{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,28]],"date-time":"2026-09-28T22:59:33Z","timestamp":1790636373836,"version":"4.1.0"},"reference-count":31,"publisher":"Georg Thieme Verlag KG","issue":"05","funder":[{"name":"Anhui Provincial Health Commission","award":["No. AHWJ2024Aa20328"],"award-info":[{"award-number":["No. AHWJ2024Aa20328"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Z Orthop Unfall"],"published-print":{"date-parts":[[2026,10]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>Various osteotomy measurement techniques to assess the posterior condylar angle (PCA) are utilized in total knee arthroplasty (TKA). However, the most accurate method remains unclear. This study made use of preoperative two-dimensional (2D) computed tomography (CT) images to measure the PCA and integrated three-dimensional (3D) printing technology for in vitro verification and to improve preoperative planning of osteotomy measurement techniques in TKA.<\/jats:p>\n                  <jats:p>A retrospective study was conducted involving a limited cohort of 10 patients diagnosed with knee osteoarthritis. These patients underwent three-dimensional CT reconstruction of the knee joint using a medical 3D model. This study employed three distinct methodologies to measure the PCA. The first method involved single-plane 2D CT measurement, which provides a clear assessment of the posterior femoral condyle axis line (PCAL) and the surgical epicondylar axis (sTEA) of the femur. The second method utilized multiplane 2D CT with continuous plane sliding positioning to identify both the PCAL and sTEA when measuring PCA. The third method incorporated a 3D printing model whereby a solid model of the patient\u2019s distal femur was fabricated using 3D printing technology. In this approach, the PCAL and sTEA were marked using in vitro Kirschner wires, followed by CT scans of the marked femur. The PCA was subsequently measured based on the positioning of the Kirschner wires, with the\n        PCA obtained from the 3D printed model considered the reference standard. The accuracy and consistency of PCA measurements obtained from different CT planes were evaluated using paired sample t-tests and intraclass correlation coefficients (ICC).<\/jats:p>\n                  <jats:p>In the single-plane 2D CT measurement group, the PCA value was 1.33\u00a0\u00b1\u00a00.50\u00b0 (0.83\u20132.1\u00b0, 95% CI: 0.97\u20131.69\u00b0) with a measurement error of \u22120.84\u00a0\u00b1\u00a01.12\u00b0 (\u22123.24\u20130.87\u00b0, 95% CI: \u22121.64\u2013\u22120.04\u00b0) and an outlier rate of 10%. In the multiplane 2D CT sliding measurement group, the PCA value was 1.61\u00a0\u00b1\u00a00.38\u00b0 (1.13\u20132.32\u00b0, 95% CI: 1.34\u20131.88\u00b0) with a measurement error of \u22120.56\u00a0\u00b1\u00a01.09\u00b0 (\u22122\u20131.6\u00b0, 95% CI: \u22121.34\u20130.22\u00b0) and no abnormal values were detected. The PCA measurement value for the 3D printed model group was 2.17\u00a0\u00b1\u00a01.16\u00b0 (0.23\u20134.01\u00b0, 95% CI: 1.34\u20133.00\u00b0). The PCA measurement values in the single-plane 2D CT group were significantly lower than those in both the multiplane 2D CT sliding measurement group and the 3D printed model group, with no significant difference observed between the latter two groups. Moreover, the measurement error and outlier rates in the multiplane 2D CT sliding measurement group were significantly lower than those in the single-plane 2D CT group. The PCA\n        measurements in the single-plane 2D CT group exhibited moderate repeatability (ICC: 0.507\u20130.641) while those in the multiplane 2D CT sliding group demonstrated high consistency (ICC: 0.840\u20130.940).<\/jats:p>\n                  <jats:p>The utilization of multiplane 2D CT sliding measurements to assess the PCA during preoperative measurement and osteotomy planning for TKA demonstrates high accuracy and repeatability. We recommend employing this method prior to surgery to determine the rotational positioning of the femoral prosthesis during osteotomy and improve the precision of the rotational alignment of the femoral prosthesis.