Femoral flexion position is a highly variable factor in total knee arthroplasty: an analysis of 593 conventionally aligned total knee replacements

Purpose

In contrast to coronal alignment, only few is known about sagittal alignment in total knee arthroplasty (TKA). The aim of this study was to identify the flexion position of the femoral component in a routine surgical setting of conventional TKA and to evaluate potential predictors for the degree of femoral flexion.

Methods

A retrospective study was performed on 593 primary TKA using the conventional intramedullary alignment technique for distal femur. Femoral flexion was measured by the verification mode of a pinless navigation system. Correlations between femoral flexion and patient-specific data, surgery-related factors and measurements of a preoperative anterior–posterior long-leg X-ray were analysed.

Results

The distal femoral resection showed a mean flexion of 5.5° ± 2.5° to the mechanical axis with high variation between 2.5° extension and 14° flexion. In a multivariate regression model, body height (p = 0.023), body weight (p = 0.046) and body mass index (p = 0.026) showed significant positive correlation to femoral flexion. There was no correlation to any preoperative alignment data from the anterior–posterior long-leg film. The sagittal position was also independent from surgery-related factors such as different knee systems or surgeons.

Conclusions

Femoral flexion is a highly variable characteristic in conventionally aligned TKA. Increasing body height, body weight and body mass index were identified as predictors for a high degree of femoral flexion.

Level of evidence

III.