Optimierung der Rotationsausrichtung der femoralen Implantatkomponente in der Kniegelenksendoprothetik mit bandspannungsbasierter Navigation

Optimized femoral component rotation in total knee arthroplasty with ligament tension-based navigation

by Jens Joachim Bussert
Doctoral thesis
Date of Examination:2013-10-01
Date of issue:2013-09-13
Advisor:Prof. Dr. Karl-Heinz Frosch
Referee:PD Dr. Tim Alexander Walde
Referee:Prof. Dr. Hans-Michael Klinger
Persistent Address: http://dx.doi.org/10.53846/goediss-4015

 

 

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Abstract

English

Femoral malrotation in total knee arthroplasty is correlated to an increased number of revisions. Bony landmarks such as Whiteside line, posterior condyle axis and transepicondylar axis are used for determining femoral component rotation. The femoral rotation achieved with the bony landmarks is compared to the femoral rotation achieved by a navigated ligament tension-based tibia-first technique. Ninety-three consecutive patients with gonarthritis were prospectively enrolled. Intraoperatively the bony landmarks for femoral rotation and the achieved femoral rotation using a navigated tension-based tibia-first technique were determined and stored for further comparison. A pre- and postoperative functional diagram displaying the extension and flexion and varus or valgus position was also part of evaluation. Using bony landmarks the rotational errors ranged from 12.2° of internal rotation to 15.5° of external rotation from parallel to the tibial resection surface at 90° flexion. A statistical significant improved femoral rotation was achieved using the ligament tension-based method with a rotational error ranged from 3.0° of internal rotation to 2.4° of external rotation. The functional analyses demonstrated statistical significant lower varus/ valgus deviations within the flexion range and an improved maximum varus deviation at 90° flexion using the ligament tension-based method. Compared to the bony landmarks a balanced, almost parallel flexion gap was achieved using a navigation technique taking the ligament tension of the knee joint into account. As a result the improved femoral rotation was demonstrated by the functional evaluation. Unilateral overloading of the polyethylene inlay and unilateral instability can thus be avoided.
Keywords: Femoral rotation; Ligament tension; Navigation; Total knee arthroplasty; Bony landmarks
Schlagwörter: Femorale Rotation; Bandspannung; Navigation; Kniegelenksendoprothetik; Knöcherne Landmarken
 
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