Reliability of bony landmarks for restoration of the joint line in revision knee arthroplasty
The aim of this study was to determine the reliability of bone landmarks for restoring the joint line in revision knee arthroplasty. The relationship of the femoral epicondyles, the tibial tubercle (TT) and the fibular head (FH) to the joint line was measured on 200 magnetic resonance imaging (MRI,...
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Published in | Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA Vol. 16; no. 3; pp. 263 - 269 |
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Main Authors | , , , , |
Format | Journal Article |
Language | English |
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Berlin/Heidelberg
Springer-Verlag
01.03.2008
Springer Nature B.V |
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Abstract | The aim of this study was to determine the reliability of bone landmarks for restoring the joint line in revision knee arthroplasty. The relationship of the femoral epicondyles, the tibial tubercle (TT) and the fibular head (FH) to the joint line was measured on 200 magnetic resonance imaging (MRI, 100 females, 100 males), including assessment on intraobserver and interobserver reliability. MRI scans demonstrating chondral lesions and osteoarthritis were excluded, as were patients with immature skeletons or a history of previous knee surgery. Sequences in sagittal, coronal and axial planes were used as well as cross-referencing with the same computer software. In order to account for size differences between patients, each bony landmark measurement was converted to a ratio relative to the femoral or/and tibial width. We found a transepicondylar axis equal to 3.11° (±1.9). The average distance from the epicondyles to the joint line was respectively 23 mm on the lateral side and 28 mm on the medial side. However there was a variation of distance from the epicondyles of the joint line up to 11 mm and a significative difference was found between male and female. We determined the distances from the tip of the FH and from the TT to the joint line. The joint line-FH distance averaged 14 mm (range 4.1–22.13) with no gender difference. The joint line-TT distance was averaged 22 mm (range 10.61–32.09). We determined an epicondylar ratio (distance from the lateral epicondyle to the joint line related to the femoral width). We found this ratio averaged 28% with no gender difference (
P
= 0.09). There is a large variation of bony landmarks depending on the size of the individual. Considering this findings, the FH is not a reliable guide for the joint line in revision surgery. Previous studies have measured the absolute values from various landmarks to the joint line. This study provides a significant advantage, in that the level of the joint line can be determined for each individual by using a ratio to account for gender and size differences. |
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AbstractList | The aim of this study was to determine the reliability of bone landmarks for restoring the joint line in revision knee arthroplasty. The relationship of the femoral epicondyles, the tibial tubercle (TT) and the fibular head (FH) to the joint line was measured on 200 magnetic resonance imaging (MRI, 100 females, 100 males), including assessment on intraobserver and interobserver reliability. MRI scans demonstrating chondral lesions and osteoarthritis were excluded, as were patients with immature skeletons or a history of previous knee surgery. Sequences in sagittal, coronal and axial planes were used as well as cross-referencing with the same computer software. In order to account for size differences between patients, each bony landmark measurement was converted to a ratio relative to the femoral or/and tibial width. We found a transepicondylar axis equal to 3.11 degree ( plus or minus 1.9). The average distance from the epicondyles to the joint line was respectively 23 mm on the lateral side and 28 mm on the medial side. However there was a variation of distance from the epicondyles of the joint line up to 11 mm and a significative difference was found between male and female. We determined the distances from the tip of the FH and from the TT to the joint line. The joint line-FH distance averaged 14 mm (range 4.1-22.13) with no gender difference. The joint line-TT distance was averaged 22 mm (range 10.61-32.09). We determined an epicondylar ratio (distance from the lateral