Accurate sagittal alignment of the femoral component in total knee arthroplasty is crucial for prosthesis longevity, improved function, and patient satisfaction. However, there is variation in the techniques used to attain optimal sagittal femoral component placement in total knee arthroplasty. Femoral component flexion in imageless navigation is based on the mechanical axis rather than the distal femoral anatomy, and there is significant variability in the anatomy of the distal femur. The purpose of this study was to accurately determine the mean distal femoral flexion angle of a representative population and whether variability of the distal femoral flexion angle correlates with race, femur length, or radius of curvature. The mean degree of distal femoral flexion was determined by assessing distal femoral anatomy on computed tomography scans of paired femurs of 1235 patients without evidence of previous fracture, deformity, or surgical implants. The mean±SD distal femoral flexion angle was 2.90°±1.52°, with 80.2% of knees within 3°±2°. Therefore, placing the component in 3° of flexion from the mechanical axis would attain a satisfactory position in most cases. However, further analysis of the patient data revealed 11.4% of Asians, 7.3% of African Americans, and 8.3% of whites had a distal femoral flexion angle greater than 5°. Additionally, the data revealed a moderately strong negative correlation between the distal femoral flexion and the overall radius of curvature of the femur. This preliminary study highlights the need for improved methods for selecting femoral component position in the sagittal plane when using navigation for total knee arthroplasty. [Orthopedics. 2017; 40(2):102-106.].
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