J Korean Orthop Assoc.  2012 Dec;47(6):432-438. 10.4055/jkoa.2012.47.6.432.

Femoral Component Rotation of Total Knee Arthroplasty in Korean Subjects: A Study Using Grand Piano Sign and Computed Tomography

• Shon HC
• Choi ES
• Kim YM
• Kim DS
• Park KJ
• Cho BK
• Park JK
• Kim SW

• KMID: 2185306
• DOI: http://doi.org/10.4055/jkoa.2012.47.6.432

Abstract

PURPOSE
We aimed to obtain a reference for the optimal rotational alignment of femoral component in Koreans through an analysis of grand piano sign observed during total knee arthroplasty (TKA) and the angle between the clinical transepicondylar axis and the posterior condylar axis (TEA-PCA angle), by computed tomography.
MATERIALS AND METHODS
The study subjects included 24 patients (30 cases), who underwent the anterior femoral resection, which was applied at an external rotation 3degrees relative to the posterior condylar axis during TKA. The relationship between anterior femoral resection with external rotation of 3degrees and the morphological pattern of Grand piano sign was evaluated. On postoperative computed tomography images, we evaluated the relationship between the clinical transepicondylar axis, posterior condylar axis of femoral component and grand piano sign. Moreover, a total of 28 Korean patients with 41 arthritic knees scheduled for a TKA had a preoperative computed tomography. We measured the TEA-PCA angle to evaluate the normal range in Korean subjects.
RESULTS
The morphological pattern of grand piano sign observed after the anterior femoral resection, which was applied at an external rotation 3degrees, showed statistically significant correlation with TEA-PCA angle. On preoperative computed tomography images, the TEA-PCA angle was 6.01 degrees (range from 3.90 to 7.86).
CONCLUSION
The TEA-PCA angle of Koreans was different from that of the westerners. More external rotation was needed for the optimal femoral rotational alignment theoretically, and we could confirm the correlation between Grand piano sign and rotational alignment of femoral component by measurement of grand piano sign and computed tomography.

Keyword

grand piano sign; arthroplasty; replacement; knee

MeSH Terms

Arthroplasty
Axis, Cervical Vertebra
Humans
Knee
Reference Values

Figure

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  Figure 1 Computed tomography scan showing the transverse view of the distal femoral condyles. c-TEA, clinical transepicondylar axis; s-TEA, surgical transepicondylar axis; PCA, posterior condylar axis.

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  Figure 2 Intraoperative photo showing measurement of the height ratio of the lateral (A-B) and medial (C-D) condyles of grand piano sign observed after the anterior femoral resection. Lat, lateral condyle of grand piano sign; Med, medial condyle of grand piano sign.

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  Figure 3 The angle between the transepicondylar axis and the posterior condylar axis of femoral component (Postoperative TEA-PCA angle) was correlated with the height ratio of the medial and lateral condyles of grand piano sign (GP Med/Lat). TEA-PCA angle, angle between the clinical transepicondylar axis and the posterior condylar axis.

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  Figure 4 Distribution of the angles between the transepicondylar axis and the posterior condylar axis (Postoperative TEA-PCA angle) by postoperative computed tomography. TEA-PCA angle, angle between the clinical transepicondylar axis and the posterior condylar axis; GP Med/Lat, medial condyle of grand piano sign/lateral condyle of grand piano sign.

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  Figure 5 Distribution of the angles between the transepicondylar axis and the posterior condylar axis (Preoperative TEA-PCA angle) by preoperative computed tomography. TEA-PCA angle, angle between the clinical transepicondylar axis and the posterior condylar axis.

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