Download PDF
J Knee Surg 2022; 35(03): 280-287
DOI: 10.1055/s-0040-1713733
Original Article

The Relationship of Transepicondylar Width with the Distal and Posterior Femoral Condyles and Its Clinical Implications: A Three-Dimensional Study

Merrill Lee 
1   Department of Orthopaedic Surgery, Singapore General Hospital, Singapore, Singapore
,
Jade Pei Yuik Ho
2   Department of Orthopaedic Surgery, National Orthopaedic Center of Excellence for Research and Learning, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
,
Jerry Yongqiang Chen
1   Department of Orthopaedic Surgery, Singapore General Hospital, Singapore, Singapore
,
Chung Kia Ng
2   Department of Orthopaedic Surgery, National Orthopaedic Center of Excellence for Research and Learning, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
,
Seng Jin Yeo
1   Department of Orthopaedic Surgery, Singapore General Hospital, Singapore, Singapore
,
Azhar M. Merican 
2   Department of Orthopaedic Surgery, National Orthopaedic Center of Excellence for Research and Learning, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
› Author Affiliations Funding None.
› Further Information
    Permissions and Reprints

Abstract

Background Restoration of the anatomical joint line, while important for clinical outcomes, is difficult to achieve in revision total knee arthroplasty (rTKA) due to distal femoral bone loss. The objective of this study was to determine a reliable method of restoring the anatomical joint line and posterior condylar offset in the setting of rTKA based on three-dimensional (3D) reconstruction of computed tomography (CT) images of the distal femur.

Methods CT scans of 50 lower limbs were analyzed. Key anatomical landmarks such as the medial epicondyle (ME), lateral epicondyle, and transepicondylar width (TEW) were determined on 3D models constructed from the CT images. Best-fit planes placed on the most distal and posterior loci of points on the femoral condyles were used to define the distal and posterior joint lines, respectively. Statistical analysis was performed to determine the relationships between the anatomical landmarks and the distal and posterior joint lines.

Results There was a strong correlation between the distance from the ME to the distal joint line of the medial condyle (MEDC) and the distance from the ME to the posterior joint line of the medial condyle (MEPC) (p < 0.001; r = 0.865). The mean ratio of MEPC to MEDC was 1.06 (standard deviation [SD]: 0.07; range: 0.88–1.27) and that of MEPC to TEW was 0.33 (SD: 0.03; range: 0.25–0.38).

Conclusions Our findings suggest that the fixed ratios of MEPC to TEW (0.33) and that of MEPC to MEDC (1.06) provide a reliable means for the surgeon to determine the anatomical joint line when used in combination.

Keywords

joint line - posterior condylar offset - distal femoral anatomy - revision knee arthroplasty


Publication History

Received: 21 November 2019

Accepted: 24 May 2020

Article published online:
06 July 2020

© 2020. Thieme. All rights reserved.

Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA

 

