{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,10]],"date-time":"2026-02-10T20:14:11Z","timestamp":1770754451601,"version":"3.50.0"},"reference-count":19,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2020,7,28]],"date-time":"2020-07-28T00:00:00Z","timestamp":1595894400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2020,7,28]],"date-time":"2020-07-28T00:00:00Z","timestamp":1595894400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["BMC Musculoskelet Disord"],"published-print":{"date-parts":[[2020,12]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec>\n<jats:title>Background<\/jats:title>\n<jats:p>Greater accuracy is needed when determining the final femoral component (FC) rotation during total knee arthroplasty (TKA), because this parameter affects soft tissue balance during flexion and patellar tracking. Anatomical markers, such as the epicondylar axis, are typically used to determine the final FC rotation, although intraoperative confirmation may be challenging. Therefore, rotational position is frequently determined with the posterior condylar axis (PCA) as a landmark. However, the thickness of the posterior condylar cartilage has not been considered and may not be represented on preoperative images. We used plain X-rays to measure the thickness of the medial and lateral posterior condylar cartilage fragments postoperatively, and investigated the effects of differences in cartilage thickness on final FC rotation.<\/jats:p>\n<\/jats:sec><jats:sec>\n<jats:title>Methods<\/jats:title>\n<jats:p>Fifty knees (19 men, 31 women) underwent primary TKA to treat medial knee osteoarthritis at our hospital between August 2015 and May 2017. All knees were treated using an Attune PS (DePuy Synthes, Inc., Warsaw, IN). We first measured the distance between the posterior femoral condyles, resected the posterior condyle, and measured the thickness of the resected cartilage fragments. We then took X-ray images from a direction tangential to the osteotomy surface, secured the cartilage fragments with digital calipers, and measured the thickness of the cartilage. We investigated the effects of differences in cartilage thickness on final FC rotation of the residual medial and lateral cartilage with a trigonometric function.<\/jats:p>\n<\/jats:sec><jats:sec>\n<jats:title>Results<\/jats:title>\n<jats:p>Medial condylar cartilage thickness averaged 0.6\u2009\u00b1\u20090.5\u2009mm and the lateral condylar thickness averaged 1.8\u2009\u00b1\u20090.6\u2009mm; posterior intercondylar distance averaged 46.1\u2009\u00b1\u20093.3\u2009mm and average impact on rotation of the cartilage remnant was 1.5\u2009\u00b1\u20090.9\u00b0 (\u2212\u20090.1\u20133.9\u00b0). There may be measurement error of up to 4\u00b0 in the maximum values compared with the preoperative plan in cases with short intercondylar distance.<\/jats:p>\n<\/jats:sec><jats:sec>\n<jats:title>Conclusions<\/jats:title>\n<jats:p>In cases where the FC external rotation angle is determined using the posterior condyles as landmarks, this angle can be affected by the intercondylar distance, especially in Japanese women who have small physical stature. This angle can potentially be much larger, so caution is advised. Our results suggest that several anatomical landmarks should be referenced to achieve accurate FC rotation.<\/jats:p>\n<\/jats:sec>","DOI":"10.1186\/s12891-020-03537-2","type":"journal-article","created":{"date-parts":[[2020,7,28]],"date-time":"2020-07-28T12:02:53Z","timestamp":1595937773000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":14,"title":["Impact of posterior femoral condylar cartilage and posterior intercondylar distance on rotation of femoral component in total knee arthroplasty"],"prefix":"10.1186","volume":"21","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1896-9138","authenticated-orcid":false,"given":"Teruyuki","family":"Miyasaka","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mitsuru","family":"Saito","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Daisaburo","family":"Kurosaka","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ryo","family":"Ikeda","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Shoki","family":"Yamanaka","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Keishi","family":"Marumo","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"297","published-online":{"date-parts":[[2020,7,28]]},"reference":[{"issue":"9","key":"3537_CR1","doi-asserted-by":"publisher","first-page":"1321","DOI":"10.2106\/00004623-198567090-00003","volume":"67","author":"RL Merkow","year":"1985","unstructured":"Merkow RL, Soudry M, Insall JN. Patellar dislocation following total knee replacement. J Bone Joint Surg Am. 1985;67(9):1321\u20137.","journal-title":"J Bone Joint Surg Am"},{"key":"3537_CR2","doi-asserted-by":"publisher","first-page":"267","DOI":"10.1016\/j.otsr.2009.04.004","volume":"95","author":"P