Open Access, Peer-reviewed
pISSN 1226-2102
eISSN 2005-8918
    J Korean Orthop Assoc. 2012 Dec;47(6):432-438. Korean.
    Published online Dec 28, 2012.
    https://doi.org/10.4055/jkoa.2012.47.6.432
    Copyright © 2012 by The Korean Orthopaedic Association
    Original Article

    Femoral Component Rotation of Total Knee Arthroplasty in Korean Subjects: A Study Using Grand Piano Sign and Computed Tomography

    Hyun-Chul Shon, M.D., Eui-Sung Choi, M.D., Yong-Min Kim, M.D., Dong-Soo Kim, M.D., Kyoung-Jin Park, M.D., Byung-Ki Cho, M.D., Ji-Kang Park, M.D. and Seok-Won Kim, M.D.
      • Department of Orthopaedic Surgery, College of Medicine, Chungbuk National University, Cheongju, Korea.
    • Correspondence to: Eui-Sung Choi, M.D. Department of Orthopaedic Surgery, College of Medicine, Chungbuk National University, 776, 1 Sunhawn-ro, Heungdeok-gu, Cheongju 360-711, Korea. TEL: +82-43-269-6077, FAX: +82-43-274-8719, Email: oseschoi@chungbuk.ac.kr
    Received May 04, 2012; Revised August 28, 2012; Accepted October 05, 2012.

    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

    We aimed to obtain a reference for the optimal rotational alignment of femoral component in Koreans through an analysis of grand piano sign observed during total knee arthroplasty (TKA) and the angle between the clinical transepicondylar axis and the posterior condylar axis (TEA-PCA angle), by computed tomography.

    Materials and Methods

    The study subjects included 24 patients (30 cases), who underwent the anterior femoral resection, which was applied at an external rotation 3o relative to the posterior condylar axis during TKA. The relationship between anterior femoral resection with external rotation of 3o and the morphological pattern of Grand piano sign was evaluated. On postoperative computed tomography images, we evaluated the relationship between the clinical transepicondylar axis, posterior condylar axis of femoral component and grand piano sign. Moreover, a total of 28 Korean patients with 41 arthritic knees scheduled for a TKA had a preoperative computed tomography. We measured the TEA-PCA angle to evaluate the normal range in Korean subjects.

    Results

    The morphological pattern of grand piano sign observed after the anterior femoral resection, which was applied at an external rotation 3o, showed statistically significant correlation with TEA-PCA angle. On preoperative computed tomography images, the TEA-PCA angle was 6.01 degrees (range from 3.90 to 7.86).

    Conclusion

    The TEA-PCA angle of Koreans was different from that of the westerners. More external rotation was needed for the optimal femoral rotational alignment theoretically, and we could confirm the correlation between Grand piano sign and rotational alignment of femoral component by measurement of grand piano sign and computed tomography.

    Keywords
    grand piano sign; arthroplasty; replacement; knee

    Figures

    Figure 1
    Computed tomography scan showing the transverse view of the distal femoral condyles. c-TEA, clinical transepicondylar axis; s-TEA, surgical transepicondylar axis; PCA, posterior condylar axis.

    Figure 2
    Intraoperative photo showing measurement of the height ratio of the lateral (A-B) and medial (C-D) condyles of grand piano sign observed after the anterior femoral resection. Lat, lateral condyle of grand piano sign; Med, medial condyle of grand piano sign.

    Figure 3
    The angle between the transepicondylar axis and the posterior condylar axis of femoral component (Postoperative TEA-PCA angle) was correlated with the height ratio of the medial and lateral condyles of grand piano sign (GP Med/Lat). TEA-PCA angle, angle between the clinical transepicondylar axis and the posterior condylar axis.

    Figure 4
    Distribution of the angles between the transepicondylar axis and the posterior condylar axis (Postoperative TEA-PCA angle) by postoperative computed tomography. TEA-PCA angle, angle between the clinical transepicondylar axis and the posterior condylar axis; GP Med/Lat, medial condyle of grand piano sign/lateral condyle of grand piano sign.

    Figure 5
    Distribution of the angles between the transepicondylar axis and the posterior condylar axis (Preoperative TEA-PCA angle) by preoperative computed tomography. TEA-PCA angle, angle between the clinical transepicondylar axis and the posterior condylar axis.

    Tables

    Table 1
    Patients' Clinical Profiles and Measured Values

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    MeSH Terms
    Arthroplasty
    Axis, Cervical Vertebra
    Humans
    Knee
    Reference Values
    Metrics
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