Abstract
Purpose: We hypothesised that independent Notch Trial is essential on same lines as other Component Trials – Femoral, Tibial and Patellar – in posterior stabilised total knee arthroplasty and evolved Notch Trial to visually ascertain adequacy of intercondylar resection and eliminate femoral intercondylar fractures.
We undertook a retrospective study to evaluate Notch Trial by the frequency of the need to remove osteophytes or file uneven surfaces in intercondylar resection by using detachable box part of trial femoral component and occurrence of distal femoral intercondylar fractures.
Methods & Results: We studied 206 patients, 113 females and 93 males, who underwent consecutive primary posterior stabilised total knee replacements applying Notch Trial between 2000 and 2008 under our team. Outcome Measurements were
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frequency of osteophyte removal or filing uneven surfaces in intercondylar resection and
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distal femoral intercondylar fractures intraoperatively or on postoperative radiographs.
We had to remove osteophytes and file cut surfaces in 183 (88.88%) patients after Notch Trial. We had no distal femoral intercondylar fractures.
Conclusions: Notch Trial allows the surgeon to directly visualise and ascertain adequacy and precise fit of femoral notch cut with cam part to ensure press fit femoral component in condylar posterior cruciate substituting total knee replacement. Notch Trial prior to Femoral Component Trial effectively pre-empts intraoperative distal femoral intercondylar fractures. We recommend that Notch Trial should become part of the protocol for cruciate substituting total knee replacement and implants of all companies should have the option of a detachable box component for Notch Trial.
Correspondence should be addressed to BOSA at the Royal College of Surgeons, 35–43 Lincoln’s Inn Fields, London WC2A 3PE, England.
