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Ten Noever de Brauw GV, Bayoumi T, Ruderman LV, Kerkhoffs GMMJ, Zuiderbaan HA, Pearle AD. Knees with isolated lateral compartment osteoarthritis show a substantial variability in functional knee phenotypes with demographic-specific variations: Phenotypic analysis of 305 knees. Knee 2024; 48:265-278. [PMID: 38820655 DOI: 10.1016/j.knee.2024.05.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Revised: 04/03/2024] [Accepted: 05/01/2024] [Indexed: 06/02/2024]
Abstract
BACKGROUND The primary aim of this study was to assess and describe the phenotypic variation in the coronal plane of knees affected by isolated lateral compartment osteoarthritis (OA). The secondary aim was to investigate the potential gender-specific and age-related differences in functional knee phenotypes among knees with isolated lateral compartment OA. METHODS A comprehensive classification system was used to categorize 305 knees with isolated lateral compartment OA based on their mechanical hip-knee-ankle angle (HKA), femoral mechanical angle (FMA), and tibial mechanical angle (TMA). The phenotypic variation of functional knee phenotypes was assessed for the entire cohort and stratified by gender and age category. RESULTS Among knees with isolated lateral compartment OA, a total of 60 distinct functional knee phenotypes were identified, with phenotype VALHKA6°NEUFMA0°VALTMA3° being the most prevalent (10.8 %). Gender-specific differences were evident, with females exhibiting significantly greater valgus alignment in both mean HKA and TMA values compared with males (HKA: -6.4° vs. -5.4°, respectively; P = 0.02 and TMA 94.4° vs. 89.0°, respectively; P = 0.005). Age-related variations included younger patients predominantly displaying femoral deformities, while older patients primarily exhibited isolated tibial- or combined femoral and tibial deformities. CONCLUSIONS There is a broad variation of functional knee phenotypes among knees affected by isolated lateral compartment OA, with gender-specific and age-related differences. Recognizing this inherent phenotypic diversity during preoperative planning may facilitate the implementation of tailored approaches that account for the unique characteristics and bony deformities of the individual knee.
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Affiliation(s)
- G V Ten Noever de Brauw
- Hospital for Special Surgery, Department of Orthopaedic Surgery, Computer Assisted Surgery Center & Sports Medicine, Weill Medical College of Cornell University, New York, NY, USA; Amsterdam UMC location University of Amsterdam, Department of Orthopaedic Surgery, Amsterdam, the Netherlands.
| | - T Bayoumi
- Hospital for Special Surgery, Department of Orthopaedic Surgery, Computer Assisted Surgery Center & Sports Medicine, Weill Medical College of Cornell University, New York, NY, USA; Amsterdam UMC location University of Amsterdam, Department of Orthopaedic Surgery, Amsterdam, the Netherlands
| | - L V Ruderman
- Hospital for Special Surgery, Department of Orthopaedic Surgery, Computer Assisted Surgery Center & Sports Medicine, Weill Medical College of Cornell University, New York, NY, USA
| | - G M M J Kerkhoffs
- Amsterdam UMC location University of Amsterdam, Department of Orthopaedic Surgery, Amsterdam, the Netherlands; Amsterdam Movement Sciences, Sports, Amsterdam, the Netherlands
| | - H A Zuiderbaan
- Medische Kliniek Velsen, Department of Orthopaedic Surgery, Velsen-Noord, the Netherlands
| | - A D Pearle
- Hospital for Special Surgery, Department of Orthopaedic Surgery, Computer Assisted Surgery Center & Sports Medicine, Weill Medical College of Cornell University, New York, NY, USA
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Sterneder CM, Faschingbauer M, Haralambiev L, Kasparek MF, Boettner F. Why Kinematic Alignment Makes Little Sense in Valgus Osteoarthritis of the Knee: A Narrative Review. J Clin Med 2024; 13:1302. [PMID: 38592153 PMCID: PMC10932440 DOI: 10.3390/jcm13051302] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2024] [Revised: 02/20/2024] [Accepted: 02/22/2024] [Indexed: 04/10/2024] Open
Abstract
There is a debate about the best alignment strategies in total knee arthroplasty (TKA). Mechanical alignment (MA) targets in combination with necessary soft tissue releases are the gold standard for TKA in end-stage valgus osteoarthritis. Some authors propagate kinematic alignment (KA) with the aim of restoring the patient's native alignment and minimizing the need for soft tissue releases. Our previous studies showed that MA with standardized soft tissue release produces reproducible results, and that the preoperative phenotype does not influence the results of patients with valgus osteoarthritis. These data suggest that there is no functional advantage to preserving valgus alignment in patients with valgus osteoarthritis. Many patients with valgus osteoarthritis present with a compromised medial collateral ligament and leaving the knee in valgus could increase the risk of secondary instability. The current literature supports MA TKA with soft tissue release as the gold standard. While using more sophisticated enabling technologies like robotic surgery might allow for aiming for very slight (1-2°) valgus alignment on the femoral side, any valgus alignment outside this range should be avoided. This review paper summarizes our current knowledge on the surgical techniques of TKA in patients with valgus osteoarthritis.