Abadie","year":"2009","unstructured":"Abadie P, Galaud B, Michaut M, Fallet L, Boisrenoult P, Beaufils P. Distal femur rotational alignment and patellar subluxation: a CT scan in vivo assessment. Orthop Traumatol Surg Res. 2009;95:267\u201371.","journal-title":"Orthop Traumatol Surg Res"},{"key":"3537_CR3","doi-asserted-by":"crossref","unstructured":"Berger RA, Crossett LS, Jacobs JJ, Rubash HE. Malrotation causing patellofemoral complications after total knee arthroplasty. Clin Orthop Relat Res. 1998:144\u201353.","DOI":"10.1097\/00003086-199811000-00021"},{"key":"3537_CR4","doi-asserted-by":"crossref","unstructured":"Akagi M, Matsusue Y, Mata T, Asada Y, Horiguchi M, Iida H, et al. Effect of rotational alignment on patellar tracking in total knee arthroplasty. Clin Orthop Relat Res. 1999:155\u201363.","DOI":"10.1097\/00003086-199909000-00019"},{"issue":"5","key":"3537_CR5","doi-asserted-by":"publisher","first-page":"682","DOI":"10.1302\/0301-620X.86B5.14927","volume":"86","author":"H B\u00e4this","year":"2004","unstructured":"B\u00e4this H, Perlick L, Tingart M, L\u00fcring C, Zurakowski D, Grifka J. Alignment in total knee arthroplasty. A comparison of computer-assisted surgery with the conventional technique. J Bone Joint Surg Br. 2004;86(5):682\u20137.","journal-title":"J Bone Joint Surg Br"},{"key":"3537_CR6","doi-asserted-by":"publisher","first-page":"1097","DOI":"10.1016\/j.arth.2007.08.001","volume":"22","author":"JB Mason","year":"2007","unstructured":"Mason JB, Fehring TK, Estok R, Banel D, Fahrbach K. Meta-analysis of alignment outcomes in computer-assisted total knee arthroplasty surgery. J Arthroplast. 2007;22:1097\u2013106.","journal-title":"J Arthroplast"},{"key":"3537_CR7","doi-asserted-by":"publisher","first-page":"47","DOI":"10.1016\/j.arth.2016.05.069","volume":"32","author":"T Miyasaka","year":"2017","unstructured":"Miyasaka T, Kurosaka D, Saito M, Omori T, Ikeda R, Marumo K. Accuracy of computed tomography\u2013based navigation-assisted total knee arthroplasty: outlier analysis. J Arthroplast. 2017;32:47\u201352. https:\/\/doi.org\/10.1016\/j.arth.2016.05.069.","journal-title":"J Arthroplast"},{"issue":"2","key":"3537_CR8","doi-asserted-by":"publisher","first-page":"255","DOI":"10.1016\/j.arth.2012.04.023","volume":"28","author":"D Nam","year":"2013","unstructured":"Nam D, Weeks KD, Reinhardt KR, Nawabi DH, Cross MB, Mayman DJ. Accelerometer-based, portable navigation vs imageless, large-console computer-assisted navigation in total knee arthroplasty. A comparison of radiographic results. J Arthroplast. 2013;28(2):255\u201361.","journal-title":"J Arthroplast"},{"issue":"Suppl 3","key":"3537_CR9","first-page":"83","volume":"39","author":"J Jiang","year":"2015","unstructured":"Jiang J, Kang X, Lin Q, Teng Y, An L, Ma J, et al. Accuracy of patient-specific instrumentation compared with conventional instrumentation in total knee arthroplasty. Orthopedics. 2015;39(Suppl 3):83\u20137.","journal-title":"Orthopedics."},{"key":"3537_CR10","doi-asserted-by":"publisher","first-page":"185","DOI":"10.1016\/j.knee.2011.02.008","volume":"19","author":"S Asada","year":"2012","unstructured":"Asada S, Akagi M, Matsushita T, Hashimoto K, Mori S, Hamanishi C. Effects of cartilage remnants of the posterior femoral condyles on femoral component rotation in varus knee osteoarthritis. Knee. 2012;19:185\u20139. https:\/\/doi.org\/10.1016\/j.knee.2011.02.008.","journal-title":"Knee."},{"key":"3537_CR11","doi-asserted-by":"publisher","first-page":"633","DOI":"10.1007\/s00276-012-0950-y","volume":"34","author":"T Fujii","year":"2012","unstructured":"Fujii T, Kondo M, Tomari K, Kadoya Y, Tanaka Y. Posterior condylar cartilage may distort rotational alignment of the femoral component based on posterior condylar axis in total knee arthroplasty. Surg Radiol Anat. 2012;34:633\u20138.","journal-title":"Surg Radiol Anat"},{"issue":"1.2","key":"3537_CR12","doi-asserted-by":"publisher","first-page":"24","DOI":"10.2152\/jmi.64.24","volume":"64","author":"D Hamada","year":"2017","unstructured":"Hamada D, Wada K, Mikami H, Toki S, Goto T, Tsutsui T, et al. The posterior condylar cartilage affects rotational alignment of the femoral component in varus knee osteoarthritis. J Med Invest. 2017;64(1.2):24\u20139.","journal-title":"J Med Invest"},{"key":"3537_CR13","doi-asserted-by":"publisher","first-page":"1463","DOI":"10.1007\/s00167-011-1691-x","volume":"20","author":"Y Tashiro","year":"2012","unstructured":"Tashiro Y, Uemura M, Matsuda S, Okazaki K, Kawahara S, Hashizume M, et al. Articular cartilage of the posterior condyle can affect rotational alignment in total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc. 2012;20:1463\u20139.","journal-title":"Knee Surg Sports Traumatol Arthrosc"},{"issue":"4","key":"3537_CR14","doi-asserted-by":"publisher","first-page":"666","DOI":"10.1097\/gme.0b013e318198e30e","volume":"16","author":"FS Hanna","year":"2009","unstructured":"Hanna FS, Teichtahl AJ, Wluka AE, Wang Y, Urquhart DM, English DR, et al. Women have increased rates of cartilage loss and progression of cartilage defects at the knee than men. Menopause. 