Download PDF
J Knee Surg 2016; 29(06): 516-521
DOI: 10.1055/s-0035-1566733
Original Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Total Limb Rotation after Unilateral Total Knee Arthroplasty: Side-to-Side Discrepancy

Kwang-Jun Oh
1   Department of Orthopaedic Surgery, KonKuk University School of Medicine, KonKuk University Medical Center, Seoul, Republic of Korea
,
Seok-Tae Yoon
1   Department of Orthopaedic Surgery, KonKuk University School of Medicine, KonKuk University Medical Center, Seoul, Republic of Korea
,
Young-Bong Ko
1   Department of Orthopaedic Surgery, KonKuk University School of Medicine, KonKuk University Medical Center, Seoul, Republic of Korea
› Author Affiliations
Further Information

Publication History

30 June 2015

20 September 2015

Publication Date:
16 November 2015 (online)

    Permissions and Reprints

Abstract

Total limb rotation, an important anatomical feature of the lower limb, is defined as any rotation of the lower limb on its longitudinal axis. The aim of the present study was to evaluate the discrepancies of rotational profiles of total limb between nonoperated and operated limb following unilateral total knee arthroplasty. We conducted an analysis of the computed tomography (CT) data from 32 patients undergoing primary unilateral total knee arthroplasty. Using these CT scan, rotational profiles of total limb, such as femoral neck anteversion angle expressed as femoral torsion angle (FTA), tibial torsion angle (TTA), knee joint rotation angle (KJRA), and total limb rotation (TLR) were measured. There were significant discrepancies of FTA and KJRA between operated and nonoperated limb following unilateral total knee arthroplasty. The mean difference of operated and nonoperated side for FTA and KJRA were −6.51 ± 11.88 degrees (p = 0.0041) and −6.83 ± 5.04 degrees (p < 0.001), respectively. However, there were no significant discrepancies of TLR, TTA. These results are due to the compensation effect of KJRA. However, excessive external rotation of the femoral component beyond the compensation effect of prosthetic knee joint can lead to a total limb rotational discrepancy in patient undergoing unilateral total knee arthroplasty.

Keywords

rotational profile - femoral torsion angle - tibial torsion angle - total limb rotation - knee joint rotation angle
 

