Evaluating distal femoral torsion and posterior condylar line reliability for adjusting femoral component rotation in TKA, Egyptian population radiographic study.

Background: Femoral component rotational alignment is critical for successful TKA. The primary study objective is to measure the preoperative distal femoral torsion (DFT) of an Egyptian patient's cohort using a seated posteroanterior (PA) knee radiograph. The secondary objectives are to check the intraoperative reliability of using the posterior condylar line (PCL) as a reference for rotation and to measure postoperative component rotation using the same radiographic technique.

Methods: 100 arthritic knees, 22 males, 78 females, 95 Varus and five valgus. A long anteroposterior radiograph [Hip to knee to ankle (HKA)] for coronal alignment assessment, and the anatomical posterior condylar angle (aPCA) between the anatomical transepicondylar axis (aTEA) and the PCL was measured in the seated PA knee radiographs for evaluating the DFT and component rotation. Intraoperative rotation was adjusted to 3° external rotation to the PCL.

Results: HKA improved from a preoperative mean 170.4° ± 6.2 to a postoperative mean 178.3° ± 1.5 (p < 0.005). DFT was internal in all knees; the mean aPCA was -4.5 ± 2.4 (0° to -9°), femoral component rotation significantly changed to a mean aPCA of -3.6 ± 2.3 (0° to -7°) (p = 0.005). Acceptable intraoperative patellar tracking in 94%, and patellar subluxation needed a lateral retinacular release in 2% (two valgus knees). The preoperative DFT was not affected by sex or direction of coronal deformity; more external DFT noticed in severe varus deformity.

Conclusions: All keens had an internal DFT not affected by sex, or coronal deformity direction. Using PCL as a guide to adjust femoral component rotation is a valid technique in our population.