Selection of Reference Axis for Distal Femoral Rotation in TKA: A Literature Review

Ravikant Kamal

Independent Researcher-Orthopaedic, SRM University, India

Ravikant Kamal, Independent Researcher-Orthopedic, SRM University, India.

Keywords: Total Knee Replacement; Distal Femoral Rotation; Transepicondyle Line; Whiteside Line; Posterior Condyle Line

Abstract

Total knee arthroplasty (TKA) is widely accepted and standard surgical procedure for osteoarthritis. Most patients are able to recover their preoperative pain completely and achieve a good range of motions to perform daily tasks after TKA. However, there is a number of patients who remained unsatisfied with the result after TKA and often complain pain in performing daily task.
Exploring reason behind post-operative pain and failure of TKA; researchers had found that in 31.2% of these cases; failure is due to aseptic loosening. Aseptic loosening is closely related to improper component placement. Orienting component in the axial direction is critical for proper outcome of TKA. Measured resection and gap balancing are two methods used for rotational alignment of component. Studies have shown that the measured resection technique has an advantage over gap balancing. However, the outcome of measured resection technique depends on the proper selection of reference axis. Transepicondyle axis, Whiteside line and Posterior condyle line are mostly used for setting the component rotation in TEA. All three rotational axis has its own advantages and pitfalls, therefore selection of reference should be based upon knee bone morphology and diseased condition. Malalignment of component placement in the axial plane may cause patella maltracking, anterior knee pain, aseptic loosening and also it could be one of the reasons behind TKA revision. The Success of rotational alignment depends upon proper preoperative planning and accurately Selection of landmarks involved in creating axis. In this review paper, Pros and cons of reference axis are discussed individually and their correlations with each other are explored based on existing literature.

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