<\/jats:p>","DOI":"10.1055\/a-2811-2115","type":"journal-article","created":{"date-parts":[[2026,3,30]],"date-time":"2026-03-30T22:49:13Z","timestamp":1774910953000},"page":"424-434","source":"Crossref","is-referenced-by-count":0,"title":["PCA Calculation Based on Multiplane Two-Dimensional Computed Tomography Sliding Measurement in Preoperative Total Knee Arthroplasty Planning"],"prefix":"10.1055","volume":"164","author":[{"given":"Yuandong","family":"Liu","sequence":"additional","affiliation":[{"name":"Fuyang People's Hospital, Anhui, China","place":["Fuyang"],"department":["Fuyang People\u2019s Hospital Affiliated to Anhui Medical University"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yinong","family":"Chang","sequence":"additional","affiliation":[{"name":"Fuyang People's Hospital, Anhui, China","place":["Fuyang"],"department":["Fuyang People\u2019s Hospital Affiliated to Anhui Medical University"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kun","family":"Liu","sequence":"additional","affiliation":[{"name":"University of Malaya Faculty of Medicine, Federal Territory of Kuala Lumpur, Malaysia","place":["Federal Territory of Kuala Lumpur"],"department":["Department of Orthopaedic Surgery"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zhibo","family":"Zhang","sequence":"additional","affiliation":[{"name":"Fuyang People's Hospital, Anhui, China","place":["Fuyang"],"department":["Fuyang People\u2019s Hospital Affiliated to Anhui Medical University"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jidong","family":"Xie","sequence":"additional","affiliation":[{"name":"Fuyang People's Hospital, Anhui, China","place":["Fuyang"],"department":["Fuyang People\u2019s Hospital Affiliated to Anhui Medical University"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Donglin","family":"Fu","sequence":"additional","affiliation":[{"name":"Fuyang People's Hospital, Anhui, China","place":["Fuyang"],"department":["Fuyang People\u2019s Hospital Affiliated to Anhui Medical University"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zongqing","family":"Fan","sequence":"additional","affiliation":[{"name":"Fuyang People's Hospital, Anhui, China","place":["Fuyang"],"department":["Fuyang People\u2019s Hospital Affiliated to Anhui Medical University"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"194","published-online":{"date-parts":[[2026,3,30]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"385","DOI":"10.1186\/s40001-025-02647-8","article-title":"Reducing the length of hospital stay for patients undergoing primary total knee arthroplasty by application of enhanced recovery after surgery (ERAS) pathway: a multicenter, prospective, randomized controlled trial","volume":"30","author":"C Liao","year":"2025","journal-title":"Eur J Med Res"},{"key":"ref2","doi-asserted-by":"publisher","first-page":"806","DOI":"10.1186\/s12891-024-07925-w","article-title":"Isolated aseptic loosening in total knee arthroplasty: a comprehensive 10-year review of partial vs. total component revisions","volume":"25","author":"YC Lin","year":"2024","journal-title":"BMC Musculoskelet Disord"},{"key":"ref3","doi-asserted-by":"publisher","DOI":"10.1016\/j.artd.2024.101325","article-title":"Highlights of the 2023 American Joint Replacement Registry Annual Report","volume":"26","author":"SP Ryan","year":"2024","journal-title":"Arthroplast Today"},{"key":"ref4","doi-asserted-by":"publisher","first-page":"594","DOI":"10.1016\/j.arth.2022.10.011","article-title":"Are 20% of Patients Actually Dissatisfied Following Total Knee Arthroplasty? A Systematic Review of the Literature","volume":"38","author":"MJ DeFrance","year":"2023","journal-title":"J Arthroplasty"},{"key":"ref5","doi-asserted-by":"publisher","first-page":"806","DOI":"10.1055\/s-0042-1743494","article-title":"Higher Pelvic Incidence Was Associated with a Higher Risk of Sagittal Malposition of Femoral Component and Poor Outcomes of Primary Total Knee Arthroplasty: A Retrospective Cohort Analysis","volume":"36","author":"H Li","year":"2023","journal-title":"J Knee Surg"},{"key":"ref6","doi-asserted-by":"publisher","first-page":"711","DOI":"10.1186\/s12891-023-06840-w","article-title":"Does mild flexion of the femoral prosthesis in total knee arthroplasty result in better early postoperative outcomes?","volume":"24","author":"H Zhou","year":"2023","journal-title":"BMC Musculoskelet Disord"},{"key":"ref7","doi-asserted-by":"publisher","first-page":"24","DOI":"10.1016\/j.knee.2021.08.022","article-title":"Preoperative