The EKA Femoral Rotation Focus Group has not identified a single best reference method to determine femoral component rotation , but surgeons mostly prefer the measured resection technique using at least two l and marks for cross-checking the rotation .
Malrotation of the femoral component after primary total knee arthroplasty ( TKA ) is one of the most important problems leading to painful TKA requiring revision surgery .
A comprehensive systematic review of the literature was performed to present current evidence on how to optimally place the femoral component in TKA .
Clinical value of SPECT/CT in the painful total knee arthroplasty (TKA): a prospective study in a consecutive series of 100 TKA
Purpose Bone single photon emission computed tomography (SPECT)/CT is considered as beneficial in unhappy patients with pain , stiffness or swelling after total knee arthroplasty ( TKA ) . The purpose of this study was to identify typical patterns of bone tracer uptake ( BTU ) , distribution and intensity values in patients after TKA . The above findings were correlated with the type and fixation of TKA , the time from TKA and intraoperative findings at revision surgery . Methods A total of 100 knees of 84 consecutive patients ( mean age ± SD 70 ± 11 years ) after TKA with persistent knee pain were prospect ively included . All patients underwent clinical examination , st and ardized radiographs and 99mTc-hydroxymethane diphosphonate ( HDP ) SPECT/CT as part of a routine diagnostic algorithm . The diagnosis before and after SPECT/CT and final treatment were recorded . TKA component position was determined on 3-D reconstructed images . Intensity and anatomical distribution of BTU was determined . Maximum intensity values were recorded as well as ratios in relation to the proximal midshaft of the femur . Univariate analyses ( chi-square test , Pearson ’s correlation and t test for independent sample s ) were performed ( p < 0.05 ) . Results SPECT/CT changed the clinical diagnosis and final treatment in 85/100 ( 85 % ) knees . Intraoperative findings confirmed the preoperative SPECT/CT diagnosis in 32/33 knees ( 97 % ) . TKA loosening as well as progression of patellofemoral osteoarthritis ( OA ) was correctly diagnosed in 100 % of knees . Typical patterns of BTU for specific pathologies were identified . Loose femoral TKA components significantly correlated with increased BTU at the lateral femoral regions ( p < 0.05 ) . Loose tibial TKA components significantly correlated with increased BTU at all tibial regions ( p < 0.05 ) and around the tibial peg ( p > 0.01 ) . Conclusion The diagnostic benefits of SPECT/CT in patients after TKA have been proven . Typical pathology-related BTU patterns were identified , which will improve reporting quality . Due to the benefits in establishing the correct diagnosis , SPECT/CT should be part of the routine diagnostic algorithm for patients with pain after TKA
The EKA Femoral Rotation Focus Group has not identified a single best reference method to determine femoral component rotation , but surgeons mostly prefer the measured resection technique using at least two l and marks for cross-checking the rotation .
Malrotation of the femoral component after primary total knee arthroplasty ( TKA ) is one of the most important problems leading to painful TKA requiring revision surgery .
A comprehensive systematic review of the literature was performed to present current evidence on how to optimally place the femoral component in TKA .