ArticleArthroplasty (London, England)2022
Could surgical transepicondylar axis be identified accurately in preoperative 3D planning for total knee arthroplasty? A reproducibility study based on 3D-CT.
Article in Arthroplasty (London, England), 2022. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 3 papers, 1 of them a synthesis that pooled it.
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3 citing papers in PubMed, 1 synthesis or guideline pooled it, 2 citations in OpenAlex.
- High variability exists in 3D leg alignment analysis, but underlying principles that might lead to agreement on a universal framework could be identified: A systematic review.Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA · 2025Pooled it
- Radiographic Accuracy and Consistency of Implant Placement Using the ROSALife (Basel, Switzerland) · 2026Article
- Coronal Alignment Does Not Adequately Predict Femoral Rotation Axes in Total Knee Arthroplasty: Application of a 3D Image-Based Robotic-Assisted Arthroplasty Platform.Bioengineering (Basel, Switzerland) · 2025Article
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Authors and funding
7 authors at 1 institution in 1 country.
Funding
Abstract
backgroundSurgical transepicondylar axis (sTEA) is frequently used for positioning of femoral component rotation in total knee arthroplasty (TKA). Previous studies showed that intraoperative identification of sTEA was not reliable. While surgeons or engineers need to identify sTEA with three-dimensional (3D) computer-aid techniques pre- or intraoperatively, the reproducibility of sTEA identification on preoperative 3D images has not been explored yet. This study aimed to investigate the reproducibility of identifying sTEA in preoperative planning based on computed tomography (CT).
methodsFifty-nine consecutive patients (60 knees involved) who received TKA in our center from April 2019 to June 2019 were included in this study. Six experienced TKA surgeons identified sTEA three times on 3D model established on the basis of knee CT data. The projection angle of each sTEA and the posterior condyle axis on the transverse plane were measured and analyzed.
resultsThe overall intra-observer reproducibility was moderate. The median intra-observer variation was 1.27°, with a maximum being up to 14.07°. The median inter-observer variation was 1.24°, and the maximum was 11.47°. The overall intra-class correlation coefficient (ICC) for inter-observer was 0.528 (95% CI 0.417, 0.643).
conclusionThe identification of sTEA on a 3D model established on the basis of knee CT data may not be reliable. Combined with the previous cadaveric and surgical studies, caution should be exercised in determining femoral component rotation by referencing sTEA both preoperatively and intraoperatively. LEVEL OF EVIDENCE: III.
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