Clin Orthop Surg.  2015 Jun;7(2):217-224. 10.4055/cios.2015.7.2.217.

Risk of Anterior Femoral Notching in Navigated Total Knee Arthroplasty

• Lee JH
• Wang SI

• KMID: 2164548
• DOI: http://doi.org/10.4055/cios.2015.7.2.217

Abstract

BACKGROUND
We retrospectively investigated the prevalence of femoral anterior notching and risk factors after total knee arthroplasty (TKA) using an image-free navigation system.
METHODS
We retrospectively reviewed 148 consecutive TKAs in 130 patients beginning in July 2005. Seventy knees (62 patients) underwent conventional TKA, and 78 knees (68 patients) received navigated TKA. We investigated the prevalence of femoral anterior notching and measured notching depth by conventional and navigated TKA. Additionally, the navigated TKA group was categorized into two subgroups according to whether anterior femoral notching had occurred. The degree of preoperative varus deformity, femoral bowing, and mediolateral suitability of the size of the femoral component were determined by reviewing preoperative and postoperative radiographs. The resection angle on the sagittal plane and the angle of external rotation that was set by the navigation system were checked when resecting the distal femur. Clinical outcomes were compared using range of motion (ROM) and the Hospital for Special Surgery (HSS) and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAX) scores between the two groups.
RESULTS
The prevalence of anterior femoral notching by conventional TKA was 5.7%, and that for navigated TKA was 16.7% (p = 0.037). Mean notching depth by conventional TKA was 2.92 +/- 1.18 mm (range, 1.8 to 4.5 mm) and 3.32 +/- 1.54 mm (range, 1.55 to 6.93 mm) by navigated TKA. Preoperative anterior femoral bowing was observed in 61.5% (p = 0.047) and both anterior and lateral femoral bowing in five cases in notching group during navigated TKA (p = 0.021). Oversized femoral components were inserted in 53.8% of cases (p = 0.035). No differences in clinical outcomes for ROM or the HSS and WOMAX scores were observed between the groups. A periprosthetic fracture, which was considered a notching-related side effect, occurred in one case each in the conventional and navigated TKA groups.
CONCLUSIONS
Surgeons should be aware of the risks associated with anterior femoral notching when using a navigation system for TKA. A modification of the femoral cut should be considered when remarkable femoral bowing is observed.

Keyword

Navigation; Total knee arthroplasty; Anterior femur; Notching

MeSH Terms

Aged
Aged, 80 and over
Arthroplasty, Replacement, Knee/*methods
Female
*Femur/injuries
Humans
Middle Aged
Postoperative Complications/*epidemiology/physiopathology/radiography
Prevalence
Range of Motion, Articular
Retrospective Studies
Risk Factors

Figure

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  Fig. 1 The depth of anterior femoral notching (h) was measured as the distance between the anterior cortex line and anterior cut line of the distal femur.

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  Fig. 2 (A) Standing anteroposterior radiograph of the entire lower limbs. a: mechanical axis of the lower limb, b and c: amount of varus deformity. (B) Lateral bowing of the femur. (C) Anterior bowing of the femoral shaft.

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