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Affiliation(s)
- Christian Manuel Sterneder
- Adult Reconstruction and Joint Replacement Department, Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021, USA
| | - Martin Faschingbauer
- Department of Orthopedic Surgery, University of Ulm, Oberer Eselsberg 45, 89081 Ulm, Germany
| | - Lyubomir Haralambiev
- Center for Orthopaedics, Trauma Surgery and Rehabilitation Medicine, University Medicine Greifswald, Ferdinand-Sauerbruch-Straße, 17475 Greifswald, Germany
| | - Maximilian F. Kasparek
- Department of Orthopedics, Evangelisches Krankenhaus, Hans-Sachs Gasse 10-12, 1180 Vienna, Austria
| | - Friedrich Boettner
- Adult Reconstruction and Joint Replacement Department, Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021, USA
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Jiang X, Xie K, Chen H, Zhang K, Hu Y, Kan T, Sun L, Ai S, Zhu X, Zhang L, Yan M, Wang L. A Radiographic Analysis of Coronal Morphological Parameters of Lower Limbs in Chinese Non-knee Osteoarthritis Populations. Orthop Surg 2024; 16:452-461. [PMID: 38088238 PMCID: PMC10834221 DOI: 10.1111/os.13952] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Revised: 10/22/2023] [Accepted: 10/24/2023] [Indexed: 02/03/2024] Open
Abstract
OBJECTIVES Analyzing the lower limb coronal morphological parameters in populations without knee osteoarthritis (KOA) holds significant value in predicting, diagnosing, and formulating surgical strategies for KOA. This study aimed to comprehensively analyze the variability in these parameters among Chinese non-KOA populations, employing a substantial sample size. METHODS A cross-sectional retrospective analysis was performed on the Chinese non-KOA populations (n = 407; 49.9% females). The study employed an in-house developed artificial intelligence software to meticulously assess the coronal morphological parameters of all 814 lower limbs. The parameters evaluated included the hip-knee-ankle angle (HKAA), weight-bearing line ratio (WBLR), joint line convergence angle (JLCA), mechanical lateral-proximal-femoral angle (mLPFA), mechanical lateral-distal-femoral angle (mLDFA), mechanical medial-proximal-tibial angle (mMPTA), and mechanical lateral-distal-tibial angle (mLDTA). Differences in these parameters were compared between left and right limbs, different genders, and different age groups (with 50 years as the cut-off point). RESULTS HKAA and JLCA exhibited left-right differences (left vs. right: 178.2° ± 3.0° vs. 178.6° ± 2.9° for HKAA, p = 0.001; and 1.8° ± 1.5° vs. 1.4° ± 1.6° for JLCA, p < 0.001); except for the mLPFA, all other parameters show gender-related differences (male vs. female: 177.9° ± 2.8° vs. 179.0° ± 3.0° for HKAA, p < 0.001; 1.5° ± 1.5° vs. 1.8° ± 1.7° for JLCA, p = 0.003; 87.1° ± 2.1° vs. 88.1° ± 2.1° for mMPTA, p < 0.001; 90.2° ± 4.0° vs. 91.1° ± 3.2° for mLDTA, p < 0.001; 38.7% ± 12.9% vs. 43.6% ± 14.1% for WBLR, p < 0.001; and 87.7° ± 2.3° vs. 87.4° ± 2.7° for mLDTA, p = 0.045); mLPFA increase with age (younger vs. older: 90.1° ± 7.2° vs. 93.4° ± 4.9° for mLPFA, p < 0.001), while no statistical difference exists for other parameters. CONCLUSIONS There were differences in lower limb coronal morphological parameters among Chinese non-KOA populations between left and right sides, different genders, and age.
