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Femur bowing could be a risk factor for implant flexion in conventional total knee arthroplasty and notching in navigated total knee arthroplasty

 Jae Han Ko  ;  Chang Dong Han  ;  Kyoo Ho Shin  ;  Levis Nguku  ;  Ick Hwan Yang  ;  Woo Suk Lee  ;  Kwang Il Kim  ;  Kwan Kyu Park 
 Knee Surgery Sports Traumatology Arthroscopy, Vol.24(8) : 2476-2482, 2016 
Journal Title
 Knee Surgery Sports Traumatology Arthroscopy 
Issue Date
Aged ; Aged, 80 and over ; Arthroplasty, Replacement, Knee/methods* ; Bone Malalignment* ; Female ; Femur/physiology* ; Humans ; Knee Joint/surgery ; Knee Prosthesis* ; Male ; Margins of Excision ; Middle Aged ; Postoperative Complications ; Range of Motion, Articular ; Retrospective Studies ; Risk Factors ; Surgery, Computer-Assisted/methods
Femur component ; Navigation ; Sagittal alignment ; Total knee arthroplasty
PURPOSE: This study aimed to investigate the relationship between preoperative femoral axes and femoral implant position and to determine how femoral sagittal axes, including femoral anterior bowing, influence the femoral component position in total knee arthroplasty (TKA). METHODS: The relationship between femoral axes (femoral anterior bowing, mechanical axis and the anterior cortical line, intramedullary axis) and implant position was compared in 50 conventional and 50 navigated TKAs. Outliers with more than a 3° margin of error in placement of the femoral component compared with the mechanical axis in the sagittal plane were calculated. RESULTS: The femoral component flexion angle was 3.1° in the conventional group and 1.6° in the navigation group (p < 0.001). Anterior femoral bowing correlated positively with the angle between the mechanical axis and implant (r = 0.360, p = 0.010) in the conventional group and negatively with the angle between the anterior cortical line and flange of the femoral component (r = -0.355, p = 0.010) in navigated TKAs. Incidence of outliers was 48 % (24 patients) in the conventional group compared with 10 % (five patients) in the navigated group (p = 0.008). CONCLUSIONS: Femoral anterior bowing was an influential factor for implant position and could be a risk factor for both femoral implant flexion in conventional TKAs and notching in navigated TKAs. The results of this study should be considered by surgeons when assessing the risk factors for femoral geometry before performing TKAs, as these results may help them to avoid an overly flexed or extended position of the femoral component, which would affect clinical long-term survival.
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1. College of Medicine (의과대학) > Dept. of Orthopedic Surgery (정형외과학교실) > 1. Journal Papers
Yonsei Authors
Ko, Jae Han(고재한)
Kim, Kwang Il(김광일)
Park, Kwan Kyu(박관규) ORCID logo https://orcid.org/0000-0003-0514-3257
Shin, Kyoo Ho(신규호)
Yang, Ick Hwan(양익환)
Lee, Woo Suk(이우석) ORCID logo https://orcid.org/0000-0002-0798-1660
Han, Chang Dong(한창동)
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