Reliability of the Transepicondylar Axis as an Anatomical Landmark in Total Knee Arthroplasty

Femoral component malalignment after total knee arthroplasty is known to cause clinical symptoms, such as anterior knee pain. For intraoperative referencing, several anatomical landmarks are used by surgeons. One frequently used landmark is the transepicondylar axis, yet the accuracy and reproducibility of defining this axis have not been established. In 6 human cadavers, 4 different experienced orthopedic surgeons performed selections of the most prominent points of the medial and lateral epicondyle. Each individual position was digitized and recorded by an accurate optical navigation system. In addition, the most prominent points of the medial and lateral epicondyle were defined on a computed tomography image. After transforming the cadaver points in the computed tomography coordinate system, distances to the epicondyles were measured. The overall distribution of selected points was located in an area of 278 mm2 upon the medial epicondyle and 298 mm2 of the lateral.