Is a “sulcus cut” technique effective for determining the level of distal femoral resection in total knee arthroplasty?

• Published in: Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA sports traumatology, arthroscopy : official journal of the ESSKA, 2014-12, Vol.22 (12), p.3060-3066
• Main Authors: Kuriyama, Shinichi, Hyakuna, Katsufumi, Inoue, Satoshi, Tanaka, Yasuyuki, Tamaki, Yasuyuki, Ito, Hiromu, Matsuda, Shuichi
• Format: Article
• Language: English
• Subjects: Aged; Aged, 80 and over; Arthroplasty, Replacement, Knee - methods; Computer Simulation; Female; Femur - diagnostic imaging; Femur - surgery; Humans; Joint replacement surgery; Knee; Knee Joint - diagnostic imaging; Knee Joint - surgery; Knee Prosthesis; Male; Medicine; Medicine & Public Health; Middle Aged; Navigation systems; Orthopedics; Osteoarthritis, Knee - diagnostic imaging; Osteoarthritis, Knee - surgery; Preoperative Care; Reproducibility of Results; Software; Surgery, Computer-Assisted; Tomography; Tomography, X-Ray Computed; Women
• ISSN: 0942-2056; 1433-7347
• DOI: 10.1007/s00167-014-3217-9

Purpose Determining the level of distal femoral resection is crucial when performing total knee arthroplasty (TKA). However, variations in distal femoral resection are encountered unexpectedly. A “sulcus cut” technique is sometimes used to determine the level of distal femoral resection, but its effectiveness has not been evaluated. The aim of this study was to examine the reliability of the sulcus cut technique using computer simulation for preoperative planning. Methods This study group comprised 40 knees in 34 patients (22 women, 12 men) scheduled for TKA. The preoperative planning software of a computed tomography (CT)-based navigation system was used. We determined the resected level of the femur so that the bone–implant interface of the femoral component was adjusted to the deepest subchondral bone of the trochlear groove in coronal CT images. We then measured each perpendicular distance from the resected surface of the proximal femur to the most distal point of the lateral and medial femoral condyles. Results The mean distances of the distal–lateral and distal–medial condylar resections from the femoral sulcus were 7 mm (±1 mm) and 8 mm (±1 mm), respectively. The resection level did not differ significantly between men and women or between different component sizes. There was a slightly positive correlation between the femoral mechanical and anatomical axis angle and the distance of the distal–lateral condylar resection from the femoral sulcus. Conclusions The sulcus cut technique can be used to determine the desirable level of the distal femoral resection in TKA. Level of evidence Case series, Level IV.