rotational assessment of the distal femur with CT may cause femoral component malrotation in TKA","volume":"33","author":"MW Kang","year":"2021","journal-title":"Knee"},{"key":"ref8","doi-asserted-by":"publisher","first-page":"445","DOI":"10.1002\/ksa.12060","article-title":"No differences in long-term clinical outcomes and survival rate of navigation-assisted versus conventional primary mobile-bearing total knee arthroplasty: A minimum 10-year follow-up","volume":"32","author":"SS Lee","year":"2024","journal-title":"Knee Surg Sports Traumatol Arthrosc"},{"key":"ref9","doi-asserted-by":"publisher","first-page":"1102","DOI":"10.1016\/j.knee.2019.07.001","article-title":"Intra- and interobserver reliability and agreement in three-dimensional computed tomography measurements of component positions after total knee arthroplasty","volume":"26","author":"K Yoshino","year":"2019","journal-title":"Knee"},{"key":"ref10","doi-asserted-by":"publisher","first-page":"e9797","DOI":"10.1097\/md.0000000000009797","article-title":"The precision and reliability evaluation of 3-dimensional printed damaged bone and prosthesis models by stereo lithography appearance","volume":"97","author":"Y Zou","year":"2018","journal-title":"Medicine (Baltimore)"},{"key":"ref11","doi-asserted-by":"publisher","first-page":"3859","DOI":"10.3390\/curroncol30040292","article-title":"Current Concepts in the Resection of Bone Tumors Using a Patient-Specific Three-Dimensional Printed Cutting Guide","volume":"30","author":"H Aiba","year":"2023","journal-title":"Curr Oncol"},{"key":"ref12","doi-asserted-by":"publisher","first-page":"757","DOI":"10.1016\/j.bioactmat.2020.08.030","article-title":"Three-dimensional bioprinting of multicell-laden scaffolds containing bone morphogenic protein-4 for promoting M2 macrophage polarization and accelerating bone defect repair in diabetes mellitus","volume":"6","author":"X Sun","year":"2021","journal-title":"Bioact Mater"},{"key":"ref13","doi-asserted-by":"publisher","first-page":"439","DOI":"10.3349\/ymj.2021.62.5.439","article-title":"Accuracy of 2D CT-Based Measurements of Rotational Alignment of the Femoral Component for Total Knee Arthroplasty","volume":"62","author":"JY Park","year":"2021","journal-title":"Yonsei Med J"},{"key":"ref14","doi-asserted-by":"publisher","DOI":"10.3389\/fpsyg.2021.793399","article-title":"Editorial: Process Data in Educational and Psychological Measurement","volume":"12","author":"H Jiao","year":"2021","journal-title":"Front Psychol"},{"key":"ref15","doi-asserted-by":"publisher","first-page":"2112","DOI":"10.1111\/os.70068","article-title":"Comprehensive Impact of Multiplanar Malalignment on Prosthetic Mechanics Under Gait Loading After Total Knee Arthroplasty-A Finite Element Analysis","volume":"17","author":"Y Luan","year":"2025","journal-title":"Orthop Surg"},{"key":"ref16","doi-asserted-by":"publisher","first-page":"362","DOI":"10.1186\/s13018-022-03248-5","article-title":"Gender differences affect the location of the patellar tendon attachment site for tibial rotational alignment in total knee arthroplasty","volume":"17","author":"LS Zhang","year":"2022","journal-title":"J Orthop Surg Res"},{"key":"ref17","doi-asserted-by":"publisher","DOI":"10.3389\/fsurg.2022.991476","article-title":"Correlation between component alignment and short-term clinical outcomes after total knee arthroplasty","volume":"9","author":"Y Luan","year":"2022","journal-title":"Front Surg"},{"key":"ref18","doi-asserted-by":"publisher","first-page":"1389","DOI":"10.1007\/s00256-020-03702-7","article-title":"A comparison of femoral component rotation after total knee arthroplasty in Kanekasu radiographs, axial CT slices and 3D reconstructed images","volume":"50","author":"EL Robertson","year":"2021","journal-title":"Skeletal Radiol"},{"key":"ref19","doi-asserted-by":"publisher","first-page":"551","DOI":"10.1002\/ca.23053","article-title":"Femoral rotational asymmetry is a common anatomical variant","volume":"31","author":"CR Newman","year":"2018","journal-title":"Clin Anat"},{"key":"ref20","first-page":"122","article-title":"Evaluation of Distal Femoral Rotational Alignment with Spiral CT Scan before Total Knee Arthroplasty (A Study in Iranian population)","volume":"4","author":"M Jabalameli","year":"2016","journal-title":"Arch Bone