Abstract：
BACKGROUND: The malimplantation of the total knee arthroplasty (TKA) components is one of the main reasons for revision surgery. For determining the correct intraoperative femoral rotation several anatomic rotational axes were described in order to achieve a parallel, balanced flexion gap. In this cadaveric study prevalent used rotational femoral axes and a navigated functional rotational axis were compared to the flexion-extension axis defined as the gold standard in rotation for femoral TKA component rotation.
METHODS: Thirteen body donors with knee osteoarthritis (mean age: 78.85 ± 6.09; eight females and five males) were examined. Rotational computer tomography was performed on their lower extremities pre- and postoperatively. Knee joint arthroplasties were implanted and CT diagnostics were used to compare the preoperatively determined flexion-extension axis (FEA). The FEA is the axis determined by our surgical technique and serves as an internal reference. It was compared to other axes such as (i) the anatomical transepicondylar axis (aTEA), (ii) the surgical transepicondylar axis (sTEA), (iii) the posterior condylar axis (PCA) and (iv) the functional rotation axis (fRA).
RESULTS: Examination of 26 knee joint arthroplasties revealed a significant angular deviation (p*** < 0.0001) for all axes when the individual axes and FEA were compared. aTEA show mean angular deviation of 5.2° (± 4.5), sTEA was 2.7° (± 2.2), PCA 2.9° (± 2.3) and the deviation of fRA was 4.3° (± 2.7). A tendency towards external rotation was observed for the relative and maximum axis deviations of the aTEA to the FEA, for the sTEA and the fRA. However, the rotation of the posterior condylar axis was towards inwards.
CONCLUSIONS: All axes showed a significant angular deviation from the FEA. We conclude that the presented technique achieves comparable results in terms of FEA reconstruction when compared with the use of the known surrogate axes, with certain deviations in terms of outliers in the internal or external rotation.
METHODS: Thirteen body donors with knee osteoarthritis (mean age: 78.85 ± 6.09; eight females and five males) were examined. Rotational computer tomography was performed on their lower extremities pre- and postoperatively. Knee joint arthroplasties were implanted and CT diagnostics were used to compare the preoperatively determined flexion-extension axis (FEA). The FEA is the axis determined by our surgical technique and serves as an internal reference. It was compared to other axes such as (i) the anatomical transepicondylar axis (aTEA), (ii) the surgical transepicondylar axis (sTEA), (iii) the posterior condylar axis (PCA) and (iv) the functional rotation axis (fRA).
RESULTS: Examination of 26 knee joint arthroplasties revealed a significant angular deviation (p*** < 0.0001) for all axes when the individual axes and FEA were compared. aTEA show mean angular deviation of 5.2° (± 4.5), sTEA was 2.7° (± 2.2), PCA 2.9° (± 2.3) and the deviation of fRA was 4.3° (± 2.7). A tendency towards external rotation was observed for the relative and maximum axis deviations of the aTEA to the FEA, for the sTEA and the fRA. However, the rotation of the posterior condylar axis was towards inwards.
CONCLUSIONS: All axes showed a significant angular deviation from the FEA. We conclude that the presented technique achieves comparable results in terms of FEA reconstruction when compared with the use of the known surrogate axes, with certain deviations in terms of outliers in the internal or external rotation.
摘要：
背景：全膝关节置换术（TKA）组件的植入不良是翻修手术的主要原因之一。为了确定正确的术中股骨旋转，描述了几个解剖旋转轴以实现平行，平衡屈曲间隙。在这项尸体研究中，将普遍使用的股骨旋转轴和导航功能旋转轴与定义为股骨TKA组件旋转的金标准的屈伸轴进行了比较。
方法：检查了13名患有膝骨关节炎的身体供体（平均年龄：78.85±6.09；8名女性和5名男性）。术前和术后对其下肢进行旋转计算机断层扫描。植入膝关节置换术，并使用CT诊断来比较术前确定的屈伸轴（FEA）。FEA是由我们的手术技术确定的轴，可作为内部参考。将其与其他轴进行比较，例如（i）解剖上髁轴（aTEA），(ii)手术经上髁轴(sTEA)，(iii)后髁轴(PCA)和(iv)功能旋转轴(fRA)。
结果：对26例膝关节置换术的检查显示，当比较各个轴和FEA时，所有轴的角度均有显着偏差（p***<0.0001）。TEA显示平均角度偏差5.2°(±4.5),sTEA为2.7°(±2.2),PCA为2.9°（±2.3），fRA的偏差为4.3°（±2.7）。对于aTEA与FEA的相对和最大轴偏差，观察到了外部旋转的趋势。sTEA和fRA.然而,后髁轴的旋转是向内。
结论：所有轴都显示出与FEA的显着角度偏差。我们得出的结论是，与使用已知的替代轴相比，所提出的技术在FEA重建方面取得了可比的结果，在内部或外部旋转的离群值方面有一定的偏差。
方法：检查了13名患有膝骨关节炎的身体供体（平均年龄：78.85±6.09；8名女性和5名男性）。术前和术后对其下肢进行旋转计算机断层扫描。植入膝关节置换术，并使用CT诊断来比较术前确定的屈伸轴（FEA）。FEA是由我们的手术技术确定的轴，可作为内部参考。将其与其他轴进行比较，例如（i）解剖上髁轴（aTEA），(ii)手术经上髁轴(sTEA)，(iii)后髁轴(PCA)和(iv)功能旋转轴(fRA)。
结果：对26例膝关节置换术的检查显示，当比较各个轴和FEA时，所有轴的角度均有显着偏差（p***<0.0001）。TEA显示平均角度偏差5.2°(±4.5),sTEA为2.7°(±2.2),PCA为2.9°（±2.3），fRA的偏差为4.3°（±2.7）。对于aTEA与FEA的相对和最大轴偏差，观察到了外部旋转的趋势。sTEA和fRA.然而,后髁轴的旋转是向内。
结论：所有轴都显示出与FEA的显着角度偏差。我们得出的结论是，与使用已知的替代轴相比，所提出的技术在FEA重建方面取得了可比的结果，在内部或外部旋转的离群值方面有一定的偏差。