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Affiliation(s)
- Xu Jiang
- Shanghai Frontiers Science Center of Degeneration and Regeneration in Skeletal System, Shanghai Key Laboratory of Orthopaedic Implants, Department of Orthopaedic SurgeryShanghai Jiao Tong University of Medicine affiliated Ninth People's HospitalShanghaiChina
| | - Kai Xie
- Shanghai Frontiers Science Center of Degeneration and Regeneration in Skeletal System, Shanghai Key Laboratory of Orthopaedic Implants, Department of Orthopaedic SurgeryShanghai Jiao Tong University of Medicine affiliated Ninth People's HospitalShanghaiChina
| | - Hongyu Chen
- Shanghai Frontiers Science Center of Degeneration and Regeneration in Skeletal System, Shanghai Key Laboratory of Orthopaedic Implants, Department of Orthopaedic SurgeryShanghai Jiao Tong University of Medicine affiliated Ninth People's HospitalShanghaiChina
| | - Kai Zhang
- Shanghai Frontiers Science Center of Degeneration and Regeneration in Skeletal System, Shanghai Key Laboratory of Orthopaedic Implants, Department of Orthopaedic SurgeryShanghai Jiao Tong University of Medicine affiliated Ninth People's HospitalShanghaiChina
| | - Yuqi Hu
- School of Biomedical EngineeringShanghai Jiao Tong UniversityShanghaiChina
| | - Tianyou Kan
- Shanghai Frontiers Science Center of Degeneration and Regeneration in Skeletal System, Shanghai Key Laboratory of Orthopaedic Implants, Department of Orthopaedic SurgeryShanghai Jiao Tong University of Medicine affiliated Ninth People's HospitalShanghaiChina
| | - Lin Sun
- Shanghai Frontiers Science Center of Degeneration and Regeneration in Skeletal System, Shanghai Key Laboratory of Orthopaedic Implants, Department of Orthopaedic SurgeryShanghai Jiao Tong University of Medicine affiliated Ninth People's HospitalShanghaiChina
| | - Songtao Ai
- Department of RadiologyShanghai Jiao Tong University of Medicine affiliated Ninth People's HospitalShanghaiChina
| | - Xianping Zhu
- Department of Orthopaedic SurgeryTaizhou Central HospitalTaizhouChina
| | - Lichi Zhang
- School of Biomedical EngineeringShanghai Jiao Tong UniversityShanghaiChina
| | - Mengning Yan
- Shanghai Frontiers Science Center of Degeneration and Regeneration in Skeletal System, Shanghai Key Laboratory of Orthopaedic Implants, Department of Orthopaedic SurgeryShanghai Jiao Tong University of Medicine affiliated Ninth People's HospitalShanghaiChina
| | - Liao Wang
- Shanghai Frontiers Science Center of Degeneration and Regeneration in Skeletal System, Shanghai Key Laboratory of Orthopaedic Implants, Department of Orthopaedic SurgeryShanghai Jiao Tong University of Medicine affiliated Ninth People's HospitalShanghaiChina
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Guo H, Zhou K, Sun Z, Feng A, Qin S, Liu L, Sun R, Wang X. Morphological Changes of the Posterior Femoral Condyle After Medial Patellar Retinaculum Plasty in Skeletally Immature Patients With Recurrent Patellar Dislocation and Trochlear Dysplasia. Orthop J Sports Med 2024; 12:23259671231225671. [PMID: 38304055 PMCID: PMC10832434 DOI: 10.1177/23259671231225671] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2023] [Accepted: 08/17/2023] [Indexed: 02/03/2024] Open
Abstract
Background Surgical correction for recurrent patellar dislocation (RPD) can improve femoral trochlear morphology; nonetheless, the effects of surgical correction on femoral condyle morphology are unclear. Purpose To investigate the morphological changes in the posterior femoral condyle in skeletally immature patients with RPD and trochlear dysplasia (TD) after surgical correction. Study Design Cohort study; Level of evidence, 3. Methods A total of 20 skeletally immature patients with bilateral RPD and TD were included in this study. For each patient, the knee that was dislocated more frequently or had sustained a recent injury was treated with medial patellar retinaculum plasty (group S; n = 20 knees), and the asymptomatic or only occasionally dislocated contralateral knee was treated conservatively (group C; n = 20 knees). The lengths of the anterior medial and lateral femoral condyles and the lengths of the posterior medial and lateral femoral condyles were evaluated preoperatively and at the final follow-up. Trochlear morphological characteristics, tibial tuberosity-trochlear groove distance, and patellar tilt angle were compared between preoperative and final follow-up values with the 2-sample paired Student t test and were compared between groups S and C with the independent-samples t test. Results The mean follow-up time was 60.7 ± 4.8 months. No knee in group S experienced a redislocation, whereas 80% (16/20) of knees in group C experienced a dislocation. There were significant group differences in the ratio of the posterior medial femoral condyle (PMFC) to the posterior lateral femoral condyle (PLFC) (group S, 1.08 ± 0.05; group C, 1.14 ± 0.06; P = .042). There was no significant difference in the ratio of the anterior lateral femoral condyle to the anterior medial femoral condyle (group S, 1.16 ± 0.13; group C, 1.18 ± 0.09; P = .635). In group S, all trochlear morphological characteristics and patellofemoral joint characteristics improved compared with preoperatively (P≤ .047 for all). In addition, all values significantly differed between groups S and C at the final follow-up (P≤ .044 for all). Conclusion The study findings demonstrated that the morphology of the posterior femoral condyle in skeletally immature patients with bilateral RPD and TD changes after surgical correction, with the PLFC growing faster than the PMFC.
