title: Partially loaded plain radiographic measurement to evaluate rotational alignment in total knee arthroplasty.
abstract: Rotational alignment of prosthetic components after total knee arthroplasty (TKA) is predominantly monitored with computer tomography (CT), for example by relating the anatomical transepicondylar axis (a-TEA) of the native femur to the posterior bicondylar axis of the prosthetic component (PBCA). The purpose of the present study was to portray a reliable, novel plain radiographic method that likewise enables the evaluation of rotational positioning of prosthetic components in TKA. Furthermore, it was intended to evaluate the prosthetic femoro-tibial functional behavior under loaded conditions.
  
  
  
  Modified plain axial radiographs under partial weight bearing (20 kg) were performed in 63 patients (63 knees) after TKA. On the obtained radiographs, all established, relevant anatomic, and prosthetic axis and angles reflecting the rotational position of the femoral (i.e., a-TEA/PBCA angle) and tibial component were detected twice by two independent examiners with an interval of one month. Additionally, in 14 cases with anterior knee pain after surgery, radiographic results were compared to obtained computer tomography images; intraclass coefficients (ICC's) for intra- and inter-rater reliability were calculated.
  
  
  
  All pre-assigned axis and angles could be identified doubtlessly by both examiners in all investigated knees. For all measurements, ICC's for intra-rater and inter-rater reliability ranged from 0.75 to 0.96. The comparison of the radiographic measurements with corresponding CT results (n = 14) revealed no significant differences (p > 0.05). Rotational alignment of the tibial tray in relation to the native tibial bone was not measurable due to display overlaying. Femoro-tibial behaviour of the prosthetic components under partial loading showed a high variability.
  
  
  
  We were able to establish a new reliable radiographic technique that is able to show the most established and relevant anatomic landmarks and prosthetic axis after TKA to assess the rotational alignment of the prosthetic components in TKA in relation to the distal femur. The evaluation of the femoro-tibal behaviour instead shows a high variability and so far does not allow valid explanatory conclusions.
authors.affiliation: Department of Orthopaedics, Sportklinik Stuttgart GmbH, Taubenheimstraße 8, 70372, Stuttgart, Germany.
authors.forename: William
authors.initials: W
authors.lastname: Pedraza
authors.affiliation: Department of Orthopaedics, Sportklinik Stuttgart GmbH, Taubenheimstraße 8, 70372, Stuttgart, Germany.
authors.forename: Johannes
authors.initials: J
authors.lastname: Beckmann
authors.affiliation: Department of Orthopaedics, Sportklinik Stuttgart GmbH, Taubenheimstraße 8, 70372, Stuttgart, Germany.
authors.forename: Constantin
authors.initials: C
authors.lastname: Mayer
authors.affiliation: Department of Orthopaedics, Sportklinik Stuttgart GmbH, Taubenheimstraße 8, 70372, Stuttgart, Germany.
authors.forename: Frieder
authors.initials: F
authors.lastname: Mauch
authors.affiliation: Department of Orthopaedics, Sportklinik Stuttgart GmbH, Taubenheimstraße 8, 70372, Stuttgart, Germany.
authors.forename: Jochen
authors.initials: J
authors.lastname: Huth
authors.affiliation: Department of Orthopaedics, Sportklinik Stuttgart GmbH, Taubenheimstraße 8, 70372, Stuttgart, Germany. Raymond.Best@med.uni-tuebingen.de.|Department of Orthopedic Sports Medicine, University of Tuebingen, Hoppe Seyler Strasse 6, 72076, Tuebingen, Germany. Raymond.Best@med.uni-tuebingen.de.
authors.forename: Raymond
authors.initials: R
authors.lastname: Best
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D019645:Arthroplasty, Replacement, Knee / Q000379:methods*; D005260:Female; D005269:Femur / Q000000981:diagnostic imaging* / Q000601:surgery; D006801:Humans; D007719:Knee Joint / Q000000981:diagnostic imaging* / Q000601:surgery; D007720:Knee Prosthesis; D008297:Male; D008875:Middle Aged; D020370:Osteoarthritis, Knee / Q000601:surgery*; D056888:Patient Positioning; D015203:Reproducibility of Results; D012189:Retrospective Studies; D013977:Tibia / Q000000981:diagnostic imaging* / Q000601:surgery; D014057:Tomography, X-Ray Computed / Q000379:methods
keywords: Femoral roll back; Knee arthroplasty; Knee kinematics; Radiographic measurement; Rotational alignment