Jt Surg"},{"key":"ref21","doi-asserted-by":"publisher","first-page":"812","DOI":"10.1016\/s0883-5403(98)90036-5","article-title":"The posterior condylar angle in osteoarthritic knees","volume":"13","author":"FM Griffin","year":"1998","journal-title":"J Arthroplasty"},{"key":"ref22","doi-asserted-by":"publisher","first-page":"e125","DOI":"10.2106\/jbjs.19.00438","article-title":"Accuracy of Reference Axes for Femoral Component Rotation in Total Knee Arthroplasty: Computed Tomography-Based Study of 2,128 Femora","volume":"101","author":"ES Jang","year":"2019","journal-title":"J Bone Joint Surg Am"},{"key":"ref23","doi-asserted-by":"publisher","first-page":"613","DOI":"10.1016\/j.arth.2003.11.008","article-title":"Distal rotational alignment of the Chinese femur and its relevance in total knee arthroplasty","volume":"19","author":"DK Yip","year":"2004","journal-title":"J Arthroplasty"},{"key":"ref24","doi-asserted-by":"publisher","first-page":"354","DOI":"10.1016\/s0883-5403(00)90739-3","article-title":"Anatomy of the epicondyles of the distal femur: MRI analysis of normal knees","volume":"15","author":"FM Griffin","year":"2000","journal-title":"J Arthroplasty"},{"key":"ref25","doi-asserted-by":"publisher","first-page":"1049","DOI":"10.1016\/j.arth.2007.02.005","article-title":"An additional reference axis for determining rotational alignment of the femoral component in total knee arthroplasty","volume":"22","author":"YY Won","year":"2007","journal-title":"J Arthroplasty"},{"key":"ref26","doi-asserted-by":"publisher","first-page":"1217","DOI":"10.1016\/j.sjbs.2020.02.017","article-title":"The application of 3D printing patient specific instrumentation model in total knee arthroplasty","volume":"27","author":"F Zhou","year":"2020","journal-title":"Saudi J Biol Sci"},{"key":"ref27","doi-asserted-by":"publisher","first-page":"451","DOI":"10.3390\/life13020451","article-title":"Research Advances in the Application of AI for Preoperative Measurements in Total Knee Arthroplasty","volume":"13","author":"W Li","year":"2023","journal-title":"Life (Basel)"},{"key":"ref28","doi-asserted-by":"publisher","first-page":"673","DOI":"10.1055\/s-0039-1685146","article-title":"Relationship of the Posterior Condylar Line and the Transepicondylar Axis: A CT-Based Evaluation","volume":"33","author":"DW Fitz","year":"2020","journal-title":"J Knee Surg"},{"key":"ref29","doi-asserted-by":"publisher","first-page":"964","DOI":"10.1186\/s13018-023-04466-1","article-title":"Accuracy and reproducibility of two-dimensional computed tomography-based positioning of femoral component rotational alignment in preoperative planning for total knee arthroplasty","volume":"18","author":"K Liu","year":"2023","journal-title":"J Orthop Surg Res"},{"key":"ref30","doi-asserted-by":"publisher","DOI":"10.2106\/jbjs.St.23.00036","article-title":"Cementless, Cruciate-Retaining Primary Total Knee Arthroplasty Using Conventional Instrumentation: Technical Pearls and Intraoperative Considerations","volume":"14","author":"AB Harris","year":"2024","journal-title":"JBJS Essent Surg Tech"},{"key":"ref31","doi-asserted-by":"publisher","DOI":"10.3389\/fsurg.2024.1363551","article-title":"The femoral anterior tangent line could serve as a reliable alternative reference axis for distal femoral rotational alignment in total knee arthroplasty: an MRI-based study","volume":"11","author":"S Li","year":"2024","journal-title":"Front Surg"}],"container-title":["Zeitschrift f\u00fcr Orthop\u00e4die und Unfallchirurgie"],"original-title":[],"language":"de","link":[{"URL":"http:\/\/www.thieme-connect.de\/products\/ejournals\/pdf\/10.1055\/a-2811-2115.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,28]],"date-time":"2026-09-28T22:30:44Z","timestamp":1790634644000},"score":1,"resource":{"primary":{"URL":"http:\/\/www.thieme-connect.de\/DOI\/DOI?10.1055\/a-2811-2115"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,3,30]]},"references-count":31,"journal-issue":{"issue":"05","published-online":{"date-parts":[[2026,9,28]]},"published-print":{"date-parts":[[2026,10]]}},"URL":"https:\/\/doi.org\/10.1055\/a-2811-2115","archive":["Portico","CLOCKSS"],"relation":{},"ISSN":["1864-6697","1864-6743"],"issn-type":[{"value":"1864-6697","type":"print"},{"value":"1864-6743","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,3,30]]}}}