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Femoral flexion position is a highly variable factor in total knee arthroplasty: an analysis of 593 conventionally aligned total knee replacements

  • Original Paper
  • Published:
Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Purpose

In contrast to coronal alignment, only few is known about sagittal alignment in total knee arthroplasty (TKA). The aim of this study was to identify the flexion position of the femoral component in a routine surgical setting of conventional TKA and to evaluate potential predictors for the degree of femoral flexion.

Methods

A retrospective study was performed on 593 primary TKA using the conventional intramedullary alignment technique for distal femur. Femoral flexion was measured by the verification mode of a pinless navigation system. Correlations between femoral flexion and patient-specific data, surgery-related factors and measurements of a preoperative anterior–posterior long-leg X-ray were analysed.

Results

The distal femoral resection showed a mean flexion of 5.5° ± 2.5° to the mechanical axis with high variation between 2.5° extension and 14° flexion. In a multivariate regression model, body height (p = 0.023), body weight (p = 0.046) and body mass index (p = 0.026) showed significant positive correlation to femoral flexion. There was no correlation to any preoperative alignment data from the anterior–posterior long-leg film. The sagittal position was also independent from surgery-related factors such as different knee systems or surgeons.

Conclusions

Femoral flexion is a highly variable characteristic in conventionally aligned TKA. Increasing body height, body weight and body mass index were identified as predictors for a high degree of femoral flexion.

Level of evidence

III.

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Abbreviations

TKA:

Total knee arthroplasty

CAS:

Computer-assisted surgery

PSI:

Patient-specific instruments

mFA-mTA:

Mechanical tibiofemoral angle

AMA:

Anatomical mechanical femoral angle

mLDFA:

Mechanical lateral distal femoral angle

mMPTA:

Mechanical medial proximal tibial angle

mLDTA:

Mechanical lateral distal tibial angle

BMI:

Body mass index

OA:

Osteoarthritis

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Funding

The authors received no specific funding for this work.

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Authors and Affiliations

  1. Department of Orthopaedics, Trauma Surgery and Sports Medicine, Cologne Merheim Medical Center, University of Witten/Herdecke, Ostmerheimer Str. 200, 51109, Cologne, Germany

    Paola Koenen, Deha Murat Ates, Thomas R. Pfeiffer, Bertil Bouillon & Holger Bäthis

Authors
  1. Paola Koenen
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  2. Deha Murat Ates
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  3. Thomas R. Pfeiffer
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  4. Bertil Bouillon
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  5. Holger Bäthis
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Contributions

PK participated in the design of the study, collected data, performed the statistical analysis and drafted the manuscript. TP participated in the design of the study and helped to collect data. DA and HB have been involved in drafting the manuscript and revising it critically. HB performed most surgeries. DA and TP helped to perform the statistical analysis and interpretation of data. BB participated in the design and coordination of the study. HB conceived of the study and participated in its design. All the authors read and approved the final manuscript.

Corresponding author

Correspondence to Paola Koenen.

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Conflict of interest

HB has a consultant agreement with the companies BrainLAB and DePuy Synthes. DA received reimbursement of travel expenses by DePuy Synthes. All the other authors declare that there is no conflict of interests.

Ethical approval

Ethical approval for data collection was received from the local ethics commission (138/2018). All procedures involving human participants were in accordance with the 1964 Helsinki declaration and its later amendments.

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Koenen, P., Ates, D.M., Pfeiffer, T.R. et al. Femoral flexion position is a highly variable factor in total knee arthroplasty: an analysis of 593 conventionally aligned total knee replacements. Knee Surg Sports Traumatol Arthrosc 28, 1014–1022 (2020). https://doi.org/10.1007/s00167-019-05548-6

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  • DOI: https://doi.org/10.1007/s00167-019-05548-6

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