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      The medial and lateral epicondyle as a reliable landmark for intra-operative joint line determination in revision knee arthroplasty

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          Abstract

          Objectives

          The purpose of this study was to develop an accurate, reliable and easily applicable method for determining the anatomical location of the joint line during revision knee arthroplasty.

          Methods

          The transepicondylar width (TEW), the perpendicular distance between the medial and lateral epicondyles and the distal articular surfaces (DMAD, DLAD) and the distance between the medial and lateral epicondyles and the posterior articular surfaces (PMAD, DLAD) were measured in 40 knees from 20 formalin-fixed adult cadavers (11 male and nine female; mean age at death 56.9 years, sd 9.4; 34 to 69). The ratios of the DMAD, PMAD, DLAD and PLAD to TEW were calculated.

          Results

          The mean TEW, DMAD, PMAD, DLAD and PLAD were 82.76 mm (standard deviation ( sd) 7.74), 28.95 mm ( sd 3.3), 28.57 mm ( sd 3), 23.97 mm ( sd 3.27) and 24.42 mm ( sd 3.14), respectively. The ratios between the TEW and the articular distances (DMAD/TEW, DLAD/TEW, PMAD/TEW and PLAD/TEW) were calculated and their means were 0.35 ( sd 0.02), 0.34 ( sd 0.02), 0.28 ( sd 0.03) and 0.29 ( sd 0.03), respectively.

          Conclusion

          This method provides a simple, reproducible and reliable technique enabling accurate anatomical joint line restoration during revision total knee arthroplasty.

          Cite this article: B. Ozkurt, T. Sen, D. Cankaya, S. Kendir, K. Basarır, Y. Tabak. The medial and lateral epicondyle as a reliable landmark for intra-operative joint line determination in revision knee arthroplasty. Bone Joint Res 2016;5:280–286. DOI: 10.1302/2046-3758.57.BJR-2016-0002.R1.

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          Most cited references25

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          The Chitranjan Ranawat award: is neutral mechanical alignment normal for all patients? The concept of constitutional varus.

          Johan Bellemans, William Colyn, Hilde Vandenneucker … (2012)
          Most knee surgeons have believed during TKA neutral mechanical alignment should be restored. A number of patients may exist, however, for whom neutral mechanical alignment is abnormal. Patients with so-called "constitutional varus" knees have had varus alignment since they reached skeletal maturity. Restoring neutral alignment in these cases may in fact be abnormal and undesirable and would likely require some degree of medial soft tissue release to achieve neutral alignment.
          Article 0 comments Cited 215 times – based on 0 reviews     Review now
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            What is the optimal alignment of the tibial and femoral components in knee arthroplasty?

            Kirill Gromov, Mounim Korchi, Morten Thomsen … (2014)
            Background Surgeon-dependent factors such as optimal implant alignment are thought to play a significant role in outcome following primary total knee arthroplasty (TKA). Exact definitions and references for optimal alignment are, however, still being debated. This overview of the literature describes different definitions of component alignment following primary TKA for (1) tibiofemoral alignment in the AP plane, (2) tibial and femoral component placement in the AP plane, (3) tibial and femoral component placement in the sagittal plane, and (4) rotational alignment of tibial and femoral components and their role in outcome and implant survival. Methods We performed a literature search for original and review articles on implant positioning following primary TKA. Definitions for coronal, sagittal, and rotational placement of femoral and tibial components were summarized and the influence of positioning on survival and functional outcome was considered. Results Many definitions exist when evaluating placement of femoral and tibial components. Implant alignment plays a role in both survival and functional outcome following primary TKA, as component malalignment can lead to increased failure rates, maltracking, and knee pain. Interpretation Based on currently available evidence, surgeons should aim for optimal alignment of tibial and femoral components when performing TKA.
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              Mechanical, Anatomical, and Kinematic Axis in TKA: Concepts and Practical Applications.

              Jeffrey J Cherian, Bhaveen H Kapadia, Samik Banerjee … (2014)
              Successful total knee arthroplasty (TKA) has often been based on the restoration of the knee to neutral alignment postoperatively. Numerous reports have linked malaligned TKA components to increased wear, poor functional outcomes, and failure. There have been many different alignment philosophies and surgical techniques that have been established to attain the goal of proper alignment, which includes such techniques as computerized navigation, and custom cutting guides. In addition, these methods could potentially have the added benefit of leading to improved functional outcomes following total knee arthroplasty. In this report, we have reviewed and analyzed recent reports concerning mechanical, anatomic, and kinematic axis/alignment schemes used in total knee arthroplasty.
              Article 0 comments Cited 65 times – based on 0 reviews     Review now
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                Author and article information

                Contributors
                B. Ozkurt: Role: Associate Professor
                T. Sen: Role: Associate Professor
                D. Cankaya: Role: Staff Surgeon
                S. Kendir: Role: Medical Doctor
                K. Basarır: Role: Associate Professor
                Y. Tabak: Role: Associate Professor
                Journal
                Journal ID (nlm-ta): Bone Joint Res
                Journal ID (publisher-id): BJR
                Journal ID (hwp): bjres
                Title: Bone & Joint Research
                ISSN (Electronic): 2046-3758
                Publication date Collection: July 2016
                Publication date (Electronic): 22 July 2016
                Volume: 5
                Issue: 7
                Pages: 280-286
                Affiliations
                [1 ]Orthopaedic Department, Ankara Numune Research and Training Hospital, Talatpasa Bulvarı Samanpazarı Ankara, Turkey
                [2 ]School of Medicine Anatomy Department Ankara University, Sıhhiye Ankara, Turkey
                Author notes
                [*]Mr B. Ozkurt; email: bulentozkurt@ 123456hotmail.com
                Article
                Publisher ID: 10.1302_2046-3758.57.BJR-2016-0002.R1
                DOI: 10.1302/2046-3758.57.BJR-2016-0002.R1
                PMC ID: 4969630
                PubMed ID: 27388715
                SO-VID: 1e28349d-ca71-4a8a-a2a2-9c23c7e6ae56
                Copyright © © 2016 Ozkurt et al.
                License:

                This is an open-access article distributed under the terms of the Creative Commons Attributions licence (CC-BY-NC), which permits unrestricted use, distribution, and reproduction in any medium, but not for commercial gain, provided the original author and source are credited.

                History
                Date received : 29 March 2016
                Date accepted : 9 May 2016
                Categories
                Subject: Knee
                Subject: 2
                Subject: Knee
                Subject: Joint Line
                Subject: Arthroplasty
                Subject: Cadaver
                Subject: Revision Arthroplasty

                Keywords: knee,joint line,arthroplasty,cadaver,revision arthroplasty
                Data availability:
                Keywords: knee, joint line, arthroplasty, cadaver, revision arthroplasty

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