ArticleZhongguo xiu fu chong jian wai ke za zhi = Zhongguo xiufu chongjian waike zazhi = Chinese journal of reparative and reconstructive surgery2026
[Application of transverse tibial axis reference method in rotational positioning of femoral prosthesis in total knee arthroplasty].
Article in Zhongguo xiu fu chong jian wai ke za zhi = Zhongguo xiufu chongjian waike zazhi = Chinese journal of reparative and reconstructive surgery, 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
Objective: To investigate the reliability of determining rotational positioning of femoral prosthesis using the coronal transverse tibial axis at 90° of knee flexion as the reference in total knee arthroplasty (TKA). Methods: Fifty-five patients with knee osteoarthritis undergoing TKA between November 2020 and February 2026 who met the selection criteria were enrolled. There were 14 males and 41 females, aged 54-82 years, with a mean age of 66.4 years. Preoperative knee CT and full-length lower-extremity X-ray films were performed to measure the hip-knee-ankle angle (HKA) and posterior condylar angle (PCA). During surgery, after distal femoral osteotomy, the knee was maintained at 90° of flexion, and the tibial transverse axis (line a) perpendicular to the coronal projection of the tibial mechanical axis was marked on the osteotomy surface. Following tibial osteotomy and gap balancing, the external rotation line of the femoral component (line b) was determined. The final external rotation osteotomy angle was established based on the above references, and four-in-one positioning pins were fixed according to this angle. The line connecting the positioning pins served as the known external rotation reference line (line r). Accordingly, the external rotation angles of Line a and Line b relative to the posterior condylar line of the femur (∠A, ∠B) were calculated separately. The differences among PCA, ∠A, and ∠B were compared, and the correlation between ∠A and ∠B,∠A and HKA were analyzed. In addition, the distribution of ∠A in and around the "safe zone" (between PCA and ∠B) was counted. Results: Preoperative HKA was (7.3±3.7)°, and PCA, ∠A, and ∠B were (3.1±1.4)°, (4.6±2.4)°, and (4.7±2.1)°, respectively. Compared with PCA, both ∠A and ∠B demonstrated greater external rotation, with significant differences ( Conclusion: The transverse tibial axis at 90° of knee flexion during TKA serves as a reliable reference for determining rotational positioning of femoral prosthesis. The severity of preoperative knee varus deformity correlates with the external rotation angle defined by this transverse tibial axis, and this angle shows high consistency with that derived from the gap balancing technique.
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