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The third gap - The forgotten space in total knee arthroplasty
William Brown1, Nicola Gallagher1, Dai Roberts2
1Outcomes Unit, Musgrave Park Hospital, Belfast, Northern, Ireland.
The Knee
|November 24, 2024
Summary
Trochlear groove height (TGH) in total knee arthroplasty (TKA) varies significantly from the anterior femoral cortex. Approximately 24.5% of patients may experience component malpositioning, impacting TKA outcomes.
Area of Science:
- Orthopedic surgery
- Biomedical engineering
- Radiology
Background:
- Total Knee Arthroplasty (TKA) aims for precise femoral component placement.
- Current methods lack focus on restoring native trochlear groove height (TGH).
- Data on TGH variation relative to the anterior cortex is limited.
Purpose of the Study:
- To quantify the variation of TGH relative to the anterior femoral cortex.
- To assess the implications of this variation on femoral component sizing in TKA.
- To investigate the relationship between TGH and the restoration of the 'third space'.
Main Methods:
- Utilized MRI to measure TGH in 110 normal subjects.
- Measurements were taken relative to the center of the anterior femoral cortex.
- Analyzed TGH variation in relation to the posterior femoral axis.
Main Results:
- Mean TGH variation from the anterior femoral cortex was 2.32 mm (SD 1.77 mm).
- A significant range of variation was observed (-1.50 mm to 6.80 mm).
- Assuming a 2.2 mm trochlear component depth, 24.5% of cases could be over- or understuffed by >2 mm.
Conclusions:
- Considerable variation in TGH exists, challenging accurate femoral component placement.
- Failure to restore native TGH may lead to suboptimal TKA results.
- Future surgical techniques should prioritize TGH restoration for improved TKA outcomes.
Keywords:
Arthroplasty
