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Concept and advantages of trochlear navigation for proper rotational alignment of the femur component  in TKA

Published in N°009 - Juanary / February 2021
Article viewed 139 times

Concept and advantages of trochlear navigation for proper rotational alignment of the femur component in TKA

By Philippe Piriou (1), Etienne Peronne (2) in category UPDATE
(1) CMC Ambroise Paré, Neuilly sur Seine - France / Mail: [email protected] - (2) Hôpital privé la châtaigneraie, Rue de la châtaigneraie, Beaumont 63110 - France / Mail: [email protected]

Rotational alignment of the femoral component during total knee arthroplasty (TKA) is an important element of operative technique and remains a hot topic in the literature. It has serious implications on the clinical outcome because it influences balancing the flexion gap and the patellofemoral tracking.

Introduction

Rotational alignment of the femoral component during total knee arthroplasty (TKA) is an important element of operative technique and remains a hot topic in the literature (1). It has serious implications on the clinical outcome because it influences balancing the flexion gap and the patellofemoral tracking (2-3). The literature reports several methods for achieving femur rotational alignment but none of them is sufficiently precise and the proper target remains still controversial (4). Intraoperative identification of the transepicondylar axis, visually or by navigation, is neither reliable nor reproducible (5-7). Empirical adjustment to 3° of external rotation does not take into account individual anatomical variability in the knees undergoing surgery. In fact, the angle formed by the posterior condylar line and the transepicondylar line (posterior condylar angle or alpha angle) tends to vary greatly between individuals (8-10). Nor have the gap balancing techniques that adjust rotation ‘automatically’ with a tensioning device been able to demonstrate their superiority.

The authors suggest trochlear navigation as an innovative technique to determine rotation of the femoral component. The rational of this technique is to consider the ideal rotation of the femoral...

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