THE POSITION OF FEMORAL COMPONENT TO OBTAIN RECTANGULAR FLEXION GAP IN TOTAL KNEE ARTHROPLASTY

Abstract

To make rectangular flexion and extension gap is an important goal in total knee arthroplasty (TKA). The purpose of this study was to determine the AP and rotational position of the femora component to obtain rectangular flexion with reference to the anatomical landmarks.

One hundred and twenty seven varus osteoarthritic knees (87 patients) undergoing TKA from June 2004 to March 2006 were included (72 women and 15 men, mean age 74.4 years). All operations were performed with Vanguard PS, Biomet (Warsaw, IN U.S.A.). The position of femoral component was determined using a modified Ranawat block (Equiflex^™) to obtain the rectangular flexion gap equal to extension gap. This instrument uses the balanced soft tissue sleeve in extension as a guide to create a balanced flexion gap. The flexion gap asymmetry after TKA was evaluated as the angle between the posterior condylar axis (PCA) and the tibial cutting line (TCL) by axial radiography of the distal femur. (Tokuhara et. al., JBJS (88-B), 2006). Briefly, axial radiography of the distal femur of flexed knee was obtained with a 1.5kg distraction force in ankle joint. This technique led to clear visualization of the asymmetry of the flexion gap. Femoral component rotation was evaluated using pre- and post-operative axial radiography of the distal femur (Kanekasu et. al., CORR (434), 2005). Condylar twist angle (CTA) is the angle between the CEA and the PCA. The rotational position femoral component relative to the PCA was calculated by subtracting post-operative CTA from pre-operative CTA. In addition, the thicknesses of resected bone from the lateral and medial posterior femoral condyles were measured.

The asymmetry of the flexion gap was 1.6±2.4° with slight laxity in the lateral side. The average amount of external rotation of the femoral component relative PCA was on 6.2 ±2.5°. The thickness of resected bone from the posterior lateral and medial condyles were 4.7 ± 2.1 mm and 8.6 ±2.1 mm respectively.

The results of this study have shown that, for a well-balanced flexion gap, femoral component should be excessively rotated by 3 degrees compared to current recommendation (Parallel to SEA) As for the AP position, the average amount of medial bone resection is equal to the implant thickness (9 mm). This information is useful for the modification of measured resection technique to obtain rectangular flexion gap.