Determining the rotational alignment of the femoral component in total knee arthroplasty using the epicondylar axis

The posterior condylar surfaces of the femur are routinely used as the reference for the rotational orientation of the femoral component during most primary total knee arthroplasties. The purpose of this investigation was to identify a clearly discernible, reproducible secondary anatomic axis useful for determining the rotational orientation of the femoral component when the posterior condylar surfaces cannot be used. Seventy-five embalmed anatomic specimen femurs were studied. A surgical epicondylar axis was defined as the line connecting the lateral epicondylar prominence and the medial sulcus of the medial epicondyle. The posterior condylar angle was measured as the angle between the posterior condylar surfaces and the surgical epicondylar axis. Measurement of the posterior condylar angle referenced from the surgical epicondylar axis yielded a mean posterior condylar angle of 3.5 degrees (+/- 1.2 degrees) of internal rotation for males and a mean posterior condylar angle of 0.3 degree (+/- 1.2 degrees) of internal rotation for females. Thus, rotational alignment of the femoral component can be accurately estimated using the posterior condylar angle. The posterior condylar angle, referenced from the surgical epicondylar axis, provides a visual rotational alignment check during primary arthroplasty and may improve alignment of the femoral component at revision.