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. 2023 Nov 15;57(12):2088-2094.
doi: 10.1007/s43465-023-01023-0. eCollection 2023 Dec.

A New Concept of Using Femoral Condyles Surface for Femoral Component Alignment During Total Knee Arthroplasty: A Technical Note

Mohammad Mahdi Sarzaeem  1 , Farzad Amouzadeh  1 , Bentolhoda Salehi  2 , Mohammad Movahedinia  3   4 , Mohammad Soleimani  5
Affiliations

A New Concept of Using Femoral Condyles Surface for Femoral Component Alignment During Total Knee Arthroplasty: A Technical Note

Mohammad Mahdi Sarzaeem et al. Indian J Orthop. .

Abstract

Background: Orthopedic surgeons favor an intramedullary guiding system on the femoral component during total knee arthroplasty (TKA); nevertheless, improper positioning of the entry point affects the final alignment. We have designed a new femoral cutting system for TKA that uses the distal and posterior femoral condyles as reference points for the setting of the cutting system regardless of the femoral canal. This study aims to evaluate the outcomes of this new guiding system.

Methods: We enrolled a series of 75 consecutive knees undergoing TKA. The alpha, gamma, and hip-knee-ankle (HKA) angles were assessed three months postoperatively. Also, surgical time and intraoperative blood loss were recorded for all patients.

Results: Fifteen patients underwent TKA using the mechanical alignment (MA) strategy, and 60 underwent kinematically aligned (KA) TKA. Both groups showed normal coronal and sagittal alignment 3 months postoperatively. The mean intraoperative blood loss was 213.11 ± 52.73 ml, which was not different between the two groups (n.s.). The mean surgical time was 43.12 ± 11.62 min, which was significantly shorter in the KA-TKA (41.11 ± 3.77 min) than in the MA-TKA (49.34 ± 4.56 min) (P < 0.001).

Conclusion: Using the new guiding system with good femoral alignment, we introduced the easily palpable and available condylar surface as a new landmark for cutting the distal femur in TKA.

Level of evidence: IV.

Keywords: Femoral alignment; Kinematic; Mechanical; Total knee arthroplasty.

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Conflict of interest statement

Conflict of InterestAll authors declared no conflict of interest.

Figures

Fig. 1
Fig. 1
Postoperative standing alignment radiography showing the gamma (A) and alpha angles (B)
Fig. 2
Fig. 2
The newly introduced guide for femoral cutting during TKA. Asterisk: the base; thick arrow: mounting mechanism; thin arrows: projections; dashed arrow: spacer; double arrow: cutting guide; arrowhead: rod; circle: screw tight fastener
Fig. 3
Fig. 3
When the tibia is in 90° of flexion, the new femoral cutting system engages the distal condyles by the planar surface of the base (asterisk) and its spacers (white arrow) in both coronal A and sagittal B planes. In this position, the two projections (not seen here) align with the posterior surfaces of the medial and lateral condyles perpendicular to the base planar surface. C Then, the base will be released using the mounting mechanism (arrowhead), and the cutting guide (black arrow) remains on the anterior cortex, just perpendicular to the posterior condyle surface
Fig. 4
Fig. 4
A A 65-year-old woman with right knee osteoarthritis and valgus deformity > 10° B, C underwent TKA using the new guide according to the mechanical concept
Fig. 5
Fig. 5
A, B An 83-year-old man with severe lateral femoral bowing and isthmus stenosis from a previous fracture filled with a femoral nail. C, D The left knee underwent TKA using the new guide without touching the canal with good alpha and gamma angles. E The alignment was correct
See this image and copyright information in PMC

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