Accuracy of Inter Femoral Head Center Distance Measurement and Evaluation for Coronal Alignment of Femoral Component during Total Knee Arthroplasty

Woon Hwa Jung; Dong Hyun Kim; Chung Woo Chun; Jae Heon Jeong; Yong Chan Ha; Jai Gon Seo

doi:10.4055/jkoa.2011.46.4.320

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Jung, Kim, Chun, Jeong, Ha, and Seo: Accuracy of Inter Femoral Head Center Distance Measurement and Evaluation for Coronal Alignment of Femoral Component during Total Knee Arthroplasty

Original Article

Journal of the Korean Orthopaedic Association

Journal of the Korean Orthopaedic Association 2011; 46(4): 320-325.

Published online: 31 August 2011

DOI: https://doi.org/10.4055/jkoa.2011.46.4.320

Accuracy of Inter Femoral Head Center Distance Measurement and Evaluation for Coronal Alignment of Femoral Component during Total Knee Arthroplasty

Woon Hwa Jung, M.D., Dong Hyun Kim, M.D., Chung Woo Chun, M.D., Jae Heon Jeong, M.D.^*, Yong Chan Ha, M.D.^*, Jai Gon Seo, M.D.^†

Department of Orthopedic Surgery, Murup Hospital, Changwon, Korea.

^*Department of Orthopedic Surgery, Chung-Ang University College of Medicine, Seoul, Korea.

^†Department of Orthopedic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.

Correspondence to: Jae Heon Jeong, M.D. Department of Orthopedic Surgery, Chung-Ang University College of Medicine, 224-1, Heukseok-dong, Dongjak-gu, Seoul 156-755, Korea. TEL: +82-2-6299-1577, FAX: +82-2-822-1710, osjjaeheon@naver.com

Received 31 August 2010 Accepted 8 February 2011

(open-access):

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

Alignment is an important factor in the long-term success of total knee arthroplasty. In the total knee arthroplasty, the conventional extramedullary femoral alignment system has significant error in femoral coronal alignment, since it is difficult to find the femoral head center and it is time consuming to determine during the operation. The purpose of our study was to evaluate the accuracy of the newly-designed marker system for extramedullary femoral alignment that uses radiologic distance between the 2 femoral head centers.

Materials and Methods

Between July 2008 and July 2009, 90 patients (100 knees) with knee osteoarthritis underwent total knee arthroplasty using the femoral extramedullary femoral guide system. We measured the distance between the femoral head centers using the radiologic picture archiving and communication system (PACS, General Electric, Milwaukee, WI) system preoperatively, then plastic rods and metal pegs were used to simulate the inter femoral head center distance. By placing the center of the plastic rod after marking the inter femoral head center distance on the central body line, we could trace the coronal mechanical axis. We measured the angle between the femoral mechanical axis and the femoral component in standing long leg antero-posterior radiograph to assess radiologically the accuracy of coronal alignment postoperatively.

Results

The average femoral length in the study group was 402.5±16.2 mm. The mean distance between the femoral head and the center of the marker was 49.6±17.9 mm. The average error in estimation of the distance between the femoral head center and the metal peg of the marker was 3.78±3.14 mm. The positional error in alignment was 1° or less in 90% and 2° or less in 100% of knees. The average angle of femoral component to femoral mechanical axis was 89.9±1.5° (range 84.4-93.6°). The coronal alignment of the femoral components was within 90°±3° in -96% of cases.

Conclusion

Our results suggest that the clinical method reported here is a simple and reliable method to localize the center of the femoral head during total knee arthroplasty.

Keywords: total knee arthroplasty, mechanical axis, extramedullary femoral guide system, interfemoral head center distance

Figures and Tables

Figure 1

(A) 100mm X-Ray Magnification Maker (B) X-ray shows calculation of the interfemoral head center distance. (C) The Mechanical Axis Marker is placed on the body center.

Figure 2

The Mechanical Axis Marker: the plastic rod and metal pegs were used to simulate the inter femoral head center distance.

Figure 3

A radiograph was taken after positioning of the patient before surgery. We measured horizontal distance from the peg to the perpendicular extending line through the line of the femoral head center.

Figure 4

Radiograph showing the mechanical axis in the coronal plane. The alignment of the coronal femoral components was measured by the intersection of a line drawn across the base of each component and the mechanical axis. FFA, frontal femoral angle.

Figure 5

Drawing shows the acceptable range of error in Mechanical Axis Marker placement.

Table 1

Demographic Data

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