2009;16(4):666\u201370.","journal-title":"Menopause."},{"key":"3537_CR15","doi-asserted-by":"publisher","first-page":"1221","DOI":"10.1016\/j.knee.2014.09.007","volume":"21","author":"M Ishimaru","year":"2014","unstructured":"Ishimaru M, Hino K, Onishi Y, Iseki Y, Mashima N, Miura H. A three-dimensional computed tomography study of distal femoral morphology in Japanese patients: gender differences and component fit. Knee. 2014;21:1221\u20134. https:\/\/doi.org\/10.1016\/j.knee.2014.09.007.","journal-title":"Knee."},{"issue":"2","key":"3537_CR16","doi-asserted-by":"publisher","first-page":"223","DOI":"10.1007\/s00264-006-0310-9","volume":"32","author":"DH Lee","year":"2008","unstructured":"Lee DH, Seo JG, Moon YW. Synchronisation of tibial rotational alignment with femoral component in total knee arthroplasty. Int Orthop. 2008;32(2):223\u20137.","journal-title":"Int Orthop"},{"issue":"Suppl 1","key":"3537_CR17","doi-asserted-by":"publisher","first-page":"13","DOI":"10.1007\/s001670000153","volume":"9","author":"PL Poilvache","year":"2001","unstructured":"Poilvache PL. The patella in total knee replacement: technical aspects on the femoral side. Knee Surg Sports Traumatol Arthrosc. 2001;9(Suppl 1):13\u20138.","journal-title":"Knee Surg Sports Traumatol Arthrosc"},{"issue":"6","key":"3537_CR18","doi-asserted-by":"publisher","first-page":"1478","DOI":"10.1016\/j.knee.2017.09.004","volume":"24","author":"H Tsukiyama","year":"2017","unstructured":"Tsukiyama H, Kuriyama S, Kobayashi M, Nakamura S, Furu M, Ito H, et al. Medial rather than lateral knee instability correlates with inferior patient satisfaction and knee function after total knee arthroplasty. Knee. 2017;24(6):1478\u201384.","journal-title":"Knee."},{"issue":"4","key":"3537_CR19","first-page":"507","volume":"76","author":"L Luyckx","year":"2010","unstructured":"Luyckx L, Luyckx T, Bellemans J, Victor J. Iliotibial band traction syndrome in guided motion TKA. A new clinical entity after TKA. Acta Orthop Belg. 2010;76(4):507\u201312.","journal-title":"Acta Orthop Belg"}],"container-title":["BMC Musculoskeletal Disorders"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s12891-020-03537-2.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1186\/s12891-020-03537-2\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s12891-020-03537-2.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2021,7,27]],"date-time":"2021-07-27T23:19:07Z","timestamp":1627427947000},"score":1,"resource":{"primary":{"URL":"https:\/\/bmcmusculoskeletdisord.biomedcentral.com\/articles\/10.1186\/s12891-020-03537-2"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2020,7,28]]},"references-count":19,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2020,12]]}},"alternative-id":["3537"],"URL":"https:\/\/doi.org\/10.1186\/s12891-020-03537-2","relation":{},"ISSN":["1471-2474"],"issn-type":[{"value":"1471-2474","type":"electronic"}],"subject":[],"published":{"date-parts":[[2020,7,28]]},"assertion":[{"value":"25 March 2020","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"23 July 2020","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"28 July 2020","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"All procedures performed in studies involving human participants were in accordance with the ethical standards of the Ethics Committee of Toshima Hospital, Tokyo Metropolitan Health and Hospitals Corporation (approval no. 31\u201361), and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. Verbal informed consent to participate in the study was obtained at the time of obtaining the surgical consent form, which was taken as documentation of consent to participate in this research. Verbal consent was approved by the ethics committee because this study used only data routinely collected during surgery. In addition, notices are posted on our hospital\u2019s website and bulletin boards explaining the use of clinical data for research purposes and informing patients of their right to opt out of the use of their data.","order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}},{"value":"Not applicable.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"Dr. Miyasaka reports grants from Japan Medical Dynamic Marketing, Inc., outside the submitted work; Dr. Marumo reports grants from Zimmer Biomet Japan, Inc., grants from Chugai Pharmaceutical Co, LTD., grants from Astellas Pharma Inc., and grants from Asahi Kasei Pharma Corp., outside the submitted work; all other authors declare no conflicts of interest.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"498"}}