epicondyle to the joint line related to the femoral width). We found this ratio averaged 28% with no gender difference (P = 0.09). There is a large variation of bony landmarks depending on the size of the individual. Considering this findings, the FH is not a reliable guide for the joint line in revision surgery. Previous studies have measured the absolute values from various landmarks to the joint line. This study provides a significant advantage, in that the level of the joint line can be determined for each individual by using a ratio to account for gender and size differences. The aim of this study was to determine the reliability of bone landmarks for restoring the joint line in revision knee arthroplasty. The relationship of the femoral epicondyles, the tibial tubercle (TT) and the fibular head (FH) to the joint line was measured on 200 magnetic resonance imaging (MRI, 100 females, 100 males), including assessment on intraobserver and interobserver reliability. MRI scans demonstrating chondral lesions and osteoarthritis were excluded, as were patients with immature skeletons or a history of previous knee surgery. Sequences in sagittal, coronal and axial planes were used as well as cross-referencing with the same computer software. In order to account for size differences between patients, each bony landmark measurement was converted to a ratio relative to the femoral or/and tibial width. We found a transepicondylar axis equal to 3.11° (±1.9). The average distance from the epicondyles to the joint line was respectively 23 mm on the lateral side and 28 mm on the medial side. However there was a variation of distance from the epicondyles of the joint line up to 11 mm and a significative difference was found between male and female. We determined the distances from the tip of the FH and from the TT to the joint line. The joint line-FH distance averaged 14 mm (range 4.1–22.13) with no gender difference. The joint line-TT distance was averaged 22 mm (range 10.61–32.09). We determined an epicondylar ratio (distance from the lateral epicondyle to the joint line related to the femoral width). We found this ratio averaged 28% with no gender difference ( P = 0.09). There is a large variation of bony landmarks depending on the size of the individual. Considering this findings, the FH is not a reliable guide for the joint line in revision surgery. Previous studies have measured the absolute values from various landmarks to the joint line. This study provides a significant advantage, in that the level of the joint line can be determined for each individual by using a ratio to account for gender and size differences. The aim of this study was to determine the reliability of bone landmarks for restoring the joint line in revision knee arthroplasty. The relationship of the femoral epicondyles, the tibial tubercle (TT) and the fibular head (FH) to the joint line was measured on 200 magnetic resonance imaging (MRI, 100 females, 100 males), including assessment on intraobserver and interobserver reliability. MRI scans demonstrating chondral lesions and osteoarthritis were excluded, as were patients with immature skeletons or a history of previous knee surgery. Sequences in sagittal, coronal and axial planes were used as well as cross-referencing with the same computer software. In order to account for size differences between patients, each bony landmark measurement was converted to a ratio relative to the femoral or/and tibial width. We found a transepicondylar axis equal to 3.11° (±1.9). The average distance from the epicondyles to the joint line was respectively 23 mm on the lateral side and 28 mm on the medial side. However there was a variation of distance from the epicondyles of the joint line up to 11 mm and a significative difference was found between male and female. We determined the distances from the tip of the FH and from the TT to the joint line. The joint line-FH distance averaged 14 mm (range 4.1-22.13) with no gender difference. The joint line-TT distance was averaged 22 mm (range 10.61-32.09). We determined an epicondylar ratio (distance from the lateral epicondyle to the joint line related to the femoral width). We found this ratio averaged 28% with no gender difference (P = 0.09). There is a large variation of bony landmarks depending on the size of the individual. Considering this findings, the FH is not a reliable guide for the joint line in revision surgery. Previous studies have measured the absolute values from