J Korean Orthop Assoc.  2017 Jun;52(3):272-278. 10.4055/jkoa.2017.52.3.272.

Rotational Alignment of the Distal Femur in Korean Female Patients with Osteoarthritis Using a Computer Image Program

• Kim GM
• Kim SR
• Bae JH
• Park YG

• KMID: 2384558
• DOI: http://doi.org/10.4055/jkoa.2017.52.3.272

Abstract

PURPOSE
The purpose of this study was to propose a method to measurement of the exact anatomical alignment from the femur using a reference axis on computed tomography (CT) images and compare the difference of alignment axis between healthy young females and female patients with osteoarthritis of knee.
MATERIALS AND METHODS
A total of 218 female patients with osteoarthritis of the knee joint (OA group), who underwent total knee arthroplasty, between January 2013 and December 2014, were enrolled in this study. The control group included 50 female patients with healthy knee joint. Each study subjects took a CT scan of their knee, and a series of axial CT images of the distal femur were overlapped using the image program. Angles were measured among the anteroposterior (AP) axis, posterior condylar axis (PCA), anatomical transepicondylar axis (aTEA), and surgical transepicondylar axis (sTEA). The differences of rotation angle between the normal and osteoarthritic knee were evaluated.
RESULTS
The mean AP-PCA angle in the OA group was 92.9°±1.70°, whereas that in the control group was 96.3°±1.87° (p<0.01). The mean AP-aTEA angle was 84.5°±2.59°, and 90.8°±1.12° respectively (p<0.01). The mean AP-sTEA angle in the OA group was 88.7°±1.98°, whereas that in the control group was 95.1°±1.27° (p<0.01). The mean aTEA-PCA angle in the OA group was 8.4°±2.84°, while control group was 5.5°±2.00° (p<0.01). The mean sTEA-PCA angle in the OA group was 4.3°±1.17°, whereas that in the control group was 1.2°±2.10° (p=0.917).
CONCLUSION
We measured the exact relationship between the rotational axes of the distal femur by overlapping the axial images of a CT scan. The OA group revealed a more internally rotated AP axis compared with aTEA and an increased angle of aTEA-PCA than control group.

Keyword

knee; osteoarthritis; alignment; total knee arthroplasty

MeSH Terms

Arthroplasty, Replacement, Knee
Female*
Femur*
Humans
Knee
Knee Joint
Methods
Osteoarthritis*
Osteoarthritis, Knee
Tomography, X-Ray Computed

Figure

• 

  Figure 1 Reference points for each axis for all axial cuts obtained by computed tomography imaging were overlapped as one comprehensive image using a computer imaging program.

• 

  Figure 2 Computed tomography images demonstrate an axial view of the distal femoral condyle. AP, anteroposterior axis; aTEA, anatomical transepicondylar axis; sTEA, surgical transepicondylar axis; PCA, posterior condylar axis.

• 

  Figure 3 Correlation of the distribution of angles measured between the two axes (A: AP-PCA, B: AP-aTEA, C: AP-sTEA, D: aTEA-PCA, E: sTEA-PCA) and age (black dots: patients group, grey dots: control group). AP-PCA, anteroposterior-posterior condylar axis; AP-aTEA, anteroposterior-anatomical transepicondylar axis; AP-sTEA, anteroposterior-surgical transepicondylar axis; aTEA-PCA, anatomical transepicondylar axis-posterior condylar axis; sTEA-PCA, surgical transepicondylar axis-posterior condylar axis.

• 

  Figure 4 Correlation of the distribution of angles measured between two axes (A: AP-PCA, B: AP-aTEA, C: AP-sTEA, D: aTEA-PCA, E: sTEA-PCA) and H-K-A angle (black dots: patients group, grey dots: control group). H-K-A angle, hip-knee-ankle angle; AP-PCA, anteroposterior-posterior condylar axis; AP-aTEA, anteroposterior-anatomical transepicondylar axis; AP-sTEA, anteroposterior-surgical transepicondylar axis; aTEA-PCA, anatomical transepicondylar axis-posterior condylar axis; sTEA-PCA, surgical transepicondylar axis-posterior condylar axis.

• 

  Figure 5 The anteroposterior-anatomical transepicondylar axis (AP-aTEA) angle from axial computed tomography image of same patient showed subtle difference among the different axial level. (A) AP-aTEA angle: 5°, (B) AP-aTEA angle: 3°.

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