. Posterior cruciate ligament effects on the flexion space in total knee arthroplasty. Clin Orthop Relat Res 1999;(360):243–250.
      1. Matsuda Y, Ishii Y, Ichimura K. Identifying the center of the femoral head using ultrasonography to assess the higher accuracy of femoral extramedullary guides in TKA. J Orthop Sci 2004;9:6–9.
      1. Brys DA, Lombardi AV Jr, Mallory TH, Vaughn BK. A comparison of intramedullary and extramedullary alignment systems for tibial component placement in total knee arthroplasty. Clin Orthop Relat Res 1991;(263):175–179.
      1. Dennis DA, Channer M, Susman MH, Stringer EA. Intramedullary versus extramedullary tibial alignment systems in total knee arthroplasty. J Arthroplasty 1993;8:43–47.
      1. Engh GA, Petersen TL. Comparative experience with intramedullary and extramedullary alignment in total knee arthroplasty. J Arthroplasty 1990;5:1–8.
      1. Kandel L, Vasili C, Kirsh G. Extramedullary femoral alignment instrumentation reduces blood loss after uncemented total knee arthroplasty. J Knee Surg 2006;19:256–258.
      1. Kumar N, Saleh J, Gardiner E, Devadoss VG, Howell FR. Plugging the intramedullary canal of the femur in total knee arthroplasty: reduction in postoperative blood loss. J Arthroplasty 2000;15:947–949.
      1. Markel DC, Femino JE, Farkas P, Markel SF. Analysis of lower extremity embolic material after total knee arthroplasty in a canine model. J Arthroplasty 1999;14:227–232.
      1. Seo JG, Kim BK, Moon YW, et al. Bony landmarks for determining the mechanical axis of the femur in the sagittal plane during total knee arthroplasty. Clin Orthop Surg 2009;1:128–131.
      1. Bargren JH, Blaha JD, Freeman MA. Alignment in total knee arthroplasty. Correlated biomechanical and clinical observations. Clin Orthop Relat Res 1983;(173):178–183.
      1. Jeffery RS, Morris RW, Denham RA. Coronal alignment after total knee replacement. J Bone Joint Surg Br 1991;73:709–714.
      1. Lotke PA, Ecker ML. Influence of positioning of prosthesis in total knee replacement. J Bone Joint Surg Am 1977;59:77–79.
      1. Rand JA, Coventry MB. Ten-year evaluation of geometric total knee arthroplasty. Clin Orthop Relat Res 1988;(232):168–173.
      1. Cates HE, Ritter MA, Keating EM, Faris PM. Intramedullary versus extramedullary femoral alignment systems in total knee replacement. Clin Orthop Relat Res 1993;(286):32–39.
      1. Baldini A, Adravanti P. Less invasive TKA: extramedullary femoral reference without navigation. Clin Orthop Relat Res 2008;466:2694–2700.
      1. Seo JG, Moon YW, Kim YS. A comparison of extramedullary and intramedullary femoral component alignment guide systems in TKA. J Korean Knee Soc 2006;18:47–54.
      1. Samarji RS, Charalambous CP, Waldron S, Noble J. Placement of a palpable marker adjacent to the mid-inguinal point: assessment of a clinical method for detecting the femoral head centre during knee arthroplasty. Knee 2009;16:228–230.
      1. Ritter MA, Campbell ED. A model for easy location of the center of the femoral head during total knee arthroplasty. J Arthroplasty 1988;3 Suppl:S59–S61.
      1. Sawant MR, Murty A, Ireland J. A clinical method for locating the femoral head centre during total knee arthroplasty. Knee 2004;11:209–212.
      1. Mullaji A, Shetty GM, Kanna R, Sharma A. Variability in the range of inter-anterior superior iliac spine distance and its correlation with femoral head centre. A prospective computed tomography study of 200 adults. Skeletal Radiol 2010;39:363–368.
    Cited by
    Crossref 1
    Google Scholar 
    MeSH Terms
    Arthroplasty
    Axis, Cervical Vertebra
    Head
    Humans
    Knee
    Leg
    Osteoarthritis, Knee
    Plastics
    Radiology Information Systems
    Metrics
    Share
    Figures
    slide
    slide
    slide
    slide
    slide

    1 / 5

    Tables
    slide

    1 / 1

    PERMALINK