various landmarks to the joint line. This study provides a significant advantage, in that the level of the joint line can be determined for each individual by using a ratio to account for gender and size differences. The aim of this study was to determine the reliability of bone landmarks for restoring the joint line in revision knee arthroplasty. The relationship of the femoral epicondyles, the tibial tubercle (TT) and the fibular head (FH) to the joint line was measured on 200 magnetic resonance imaging (MRI, 100 females, 100 males), including assessment on intraobserver and interobserver reliability. MRI scans demonstrating chondral lesions and osteoarthritis were excluded, as were patients with immature skeletons or a history of previous knee surgery. Sequences in sagittal, coronal and axial planes were used as well as cross-referencing with the same computer software. In order to account for size differences between patients, each bony landmark measurement was converted to a ratio relative to the femoral or/and tibial width. We found a transepicondylar axis equal to 3.11 degrees (+/-1.9). The average distance from the epicondyles to the joint line was respectively 23 mm on the lateral side and 28 mm on the medial side. However there was a variation of distance from the epicondyles of the joint line up to 11 mm and a significative difference was found between male and female. We determined the distances from the tip of the FH and from the TT to the joint line. The joint line-FH distance averaged 14 mm (range 4.1-22.13) with no gender difference. The joint line-TT distance was averaged 22 mm (range 10.61-32.09). We determined an epicondylar ratio (distance from the lateral epicondyle to the joint line related to the femoral width). We found this ratio averaged 28% with no gender difference (P = 0.09). There is a large variation of bony landmarks depending on the size of the individual. Considering this findings, the FH is not a reliable guide for the joint line in revision surgery. Previous studies have measured the absolute values from various landmarks to the joint line. This study provides a significant advantage, in that the level of the joint line can be determined for each individual by using a ratio to account for gender and size differences. |
Author | Giuffrè, Bruno M. Viskontas, Darius Servien, Elvire Parker, David A. Coolican, Myles R. J. |
Author_xml | – sequence: 1 givenname: Elvire surname: Servien fullname: Servien, Elvire email: elvire.servien@chu-lyon.fr organization: Department of Orthopaedic Surgery, Centre Albert Trillat, Hopital de la Croix Rousse, Hospices Civils de Lyon, Department of Orthopaedic Surgery, Royal North Shore Hospital, Sydney Orthopaedic Research Institute – sequence: 2 givenname: Darius surname: Viskontas fullname: Viskontas, Darius organization: Department of Orthopaedic Surgery, Royal North Shore Hospital, Sydney Orthopaedic Research Institute – sequence: 3 givenname: Bruno M. surname: Giuffrè fullname: Giuffrè, Bruno M. organization: Department of Diagnostic Radiology, Royal North Shore Hospital – sequence: 4 givenname: Myles R. J. surname: Coolican fullname: Coolican, Myles R. J. organization: Department of Orthopaedic Surgery, Royal North Shore Hospital, Sydney Orthopaedic Research Institute – sequence: 5 givenname: David A. surname: Parker fullname: Parker, David A. organization: Department of Orthopaedic Surgery, Royal North Shore Hospital, Sydney Orthopaedic Research Institute |
BackLink | https://www.ncbi.nlm.nih.gov/pubmed/18046537$$D View this record in MEDLINE/PubMed |
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Keywords | Knee Arthroplasty Revision Epicondyle Joint line |
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PublicationTitle | Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA |
PublicationTitleAbbrev | Knee Surg Sports Traumatol Arthr |
