Three-dimensional color map: a novel tool to locate the surgical transepicondylar axis

Accurate localization of the surgical transepicondylar axis (sTEA) in total knee arthroplasty (TKA), the most reliable anatomical reference for femoral rotation, has long been a challenge, primarily because it is intractable to locate the center of the sulcus of the medial epicondyle. This study aimed to introduce and verify a novel method to locate the sTEA more precisely.

This study included 26 adult femoral specimens and 80 adult patients with computed tomography (CT) scan data. Three dimensions (3D) models based on CT scans of the distal femurs were reconstructed with Mimics and imported into Geomagic Studio. The 3D color map method was applied to locate the sTEA. To further verify the accuracy of the method, the identified sTEA was transferred to the femoral specimens and compared with the points identified by the total station machine. We further compared the recognition rate of sTEA between 3D color map method and two-dimensional (2D) CT slices method. The repeatability of this novel method was also evaluated.

The 3D color map method located the centers of the sulcus of the medial epicondyle and the most prominent point of the lateral epicondyle of all the femoral specimens, which were further identified and confirmed by patient-specific guide plates and total station machine on femoral specimens. The 3D color map method achieved a recognition rate of up to 96.23%, while the recognition rate of the 2D CT slices method was only 68.87%. The repeatability of this objective method was excellent.

The results of this study indicated that the 3D color map method could be used to accurately and objectively locate the sTEA, with high repeatability and recognition rate. However, the proposed novel method requires further validation in clinical applications.