Strong correlation between the morphology of the proximal femur and the geometry of the distal femoral trochlea.

Authors:
Samantha J Wright
Samantha J Wright
University of Bath
Bernd Grimm
Bernd Grimm
Ikazia Hospital
Netherlands
Anthony W Miles
Anthony W Miles
University of Bath
United Kingdom
Oliver Kessler
Oliver Kessler
University of Zurich
Switzerland

Knee Surg Sports Traumatol Arthrosc 2014 Dec 2;22(12):2900-10. Epub 2014 Oct 2.

Department of Mechanical Engineering, Centre for Orthopaedic Biomechanics, University of Bath, Bath, BA2 7AY, UK,

Purpose: Previous investigations suggested that the geometry of the proximal femur may be related to osteoarthritis of the tibiofemoral joint and various patellofemoral joint conditions. This study aims to investigate the correlation between proximal and distal femoral geometry. Such a correlation could aid our understanding of patient complications after total knee arthroplasty (TKA) and be of benefit for further development of kinematic approaches in TKA.

Methods: CT scans of 60 subjects (30 males, 30 females) were used to identify anatomical landmarks to calculate anatomical parameters of the femur, including the femoral neck anteversion angle, neck-shaft angle (NSA), mediolateral offset (ML-offset), condylar twist angle (CTA), trochlear sulcus angle (TSA) and medial/lateral trochlear inclination angles (MTIA/LTIA). Correlation analyses were carried out to assess the relationship between these parameters, and the effect of gender was investigated.

Results: The CTA, TSA and LTIA showed no correlation with any proximal parameter. The MTIA was correlated with all three proximal parameters, mostly with the NSA and ML-offset. Per 5° increase in NSA, the MTIA was 2.1° lower (p < 0.01), and for every 5 mm increase in ML-offset, there was a 2.6° increase in MTIA (p < 0.01). These results were strongest and statistically significant in females and not in males and were independent of length and weight.

Conclusions: Proximal femoral geometry is distinctively linked with trochlear morphology. In order to improve knowledge on the physiological kinematics of the knee joint and to improve the concept of kinematic knee replacement, the proximal femur seems to be a factor of clinical importance.

Level Of Evidence: III.

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December 2014
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