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Accuracy and reliability of distal femoral rotation measurements using the transepicondylar axis in total knee arthroplasty: A cadaver study

  • Seyyed Morteza Kazemi ,
  • Reza Minaei ,
  • Mohammad Nabi Bahrami ,


Abstract

Introduction: The correct alignment of femoral components is necessary to achieve a successful total knee arthroplasty (TKA) and preventing complications such as pain, stiffness, loosening, instability; which itself, depends on making perfect cuts. The posterior distal femoral cut, is one of the most important factors. Yet, the best method of its measurement is controversial.

Methods: In this study, 20 cadavers of femoral bones were used; on which, the distal femoral rotation (DFR) was measured manually by 8 orthopedic surgeons and also was calculated on the basis of the trans-epicondylar axis (TEA) by 2 orthopedic surgeons and 2 radiologists on CT scan image. Accuracy and reliability were assessed in both groups, and the risk of severe malrotation was determined according to an outlier defined as 3 and 5 degrees.

Results: The mean DFR measured manually, was 1.8±2.1º and the one attained by CT scan images was reported 3.3±1.1º, projecting a remarkable difference between two groups. The Kappa reliability index was calculated about 0.81 in CT scan results and 0.64 in the other group. (k>0.7 was considered as valuable). With an outlier defined as 3º, from the normal distal femoral rotation based on posterior condylar axis (PCA), 3º external rotation; 12% of data were outlying in the manually of measured data, and there was no outlier data were reported in the other group. (With a statistically significant difference between two groups)

Conclusion: According to the unreliability and noticeable risk of error in measuring DFR manually based on TEA, this study suggests using CT scan in the patient’s pre-op assessment to obtain the most accurate data.

Keywords: Total knee arthroplasty Distal femoral rotation Transepicondylar axis Rotational alignment

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How to Cite

Kazemi, S. M., Minaei, R., & Bahrami, M. N. (2017). Accuracy and reliability of distal femoral rotation measurements using the transepicondylar axis in total knee arthroplasty: A cadaver study. Bali Medical Journal, 6(3), 491–494. https://doi.org/10.15562/bmj.v6i3.683
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Seyyed Morteza Kazemi
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BMJ Journal

Reza Minaei
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BMJ Journal

Mohammad Nabi Bahrami
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BMJ Journal