  • References

  • 1 Porteous AJ, Hassaballa MA, Newman JH. Does the joint line matter in revision total knee replacement?. J Bone Joint Surg Br 2008; 90 (07) 879-884
    CrossrefPubMedGoogle Scholar
  • 2 van Lieshout WAM, Valkering KP, Koenraadt KLM, van Etten-Jamaludin FS, Kerkhoffs GMMJ, van Geenen RCI. The negative effect of joint line elevation after total knee arthroplasty on outcome. Knee Surg Sports Traumatol Arthrosc 2019; 27 (05) 1477-1486
    CrossrefPubMedGoogle Scholar
  • 3 Yoshii I, Whiteside LA, White SE, Milliano MT. Influence of prosthetic joint line position on knee kinematics and patellar position. J Arthroplasty 1991; 6 (02) 169-177
    CrossrefPubMedGoogle Scholar
  • 4 Bellemans J. Restoring the joint line in revision TKA: does it matter?. Knee 2004; 11 (01) 3-5
    CrossrefPubMedGoogle Scholar
  • 5 Selvarajah E, Hooper G. Restoration of the joint line in total knee arthroplasty. J Arthroplasty 2009; 24 (07) 1099-1102
    CrossrefPubMedGoogle Scholar
  • 6 Han HS, Yu CH, Shin N, Won S, Lee MC. Femoral joint line restoration is a major determinant of postoperative range of motion in revision total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 2019; 27 (07) 2090-2095
    CrossrefPubMedGoogle Scholar
  • 7 Laskin RS. Joint line position restoration during revision total knee replacement. Clin Orthop Relat Res 2002; (404) 169-171
    CrossrefPubMedGoogle Scholar
  • 8 Romero J, Seifert B, Reinhardt O, Ziegler O, Kessler O. A useful radiologic method for preoperative joint-line determination in revision total knee arthroplasty. Clin Orthop Relat Res 2010; 468 (05) 1279-1283
    CrossrefPubMedGoogle Scholar
  • 9 Iacono F, Raspugli GF, Filardo G. et al. The adductor tubercle: an important landmark to determine the joint line level in revision total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 2016; 24 (10) 3212-3217
    CrossrefPubMedGoogle Scholar
  • 10 Sato T, Koga Y, Sobue T, Omori G, Tanabe Y, Sakamoto M. Quantitative 3-dimensional analysis of preoperative and postoperative joint lines in total knee arthroplasty: a new concept for evaluation of component alignment. J Arthroplasty 2007; 22 (04) 560-568
    CrossrefPubMedGoogle Scholar
  • 11 Ozkurt B, Sen T, Cankaya D, Kendir S, Basarır K, Tabak Y. The medial and lateral epicondyle as a reliable landmark for intra-operative joint line determination in revision knee arthroplasty. Bone Joint Res 2016; 5 (07) 280-286
    CrossrefPubMedGoogle Scholar
  • 12 Matsuda S, Miura H, Nagamine R. et al. Anatomical analysis of the femoral condyle in normal and osteoarthritic knees. J Orthop Res 2004; 22 (01) 104-109
    CrossrefPubMedGoogle Scholar
  • 13 Meric G, Gracitelli GC, Aram LJ, Swank ML, Bugbee WD. Variability in distal femoral anatomy in patients undergoing total knee arthroplasty: measurements on 13,546 computed tomography scans. J Arthroplasty 2015; 30 (10) 1835-1838
    CrossrefPubMedGoogle Scholar
  • 14 Du PZ, Markolf KL, Levine BD, McAllister DR, Jones KJ. Differences in the radius of curvature between femoral condyles: implications for osteochondral allograft matching. J Bone Joint Surg Am 2018; 100 (15) 1326-1331
    CrossrefPubMedGoogle Scholar
  • 15 Mattei L, Pellegrino P, Calò M, Bistolfi A, Castoldi F. Patient specific instrumentation in total knee arthroplasty: a state of the art. Ann Transl Med 2016; 4 (07) 126
    CrossrefPubMedGoogle Scholar
  • 16 Suero EM, Hüfner T, Stübig T, Krettek C, Citak M. Use of a virtual 3D software for planning of tibial plateau fracture reconstruction. Injury 2010; 41 (06) 589-591
    CrossrefPubMedGoogle Scholar
  • 17 Subburaj K, Ravi B, Agarwal M. Automated identification of anatomical landmarks on 3D bone models reconstructed from CT scan images. Comput Med Imaging Graph 2009; 33 (05) 359-368
    CrossrefPubMedGoogle Scholar
  • 18 Hirschmann MT, Konala P, Amsler F, Iranpour F, Friederich NF, Cobb JP. The position and orientation of total knee replacement components: a comparison of conventional radiographs, transverse 2D-CT slices and 3D-CT reconstruction. J Bone Joint Surg Br 2011; 93 (05) 629-633
