Prediction of Distal Femoral and Posterior Articular Surfaces in Total Knee Arthroplasty With Severe Bone Defects Using Computed Tomography-Based Templating Software

TL;DR

This study uses CT-based software to predict femoral and articular surfaces in knee surgery when bone defects are severe.

Contribution

The study introduces a method using CT-based templating to define joint line relationships in knees with bone loss.

Findings

The medial epicondyle to posterior articular surface distance was 29.4 ± 2.2 mm in the axial plane.

The femoral width averaged 75.2 ± 4.2 mm, with consistent ratios between distances and width.

Distances from epicondyles to articular surfaces correlate with femoral width, aiding joint line reconstruction.

Abstract

Introduction

Optimal repair of the joint line (JL) in total knee arthroplasty (TKA) is critical for knee joint motion reconstruction and ligament balance. Identification of JL may be difficult, particularly in revision or primary cases of severe femoral condylar bone loss. We aimed to define the relationship between the epicondyles and the articular surface (AS) of the femur using computed tomography-based three-dimensional digital templating software.

Methods

The study included 127 knees with osteoarthritis of the knee below grade 2 on the Kellgren-Lawrence index. A perpendicular line was drawn from the medial and lateral femoral epicondylar processes to the most distal point of the AS, and the distance was measured in the axial and coronal planes. Femoral width was measured as the distance between the medial and lateral epicondyles. All distances described above were converted to a ratio by division with femoral width.

Results

On the axial plane, the distance from epicondyles to the posterior ASs was 29.4 ± 2.2 mm medially and 21.3 ± 2.1 mm laterally. The width of the distal femur was 75.2 ± 4.2 mm. On the coronal plane, the distances from epicondyles to the distal ASs were 25.2 ± 2.9 mm on the medial side and 21.3 ± 2.5 mm on the lateral side. The ratio of the distance from epicondyles to the distal and posterior ASs divided by the width of the femur was 0.39 ± 0.02, 0.28 ± 0.03, 0.34 ± 0.03, and 0.28 ± 0.03.

Conclusions

The distance from the epicondyles to the distal and posterior JLs correlates with the distal femur width. These findings may be useful in determining an appropriate JL.

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