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References_xml | – volume: 11 start-page: 3 year: 2004 end-page: 5 ident: CR1 article-title: Restoring the joint line in revision TKA: does it matter? publication-title: Knee doi: 10.1016/S0968-0160(03)00099-1 contributor: fullname: Bellemans – volume: 406 start-page: 136 year: 2003 end-page: 140 ident: CR2 article-title: The proximal tibiofibular joint: an anatomic study publication-title: Clin Orthop Relat Res doi: 10.1097/00003086-200301000-00022 contributor: fullname: Gunal – volume: 10 start-page: 194 year: 2002 end-page: 197 ident: CR5 article-title: Interindividual reproducibility in perioperative rotational alignment of femoral components in knee prosthetic surgery using the transepicondylar axis publication-title: Knee Surg Sports Traumatol Arthrosc doi: 10.1007/s00167-001-0271-x contributor: fullname: Filler – volume: 367 start-page: 165 year: 1999 end-page: 171 ident: CR8 article-title: Joint line restoration after revision total knee arthroplasty publication-title: Clin Orthop Relat Res doi: 10.1097/00003086-199910000-00020 contributor: fullname: Moore – volume: 12 start-page: 89 year: 2005 end-page: 92 ident: CR10 article-title: The use of the knee joint-line balancer to control patella position in revision total knee arthroplasty publication-title: Knee doi: 10.1016/j.knee.2004.05.004 contributor: fullname: Jacobs – volume: 10 start-page: 785 year: 1995 end-page: 789 ident: CR9 article-title: Morphology of the transepicondylar axis and its application in primary and revision total knee arthroplasty publication-title: J Arthroplasty doi: 10.1016/S0883-5403(05)80072-5 contributor: fullname: Abbott – volume: 15 start-page: 354 year: 2000 end-page: 359 ident: CR4 article-title: Anatomy of the epicondyles of the distal femur: MRI analysis of normal knees publication-title: J Arthroplasty doi: 10.1016/S0883-5403(00)90739-3 contributor: fullname: Poilvache – volume: 404 start-page: 169 year: 2002 end-page: 171 ident: CR6 article-title: Joint line position restoration during revision total knee replacement publication-title: Clin Orthop Relat Res doi: 10.1097/00003086-200211000-00029 contributor: fullname: Laskin – volume: 68 start-page: 1035 year: 1986 end-page: 1040 ident: CR3 article-title: The influence of tibial-patellofemoral location on function of the knee in patients with the posterior stabilized condylar knee prosthesis publication-title: J Bone Joint Surg Am contributor: fullname: Gordon – volume: 9 start-page: 3 year: 2002 end-page: 6 ident: CR7 article-title: Patellar tendon length—the factor in patellar instability? publication-title: Knee doi: 10.1016/S0968-0160(01)00136-3 contributor: fullname: Chambat – volume: 10 start-page: 785 year: 1995 ident: 449_CR9 publication-title: J Arthroplasty doi: 10.1016/S0883-5403(05)80075-0 contributor: fullname: JB Stiehl – volume: 9 start-page: 3 year: 2002 ident: 449_CR7 publication-title: Knee doi: 10.1016/S0968-0160(01)00136-3 contributor: fullname: P Neyret – volume: 367 start-page: 165 year: 1999 ident: 449_CR8 publication-title: Clin Orthop Relat Res doi: 10.1097/00003086-199910000-00020 contributor: fullname: PF Partington – volume: 15 start-page: 354 year: 2000 ident: 449_CR4 publication-title: J Arthroplasty doi: 10.1016/S0883-5403(00)90739-3 contributor: fullname: FM Griffin – volume: 12 start-page: 89 year: 2005 ident: 449_CR10 publication-title: Knee doi: 10.1016/j.knee.2004.05.004 contributor: fullname: AM ten Ham – volume: 406 start-page: 136 year: 2003 ident: 449_CR2 publication-title: Clin Orthop Relat Res doi: 10.1097/00003086-200301000-00022 contributor: fullname: M Bozkurt – volume: 11 start-page: 3 year: 2004 ident: 449_CR1 publication-title: Knee doi: 10.1016/S0968-0160(03)00099-1 contributor: fullname: J Bellemans – volume: 68 start-page: 1035 year: 1986 ident: 449_CR3 publication-title: J Bone Joint Surg Am doi: 10.2106/00004623-198668070-00009 contributor: fullname: HE Figgie III – volume: 404 start-page: 169 year: 2002 ident: 449_CR6 publication-title: Clin Orthop Relat Res doi: 10.1097/00003086-200211000-00029 contributor: fullname: RS Laskin – volume: 10 start-page: 194 year: 2002 ident: 449_CR5 publication-title: Knee Surg Sports Traumatol Arthrosc doi: 10.1007/s00167-001-0271-x contributor: fullname: J Jerosch |
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SubjectTerms | Adult Arthritis Arthroplasty, Replacement, Knee - methods Biomechanical Phenomena Cartilage Computers Female Females Femur - anatomy & histology Fibula - anatomy & histology Gender differences Humans Joint replacement surgery Joints Knee Knee Joint - anatomy & histology Knees Magnetic Resonance Imaging Male Males Measurement Measurement techniques Medicine Medicine & Public Health Orthopedics Osteoarthritis Patients Reliability Reoperation Sex differences Skeleton Surgery Tibia - anatomy & histology |
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Title | Reliability of bony landmarks for restoration of the joint line in revision knee arthroplasty |
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