    CrossrefPubMedGoogle Scholar
  • 19 Iranpour F, Merican AM, Dandachli W, Amis AA, Cobb JP. The geometry of the trochlear groove. Clin Orthop Relat Res 2010; 468 (03) 782-788
    CrossrefPubMedGoogle Scholar
  • 20 Servien E, Viskontas D, Giuffrè BM, Coolican MR, Parker DA. Reliability of bony landmarks for restoration of the joint line in revision knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 2008; 16 (03) 263-269
    CrossrefPubMedGoogle Scholar
  • 21 Partington PF, Sawhney J, Rorabeck CH, Barrack RL, Moore J. Joint line restoration after revision total knee arthroplasty. Clin Orthop Relat Res 1999; (367) 165-171
    PubMedGoogle Scholar
  • 22 Clavé A, Le Henaff G, Roger T, Maisongrosse P, Mabit C, Dubrana F. Joint line level in revision total knee replacement: assessment and functional results with an average of seven years follow-up. Int Orthop 2016; 40 (08) 1655-1662
    CrossrefPubMedGoogle Scholar
  • 23 White D, Chelule KL, Seedhom BB. Accuracy of MRI vs CT imaging with particular reference to patient specific templates for total knee replacement surgery. Int J Med Robot 2008; 4 (03) 224-231
    CrossrefPubMedGoogle Scholar
  • 24 Victor J, Van Doninck D, Labey L, Innocenti B, Parizel PM, Bellemans J. How precise can bony landmarks be determined on a CT scan of the knee?. Knee 2009; 16 (05) 358-365
    CrossrefPubMedGoogle Scholar
  • 25 Victor J, Van Doninck D, Labey L, Van Glabbeek F, Parizel P, Bellemans J. A common reference frame for describing rotation of the distal femur: a ct-based kinematic study using cadavers. J Bone Joint Surg Br 2009; 91 (05) 683-690
    CrossrefPubMedGoogle Scholar
  • 26 Ng CK, Chen JY, Yeh JZY, Ho JPY, Merican AM, Yeo SJ. Distal femoral rotation correlates with proximal tibial joint line obliquity: a consideration for kinematic total knee arthroplasty. J Arthroplasty 2018; 33 (06) 1936-1944
    CrossrefPubMedGoogle Scholar
  • 27 Pereira GC, von Kaeppler E, Alaia MJ. et al. Calculating the position of the joint line of the knee using anatomical landmarks. Orthopedics 2016; 39 (06) 381-386
    CrossrefPubMedGoogle Scholar
  • 28 Rajagopal TS, Nathwani D. Can interepicondylar distance predict joint line position in primary and revision knee arthroplasty?. Am J Orthop 2011; 40 (04) 175-178
    PubMedGoogle Scholar
  • 29 Griffin FM, Math K, Scuderi GR, Insall JN, Poilvache PL. Anatomy of the epicondyles of the distal femur: MRI analysis of normal knees. J Arthroplasty 2000; 15 (03) 354-359
    CrossrefPubMedGoogle Scholar
  • 30 Maderbacher G, Keshmiri A, Schaumburger J. et al. Accuracy of bony landmarks for restoring the natural joint line in revision knee surgery: an MRI study. Int Orthop 2014; 38 (06) 1173-1181
    CrossrefPubMedGoogle Scholar
  • 31 Yue B, Varadarajan KM, Ai S, Tang T, Rubash HE, Li G. Differences of knee anthropometry between Chinese and white men and women. J Arthroplasty 2011; 26 (01) 124-130
    CrossrefPubMedGoogle Scholar
  • 32 Chin PL, Tey TT, Ibrahim MY, Chia SL, Yeo SJ, Lo NN. Intraoperative morphometric study of gender differences in Asian femurs. J Arthroplasty 2011; 26 (07) 984-988
    CrossrefPubMedGoogle Scholar
  • 33 Malviya A, Lingard EA, Weir DJ, Deehan DJ. Predicting range of movement after knee replacement: the importance of posterior condylar offset and tibial slope. Knee Surg Sports Traumatol Arthrosc 2009; 17 (05) 491-498
    CrossrefPubMedGoogle Scholar
  • 34 Massin P, Gournay A. Optimization of the posterior condylar offset, tibial slope, and condylar roll-back in total knee arthroplasty. J Arthroplasty 2006; 21 (06) 889-896
    CrossrefPubMedGoogle Scholar
  • 35 Stoeckl B, Nogler M, Krismer M, Beimel C, de la Barrera JL, Kessler O. Reliability of the transepicondylar axis as an anatomical landmark in total knee arthroplasty. J Arthroplasty 2006; 21 (06) 878-882
    CrossrefPubMedGoogle Scholar
  • 36 Yan CH, Yau WP, Ng TP, Lie WH, Chiu KY, Tang WM. Inter- and intra-observer errors in identifying the transepicondylar axis and Whiteside's line. J Orthop Surg (Hong Kong) 2008; 16 (03) 316-320
    CrossrefPubMedGoogle Scholar