Hofmann Siegfried, Tecame Andrea, Seitlinger Gerd, Innocenti Bernardo
Orthopedic Department, LKH Murtal-Stolzalpe, Stolzalpe 77, Standort Stolzalpe, Stolzalpe, 8352, Austria.
Department of Orthopaedic and Trauma Surgery, Città di Parma Clinic, Piazzale Athos Maestri, 5, Parma, 43123, Italy.
Arch Orthop Trauma Surg. 2025 May 12;145(1):287. doi: 10.1007/s00402-025-05898-6.
Proper rotational alignment of the femur components represents one of the key factors for the functional outcome of patients after total knee arthroplasty (TKA). Recent 3-D imaging data have shown a wide variability of the distal femur bony anatomy in the axial plane. The identification and intraoperative correction of these bony torsional deformities remain controversial. During the last decades various bony landmarks and surgical techniques have been proposed for proper femur rotational alignment but there is no consensus or evidence which method will be the best.This study employs a Delphi consensus methodology among European Knee Society (EKS) experts to address key questions regarding femur rotational alignment in TKA. Through a systematic literature review and expert discussions, a strong consensus was achieved on three main points: (1) Proper femoral rotational alignment must establish a balanced flexion gap and ensure proper patella tracking through the 3-D positioning of the trochlear groove. There is no consensus or evidence indicating whether the transepicondylar or trans-cylindric axis is the best compromise for the TKA flexion/extension axis. (2) For the three main techniques (measured resection, balanced flexion gap and combined/hybrid) and the new personalized alignment philosophies, no agreement on the best femoral rotational alignment exist. (3) Computer-Assisted Surgery (CAS) techniques using 3-D imaging preoperatively can help to identify the key rotational bony landmarks. Until now CAS has not delivered conclusive data to link these pre- and intraoperative findings to the clinical outcome to allow any recommendation for proper rotational alignment of the femur.This Delphi consensus statement summarizes the controversies, current practices, and evidence on the three key questions regarding proper femoral rotational alignment. There is a need for further high-level studies to identify the correct individual femoral rotational alignment to achieve better TKA outcomes.
股骨组件的正确旋转对线是全膝关节置换术（TKA）后患者功能结局的关键因素之一。最近的三维成像数据显示，股骨远端在轴平面上的骨解剖结构存在很大差异。对这些骨扭转畸形的识别和术中矫正仍存在争议。在过去几十年中，人们提出了各种骨标志和手术技术来实现股骨的正确旋转对线，但对于哪种方法是最佳方法尚无共识或证据。本研究采用德尔菲共识方法，在欧洲膝关节协会（EKS）专家中探讨TKA中股骨旋转对线的关键问题。通过系统的文献综述和专家讨论，就三个主要观点达成了强烈共识：（1）正确的股骨旋转对线必须建立平衡的屈曲间隙，并通过滑车沟的三维定位确保髌骨轨迹正常。对于TKA屈伸轴而言，无论是经髁间轴还是经圆柱轴是否是最佳折衷方案，尚无共识或证据。（2）对于三种主要技术（测量截骨、平衡屈曲间隙和联合/混合技术）以及新的个性化对线理念，在最佳股骨旋转对线上没有达成一致意见。（3）术前使用三维成像的计算机辅助手术（CAS）技术有助于识别关键的旋转骨标志。到目前为止，CAS尚未提供确凿的数据将这些术前和术中发现与临床结局联系起来，以便对股骨的正确旋转对线提出任何建议。本德尔菲共识声明总结了关于正确股骨旋转对线的三个关键问题的争议、当前做法和证据。需要进一步的高水平研究来确定正确的个体股骨旋转对线，以获得更好的TKA结局。
