ArticleArthroplasty (London, England)2026
The transepicondylar axis or the posterior condylar axis: Which is the best reference for femoral component rotation in robotic-assisted total knee arthroplasty?
Article in Arthroplasty (London, England), 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundFor robotic-assisted total knee arthroplasty (TKA), accurate identification of anatomical landmarks directly affects the displayed value for femoral component rotation. This study aimed to quantify the inter-surgeon consistency of the TEA-reference angle (the angle between the transepicondylar axis and the femoral component axis) and the PCA-reference angle (the angle between the posterior condylar axis and the femoral component axis).
methodsThe anatomical data of 56 patients who underwent robotic-assisted TKA at our institution were analyzed. Two surgeons independently identified the transepicondylar axis (TEA) and posterior condylar axis (PCA) landmarks on the 3D femoral models generated by the MAKO TKA system. The TEA-reference angle was recorded as α with the PCA-reference angle standardized to 0°, and the PCA-reference angle was recorded as β with the TEA-reference angle standardized to 0°. The measured values were α
resultsThe inter-surgeon intraclass correlation coefficient (ICC) for α was 0.761 (95% CI: 0.592-0.860), and that for β was 0.943 (95% CI: 0.902-0.966). The absolute difference between surgeons (∆α) was > 2° in 15/56 (26.8%) patients and ≤ 1° in 24/56 (42.9%) patients. With respect to ∆β, 3/56 (5.4%) patients had a difference > 2°, whereas 45/56 (80.4%) patients had a difference ≤ 1°.
conclusionThe inter-surgeon consistency of the PCA was significantly greater than that of the TEA in robotic-assisted TKA planning. To mitigate the risk of inappropriate femoral component rotation, surgeons should verify landmark positions, particularly in patients with anatomical abnormalities of the distal femur, and consider cross-referencing both axes. Video Abstract.
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