Can the Visibility of Both Prosthetic Posterior Femoral Condyles on a Postoperative Radiograph Assure that Limb Rotation Is Appropriate to Allow Accurate Measurement of the Anatomic Knee Axis?

Abstract

To better define radiographic parameters for a true anterior-posterior (AP) knee radiograph after total knee arthroplasty, we cataloged the radiographic appearance of 7 different designs of commercially available femoral components at various points of rotation to correlate the visibility of the prosthetic posterior femoral condyles (PPFCs) with the amount of rotation of the femoral component, and hence, the limb. AP radiographs of 7 left-sided, cruciate-retaining femoral trial components were obtained at 5° increments of rotation from 20° internal rotation (IR) to 20° external rotation (ER). Rotational profiles were cataloged based on the visibility of either or both of the PPFCs. Three categories of femoral component rotation profiles were noted, based on the visibility of the PPFC: overt ER with only the medial PFC visible at greater than 10° ER, overt IR with only the lateral PFC visible at greater than 20° IR, and near-neutral rotation with both medial and lateral PPFCs visible between 5° ER and 15° IR. An acceptable AP radiograph to measure the anatomic knee axis after total knee arthroplasty is one where both the medial and lateral PPFCs are visible on either side of the trochlear flange.