Distal Femoral Rotation is not Associated With Preoperative Proximal Tibial Varus Angle in Patients With Isolated Medial Compartment Osteoarthritis

J Arthroplasty. 2019 Feb;34(2):281-285. doi: 10.1016/j.arth.2018.09.080. Epub 2018 Sep 28.


Background: Prior studies have found that greater proximal tibial varus was associated with increased external femoral rotation at time of total knee arthroplasty. These works suggest that measuring the tibial plateau-tibial shaft (TPTS) angle on preoperative weight-bearing long leg radiographs could predict significant variations in the posterior condylar angle.

Methods: A minimum of 68 patients were needed to reach 80% power. Patients were included if they had primary medial compartment osteoarthritis and excluded if they had a valgus mechanical axis. The clinical posterior condylar angle (cPCA) was defined as the angle between the anatomic transepicondylar axis and posterior condylar line. Correlation analyses were performed to test for any relationship between the TPTS and cPCA. Two patient groups were created based on TPTS angle: TPTS ≤4° (mild varus) and TPTS >4° (moderate varus). Mechanical axis and rotational measurements were compared between the groups using independent t-tests.

Results: The mean mechanical axis and TPTS angle were 6.9° and 4.8° of varus, respectively. The mean cPCA was 5.0° (standard deviation [SD], 1.4°; range, 2.4°-7.9°). No correlation was found between the TPTS angle and cPCA (P = .15). The mean cPCA in the mild varus group (n = 28 patients) was 5.2° (SD, 1.5°; range, 2.7°-7.9°), and the mean cPCA in the moderate varus group (n = 45 patients) was 4.4° (SD, 1.7°; range, 0.6°-7.5°). These groups were not statistically significantly different from each other (P = .62).

Conclusion: The present study does not support the conclusions of previous works and suggests that the amount of distal femoral rotation cannot be predicted by tibial varus alignment measured on preoperative long leg radiographs. Consequently, we believe that proximal tibial varus should not be used to preoperatively predict external rotation of the femoral component in patients with isolated medial compartment osteoarthritis.

Keywords: CT scan measurements; distal femoral rotation; preoperative planning; primary total knee arthroplasty; varus knee.

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Arthroplasty, Replacement, Knee*
  • Bone Malalignment / diagnostic imaging*
  • Diaphyses
  • Female
  • Femur / surgery
  • Humans
  • Knee Joint / diagnostic imaging*
  • Knee Joint / surgery
  • Male
  • Middle Aged
  • Osteoarthritis, Knee / diagnostic imaging*
  • Osteoarthritis, Knee / surgery
  • Radiography
  • Rotation
  • Tibia / diagnostic imaging*
  • Tibia / surgery
  • Tomography, X-Ray Computed
  • Weight-Bearing