Computed tomography measurement of the surgical and clinical transepicondylar axis of the distal femur in osteoarthritic knees

To assess rotational alignment of the distal femur, 2 types of transepicondylar axes have been used in the literature. We compared surgical and clinical epicondylar axes in the measurement of rotational alignment of the femur in planning for total knee arthroplasty (TKA). We examined 48 patients who were candidates for TKA. Computed tomography images of both knees were obtained, and condylar twist angle and posterior condylar angle were measured. The medial sulcus was detected in only 33 knees. The more severe the grade of osteoarthritis, the more difficult it was to detect the medial sulcus. The most prominent point of medial epicondyle was detectable in all knees. We recommend the use of the clinical epicondylar axis in computed tomography measurement in selective planning for TKA.