ANADOLU POPÜLASYONUNDA DİSTAL FEMURUN ROTASYONEL HİZALANMASI - DİZ ARTROPLASTİSİ İÇİN STANDART KILAVUZLARIN UYGUNLUĞU

Year 2024, Volume: 26 Issue: 3, 363 - 367, 24.12.2024

Oğuzhan Çimen , Ruhat Ünlü

Abstract

Amaç: Total diz artroplastisi (TDA) ameliyatında femoral komponentin rotasyonu diz kinematiği ve fonksiyonel sonuçlar açısından oldukça önemlidir. Bu çalışmanın amacı, Anadolu popülasyonunda posterior kondiler açı (PKAç) ve Kondiler bükülme açısını (KBA) değerlendirmektir. Ayrıca, TDA’da kullanılan standart posterior kondiler aks (PKA) referans insizyon bloklarının Anadolu popülasyonu için uygunluğunun değerlendirilmesidir.
Gereç ve Yöntemler: Bu retrospektif, gözlemsel, analitik çalışmada 18-60 yaş arası 130 hastanın diz bilgisayarlı tomografi (BT) görüntüleri üzerinde ölçümler yapıldı. PKAç medial epikondiler sulkustan lateral epikondile uzanan aks (cTEA) ile PKA arasındaki açı, KBA ise medial epikondilden lateral epikondile uzanan aks (aTEA) ile PKA arasındaki açı olarak ölçüldü.
Bulgular: Ortalama PKAç 3.52°±1.45° (1.8° dış rotasyon ile 8° iç rotasyon aralığı), KBA 6.58° ± 1.47° (2°-9.9° iç rotasyon aralığı) olarak ölçüldü. Yüz beş diz (%80.8) PKAç açısından bireysel anatomik sınırlar içindeyken, 9'u eksternal rotasyonda (ER) ve 16'sı internal rotasyonda (İR) grubunda olmak üzere 25 aykırı değer (%19.2) vardı. BT'deki açı ölçümleri, hem gözlemci içi hem de gözlemciler arası güvenilirliği mükemmeldi.
Sonuç: Bu çalışma, Anadolu popülasyonun %80.8’inde posterior kondiler referansın TDA ameliyatında femoral komponent rotasyonu için kabul edilebilir bir referans olduğu, fakat %19.2’sinde ise malrotasyona neden olacağı için uygun bir referans olmadığını göstermektedir. Ortopedik cerrahlar, TDA'yı posterior referans ekipmanı ile uygularken femoral implantı TEA boyunca düzgün bir şekilde hizalamak için diğer referans noktaları dikkate alarak cerrahi tekniği gerektiğinde değiştirmeye hazır olmalıdır.

Keywords

Posterior kondiler aks, trans epikondiler aks, kondiler bükülme açısı, total diz artroplastisi, bilgisayarlı tomografi

Rotational Alignment of the Distal Femur in the Anatolian Population - Suitability of Standard Guidelines for Knee Arthroplasty

Abstract

Objective: The rotation of the femoral component in total knee arthroplasty (TKA) is crucial for knee kinematics and functional outcomes. This study aimed to evaluate the posterior condylar angle (PCAn) and the condylar twisting angle (CTA) in an Anatolian population. Additionally, we aimed to assess the suitability of standard posterior condylar axis (PCA) reference incision blocks used in TKA for this population.
Material and Methods: In this retrospective, observational, analytical study, we examined knee computed tomography (CT) images of 130 patients aged 18 to 60 years. The PCAn was measured as the angle between the axis extending from the medial epicondylar sulcus to the lateral epicondyle (cTEA) and PCA. The CTA was defined as the angle between the axis extending from the medial epicondyle to the lateral epicondyle (aTEA) and PCA.
Results: The mean PCAn was measured as 3.52°±1.45° (1.8° external rotation to 8° internal rotation), and the CTA was measured as 6.58°±1.47° (range 2°-9.9° internal rotation). One hundred and five knees (80.8%) were within individual anatomic limits for PCAn, while there were 25 outliers (19.2%), 9 in the external rotation (ER) group and 16 in the internal rotation (IR) group. The angle measurements on CT had excellent intra- and inter-observer reliability.
Conclusion: This study shows that in 80.8% of the Anatolian population, the posterior condylar reference is an acceptable reference for femoral component rotation in TKA surgery, but in 19.2%, it is not an appropriate reference because it will cause malrotation. Orthopedic surgeons should be ready to modify the surgical technique when necessary, considering other reference points to properly align the femoral implant along the TEA while performing TKA with posterior reference equipment.

Keywords

Posterior condylar axis, trans epicondylar axis, condylar twist angle, total knee arthroplasty, computerized tomography

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