Purpose

To evaluate the normal bony profiles of the anterior surface of the distal femoral cortex, its relation to the posterior condylar plane and assess the implications of these findings to anterior femoral referencing.

Purpose of the study: Rotation of the tibial implant is an important factor for the functional outcome of total knee arthroplasty (TKA). Any rotational malposition will cause eccentric loading of the plateau. Several techniques have been recommended to avoid malposition, but none has proven superior over the others in terms of reliability or reproductibility. The landmark used to establish rotation must meet two prerequisites: easy identification and reliable representation of the anatomic rotation of the proximal tibia. This study was conducted to compare seven different techniques for landmarking used for choosing the rotation of the tibial base in TKA.

Material and methods: An optoelectronic method was used to measure 50 tibia selected among a collection of 600 skeletons. A palper was used to locate 34 distinct landmarks and institute each reference system. The groups of anatomic points were reconstructed to form lines and plans depending on the comparisons to make: posterior condylar alignment (PCA), transversal alignment (TA), anterior condylar alignment (ACA), alignment of the anterior tibial tuberosity (ATT), the transmalleolar alignment (TMA), the line of the tibial crest (LTC) and a new line, the anterior distal line (ADL). The PCA was used as the reference.

Results: Intra-observer variation was determined in a preliminary study using ten consecutive measurements. The standard deviation was 0.5° with a distribution of 1.8°. Angle: mean [-:internal rotation; +external rotation], standard deviation: difference between the minimum and the maximum. TA: −5.13; 9.2; 38.03; ACA: −12.81; 6.7; 41.74; ATT: 68.72; 8.6; 58.46; TMA: −22.68; 11.6; 72.84; LTC: 67.56; 10.3; 46.11; ADL: 16.61; 13.2; 74.93.

Discussion: This study did not prove convincingly that any one of the tibial alignments was better than another; which demonstrates that use of a single reference is probably inappropriate to determine the rotational alignment of the tibial base for TKA. It was noted however that the anterior condylar line (mean external rotation 12.8°-SD< 7° relative to the PCA) could be pertinent for future research since this line is easily accessible and palpable, particularly during navigated surgery.