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Updated: Jun 1, 2026
Three-Dimensional Preoperative Virtual Planning in Derotational Proximal Femoral Osteotomy
Published on: February 17, 2023
Rotational alignment in total knee arthroplasty: intraoperative inter- and intraobserver reliability of Whiteside's
Nicolas Vanin1, Martin Panzica, Gregory Dikos
1Trauma Department, Hannover Medical School, Carl-Neuberg-Str. 1, 30625 Hannover, Germany. Vanin.Nicolas@mh-hannover.de
Introduction:
Proper rotational alignment is a critical step of total knee arthroplasty. For intraoperative determination of femoral rotation, Whiteside suggests a perpendicular line to the axis of the center of the trochlea and the intercondylar notch (Whiteside's line).
Method:
In a prospective clinical study, the intraoperative position of Whiteside's line was measured in 30 patients with the help of a navigation system.
Results:
Whiteside's line was 2.1° ± 1.5° externally rotated compared to a navigation based computer calculated preliminary AP axis of the femur. The intraobserver-reliability after 3 repeated measurements each was 1.6° for the senior surgeon and 1.4° for the junior surgeon (p = 0.598, p = 0.968). The interobserver reliability between the measurements by the senior and junior surgeon was 1.4° (p = 0.547).
Conclusion:
Navigated intraoperative measurements of Whiteside's line showed a high inter- and intraobserver reliability. Considering the variability between Whiteside's line and the transepicondylar axis, intraoperative assessment of both the methods is recommended.