  • References

  • 1 Bråten M, Terjesen T, Rossvoll I. Torsional deformity after intramedullary nailing of femoral shaft fractures. Measurement of anteversion angles in 110 patients. J Bone Joint Surg Br 1993; 75 (5) 799-803
    CrossrefPubMedGoogle Scholar
  • 2 Christie J, Court-Brown C, Kinninmonth AW, Howie CR. Intramedullary locking nails in the management of femoral shaft fractures. J Bone Joint Surg Br 1988; 70 (2) 206-210
    PubMedGoogle Scholar
  • 3 Jaarsma RL, Pakvis DF, Verdonschot N, Biert J, van Kampen A. Rotational malalignment after intramedullary nailing of femoral fractures. J Orthop Trauma 2004; 18 (7) 403-409
    CrossrefPubMedGoogle Scholar
  • 4 Liodakis E, Aljuneidi W, Krettek C, Ettinger M, Kenawey M. The neck-malleolar angle: an alternative method for measuring total lower limb torsion that considers the knee joint rotation angle. Skeletal Radiol 2011; 40 (5) 617-621
    CrossrefPubMedGoogle Scholar
  • 5 Søjbjerg JO, Eiskjaer S, Møller-Larsen F. Locked nailing of comminuted and unstable fractures of the femur. J Bone Joint Surg Br 1990; 72 (1) 23-25
    PubMedGoogle Scholar
  • 6 Jaarsma RL, Verdonschot N, van der Venne R, van Kampen A. Avoiding rotational malalignment after fractures of the femur by using the profile of the lesser trochanter: an in vitro study. Arch Orthop Trauma Surg 2005; 125 (3) 184-187
    CrossrefPubMedGoogle Scholar
  • 7 Netz P, Olsson E, Ringertz H, Stark A. Functional restitution after lower leg fractures. A long-term follow-up. Arch Orthop Trauma Surg 1991; 110 (5) 238-241
    CrossrefPubMedGoogle Scholar
  • 8 Puloski S, Romano C, Buckley R, Powell J. Rotational malalignment of the tibia following reamed intramedullary nail fixation. J Orthop Trauma 2004; 18 (7) 397-402
    CrossrefPubMedGoogle Scholar
  • 9 Hauschild O, Muenzberg M, Knothe D , et al. Rotational limb alignment changes following total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 2013; 21 (10) 2346-2354
    CrossrefPubMedGoogle Scholar
  • 10 Tazawa M, Sohmiya M, Wada N, Defi IR, Shirakura K. Toe-out angle changes after total knee arthroplasty in patients with varus knee osteoarthritis. Knee Surg Sports Traumatol Arthrosc 2014; 22 (12) 3168-3173
    CrossrefPubMedGoogle Scholar
  • 11 Akagi M, Matsusue Y, Mata T , et al. Effect of rotational alignment on patellar tracking in total knee arthroplasty. Clin Orthop Relat Res 1999; (366) 155-163
    PubMedGoogle Scholar
  • 12 Bell SW, Young P, Drury C , et al. Component rotational alignment in unexplained painful primary total knee arthroplasty. Knee 2014; 21 (1) 272-277
    CrossrefPubMedGoogle Scholar
  • 13 Berger RA, Crossett LS, Jacobs JJ, Rubash HE. Malrotation causing patellofemoral complications after total knee arthroplasty. Clin Orthop Relat Res 1998; (356) 144-153
    PubMedGoogle Scholar
  • 14 Berger RA, Rubash HE. Rotational instability and malrotation after total knee arthroplasty. Orthop Clin North Am 2001; 32 (4) 639-647 , ix
    CrossrefPubMedGoogle Scholar
  • 15 Heesterbeek PJ, Jacobs WC, Wymenga AB. Effects of the balanced gap technique on femoral component rotation in TKA. Clin Orthop Relat Res 2009; 467 (4) 1015-1022
    CrossrefPubMedGoogle Scholar
  • 16 Heesterbeek PJ, Wymenga AB. Correction of axial and rotational alignment after medial and lateral releases during balanced gap TKA. A clinical study of 54 patients. Acta Orthop 2010; 81 (3) 347-353
    CrossrefPubMedGoogle Scholar
  • 17 Sharkey PF, Hozack WJ, Rothman RH, Shastri S, Jacoby SM. Insall Award paper. Why are total knee arthroplasties failing today?. Clin Orthop Relat Res 2002; (404) 7-13
    PubMedGoogle Scholar
  • 18 Eckhoff DG, Metzger RG, Vandewalle MV. Malrotation associated with implant alignment technique in total knee arthroplasty. Clin Orthop Relat Res 1995; (321) 28-31
    PubMedGoogle Scholar
  • 19 Hernandez RJ, Tachdjian MO, Poznanski AK, Dias LS. CT determination of femoral torsion. AJR Am J Roentgenol 1981; 137 (1) 97-101
    CrossrefPubMedGoogle Scholar
  • 20 Oberst M, Bertsch C, Konrad G, Lahm A, Holz U. CT analysis after navigated versus conventional implantation of TKA. Arch Orthop Trauma Surg 2008; 128 (6) 561-566
    CrossrefPubMedGoogle Scholar
  • 21 Waidelich HA, Strecker W, Schneider E. [Computed tomographic torsion-angle and length measurement of the lower extremity. The methods, normal values and radiation load]. Rofo 1992; 157 (3) 245-251
    Article in Thieme ConnectPubMedGoogle Scholar
  • 22 Liodakis E, Doxastaki I, Chu K , et al. Reliability of the assessment of lower limb torsion using computed tomography: analysis of five different techniques. Skeletal Radiol 2012; 41 (3) 305-311
    CrossrefPubMedGoogle Scholar
  • 23 Nicoll D, Rowley DI. Internal rotational error of the tibial component is a major cause of pain after total knee replacement. J Bone Joint Surg Br 2010; 92 (9) 1238-1244
    PubMedGoogle Scholar
  • 24 Citak M, Suero EM, O'Loughlin PF , et al. Femoral malrotation following intramedullary nailing in bilateral femoral shaft fractures. Arch Orthop Trauma Surg 2011; 131 (6) 823-827
    CrossrefPubMedGoogle Scholar
  • 25 Strecker W, Keppler P, Gebhard F, Kinzl L. Length and torsion of the lower limb. J Bone Joint Surg Br 1997; 79 (6) 1019-1023
    CrossrefPubMedGoogle Scholar
  • 26 Theriault B, Turgeon AF, Pelet S. Functional impact of tibial malrotation following intramedullary nailing of tibial shaft fractures. J Bone Joint Surg Am 2012; 94 (22) 2033-2039
    CrossrefPubMedGoogle Scholar
  • 27 Watanabe S, Sato T, Omori G, Koga Y, Endo N. Change in tibiofemoral rotational alignment during total knee arthroplasty. J Orthop Sci 2014; 19 (4) 571-578
    CrossrefPubMedGoogle Scholar
  • 28 Kenawey M, Liodakis E, Krettek C, Ostermeier S, Horn T, Hankemeier S. Effect of the lower limb rotational alignment on tibiofemoral contact pressure. Knee Surg Sports Traumatol Arthrosc 2011; 19 (11) 1851-1859
    CrossrefPubMedGoogle Scholar
  • 29 Galaud B, Beaufils P, Michaut M, Abadie P, Fallet L, Boisrenoult P. Distal femoral torsion: comparison of CT scan and intra operative navigation measurements during total knee arthroplasty. A report of 70 cases [in French]. Rev Chir Orthop Repar Appar Mot 2008; 94 (6) 573-579
    PubMedGoogle Scholar
  • 30 van der Linden-van der Zwaag HM, Bos J, van der Heide HJ, Nelissen RG. A computed tomography based study on rotational alignment accuracy of the femoral component in total knee arthroplasty using computer-assisted orthopaedic surgery. Int Orthop 2011; 35 (6) 845-850
    CrossrefPubMedGoogle Scholar
  • 31 Akagi M, Mori S, Nishimura S, Nishimura A, Asano T, Hamanishi C. Variability of extraarticular tibial rotation references for total knee arthroplasty. Clin Orthop Relat Res 2005; (436) 172-176
    PubMedGoogle Scholar
  • 32 Buck FM, Guggenberger R, Koch PP, Pfirrmann CW. Femoral and tibial torsion measurements with 3D models based on low-dose biplanar radiographs in comparison with standard CT measurements. AJR Am J Roentgenol 2012; 199 (5) W607-W612
    CrossrefPubMedGoogle Scholar
  • 33 Gandhi S, Singla RK, Kullar JS , et al. Human tibial torsion—morphometric assessment and clinical relevance. Biom J 2014; 37 (1) 10-13
    CrossrefPubMedGoogle Scholar
  • 34 Eckhoff DG, Johnson KK. Three-dimensional computed tomography reconstruction of tibial torsion. Clin Orthop Relat Res 1994; (302) 42-46
    PubMedGoogle Scholar