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      3D-surface scan based validated new measurement technique of femoral joint line reconstruction in total knee arthroplasty


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          This study aimed to validate a new joint line measurement technique in total knee arthroplasty for separated assessment of the medial and lateral femoral joint line alteration with 3D-surface scan technology. Separate assessment of the medial and lateral joint line alteration may improve TKA alignment assessment regarding to joint line restoration in kinematic alignment and use of robotic-assisted TKA surgery.


          The medial and lateral joint line difference after TKA implantation on an artificial bone model was analyzed and compared with a 3D-scan and full femoral radiographs pre- and postoperatively. Radiographic analysis included the perpendicular distance between the most distal point of the medial and lateral condyle and the reproduced preoperative lateral distal femoral angle (LDFA). For evaluation of validity and reliability, radiographs were captured initially with true anteroposterior view and subsequently with combined flexion and rotation malpositioning. Reliability of the introduced measurement technique in between three observers was tested with intraclass correlation coefficient (ICC).


          Radiographic measurement showed a mean difference of 0.9 mm on the medial side and 0.6 mm on the lateral side when compared to the 3D-surface scan measurement. The reliability of measurement accuracy was ≤ 1 mm in x-rays with < 10° flexion error regardless to malrotation in these images. The ICC test showed very good reliability for the medial joint line evaluation and good reliability for lateral joint line evaluation (ICC 0.92, ICC 0.86 respectively).


          The new introduced joint line measurement method showed a sufficient reliability, accuracy and precision. It provides separated information about medial and lateral joint line alteration in TKA surgery in absolute values.

          Level of evidence

          V - Experimental Study

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          Most cited references 35

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          Three-dimensional mechanics, kinematics, and morphology of the knee viewed in virtual reality.

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            Results of an initial experience with custom-fit positioning total knee arthroplasty in a series of 48 patients.

            The custom-fit approach to total knee arthroplasty in conjunction with removal of osteophytes and preservation of ligaments rapidly returned function; restored motion, stability, and postoperative mechanical axis alignment; effected high patient satisfaction; and had an acceptable clinical outcome.
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              Clinical and radiographic analysis of accurate restoration of the joint line in revision total knee arthroplasty.

              A clinical and radiographic analysis was performed on 89 consecutive revision total knee arthroplasties. The postoperative joint line position was evaluated and correlated with the clinical outcome. The joint line position was evaluated radiographically. Average follow-up was 8.2 years (24-197 months). Clinical outcome values were correlated to joint line position. More improvement was seen with recreation of the normal joint line to within +/-4 mm of the normal unaffected knee for Knee Society Score, average total arc of motion, flexion, and extension. There was a significant difference found for all 4 variables when combined outliers were compared with goal range (-4 to 4 mm). In this study, clinical outcome was improved if the joint line was accurately reproduced.

                Author and article information

                J Exp Orthop
                J Exp Orthop
                Journal of Experimental Orthopaedics
                Springer Berlin Heidelberg (Berlin/Heidelberg )
                25 February 2021
                25 February 2021
                December 2021
                : 8
                [1 ]GRID grid.10423.34, ISNI 0000 0000 9529 9877, Department of Orthopaedic Surgery, , Medical School Hannover, ; Anna-von-Borries-Str. 1-7, 30625 Hannover, Germany
                [2 ]GRID grid.10423.34, ISNI 0000 0000 9529 9877, Laboratory for Biomechanics and Biomaterials, , Medical School Hannover, ; Anna-von-Borries-Str. 1-7, 30625 Hannover, Germany
                © The Author(s) 2021

                Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.

                Funded by: Medizinische Hochschule Hannover (MHH) (3118)
                Original Paper
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                © The Author(s) 2021


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