The combined Whiteside’s and posterior condylar line as a reliable reference to describe axial distal femoral anatomy in patient-specific instrument planning

Purpose: Aligning the femoral component in the axial plane parallel to the surgical epicondylar axis (SEA) has been generally recommended. In this retrospective study on the axial anatomy of the distal femur, as determined by the patient-specific instruments (PSI) planning tool based on MRI and 3D reconstructions, the different rotational axes were compared. The purpose of this study was to compare the impact of posterior axial anatomy on anterior anatomy and to compare the different angles of rotation obtained by a PSI-planning engineer. Methods: The preoperative planning of 77 PSI patients with a mean (SD) age of 65.6 (9.6) years undergoing primary total knee replacement for osteoarthritis was analysed for rotational anatomy of the distal femur. The angles between the posterior condylar line (PCL) and the SEA called posterior condylar angle (PCA), between Whiteside’s line and the SEA and finally between Whiteside’s line and the PCL, were retrieved from the PSI axial rotation planning screen. Results: The mean (SD) PCA was 3.2° (1.4°). The mean (SD) angle between Whiteside’s line and the SEA was 91.4° (2.2°), and the mean (SD) angle between Whiteside’s line and the PCL was 94.5° (2.3°). No significant difference for this last rotational parameter was found in between varus and valgus knees. Conclusion: Patient-specific instrument’s preoperative planning found consistent angles to describe the distal femoral anatomy as previously published in the literature. The angle between Whiteside’s line and the PCL as measured on PSI planning is a mean angle of 94.5° (2.3°) for both varus and valgus knees. Setting a fixed PCA of 5° of external rotation referenced of the PCL makes this planning repeatable during conventional surgery