Lateralization of Femoral Entry Point to Improve the Coronal Alignment During Total Knee Arthroplasty in Patients With Bowed Femur

Intramedullary jigs are most often used for distal femoral bone cuts in total knee arthroplasty (TKA). However, the accuracy of bone cuts in the distal femur may be affected by the presence of diaphyseal deformities of the femur.

Sixty-three patients (88 knees) with lateral bowing of the femur underwent primary TKA using a lateralized femoral entry point for intramedullary femoral guide. The following measurements were obtained on the preoperative and postoperative scanograms–mechanical axis deviation, degree of femoral bowing, femoral entry point from the intercondylar sulcus, distance from the center of the knee to the mechanical axis, and coronal alignment of femoral and tibial components.

In 48.8% of cases, the femoral entry point was 3-5 mm lateral to the intercondylar notch, in 44.4% of cases, it was 6-10 mm lateral to the notch, and in 6.8% of cases, it was 10-15 mm lateral to the intercondylar notch. Postoperatively the tibiofemoral angle was 6-10 degrees of valgus in 96% of cases. The postoperative mechanical axis was within 3 mm from the center of the knee in 80 of the 88 knees (90.9%). For every 1° increase in femoral bowing, the entry point was lateralized by an average of 1.04 mm.

The location of femoral entry point is important in TKA in patients with coronal plane deformity of the femur. In patients with lateral femoral bowing of 5° or more, a lateralized femoral entry point is useful in allowing straighter passage of long intramedullary femoral rod and this resulted in good mechanical axis alignment and femorotibial component alignment in over 90% of patients in our series.