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Affiliation(s)
- Hailong Guo
- Department of Orthopaedic Surgery, The Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, China
| | - Kezhen Zhou
- Department of Orthopaedic Surgery, The Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, China
| | - Zhiwen Sun
- Department of Orthopaedic Surgery, The Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, China
| | - Ao Feng
- Department of Orthopaedic Surgery, The Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, China
| | - Shiqi Qin
- Department of Orthopaedic Surgery, The Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, China
| | - Lei Liu
- Department of Orthopaedic Surgery, The Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, China
| | - Ran Sun
- Department of Orthopaedic Surgery, The Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, China
| | - Xiaofeng Wang
- Department of Orthopaedic Surgery, The Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, China
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Motta DP, Faria JLR, Couto A, Aguiar DP, Amaral MVG, Kropf LL, Motta GAVA, Cerqueira FS, Leonetti BD. Gradual Correction of Valgus Deformities of the Tibia Using a Monolateral External Fixator. Strategies Trauma Limb Reconstr 2023; 18:123-132. [PMID: 37942429 PMCID: PMC10628620 DOI: 10.5005/jp-journals-10080-1585] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2023] [Accepted: 05/03/2023] [Indexed: 11/10/2023] Open
Abstract
Objective To present a review of patients subjected to gradual correction of a valgus deformity of the tibia using a monolateral external fixator. Method This retrospective review included patients from January 2012 to May 2022 who met the following inclusion criteria: deviation of mechanical axis of the limb due to valgus deformity of the tibia; tibial deformity in the coronal plane on radiographic examination; a documented outpatient pre-operative evaluation by an orthopaedic surgeon and age between 10 and 70 years. The following exclusion criteria were applied: the presence of another tibia deformity preventing gradual correction using the proposed assembly; skin conditions incompatible with the surgical procedure; inadequate pre- or post-operative radiological evaluation; and insufficient information in the medical records. Results The mean age of patients with a valgus deformity of the tibia was 30.8 ± 15.9 years. These patients had a body mass index (BMI) of 26.1 ± 5.5 kg/m2. A congenital or developmental aetiology was attributed to 58.3% of the cases. Most commonly, the deformity was found in the middle third of the tibia with a mean deformity of 14.7 ± 6.6 degrees. The total external fixator time ranged from 73 to 229 days (average 149.7 ± 36.1 days). The mean medial proximal and lateral distal tibial angles differed significantly for pre- and post-operative measurements (p ≤ 0.05). There were complications in eight cases; five cases of pin site infections, two cases of medial cortical fracture and one case of peroneal nerve neuropraxia. Conclusion The proposed correction technique produces a satisfactory angular correction and with similar outcomes as described in the literature. How to cite this article Motta DP, Faria JLR, Couto A, et al. Gradual Correction of Valgus Deformities of the Tibia Using a Monolateral External Fixator. Strategies Trauma Limb Reconstr 2023;18(2):123-132.
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Affiliation(s)
- DP Motta
- Center for Specialized Care of the Treatment Area of Dysmetry and Deformities of the Locomotor System, National Institute of Traumatology and Orthopedics, Rio de Janeiro, Brazil
| | - JLR Faria
- Center for Specialized Care of Knee Surgery, National Institute of Traumatology and Orthopedics, Rio de Janeiro, Brazil
| | - A Couto
- National Institute of Traumatology and Orthopedics, Rio de Janeiro, Brazil
| | - DP Aguiar
- Biophysics Chair, State University of Rio de Janeiro, Brazil
| | - MVG Amaral
- Center for Specialized Care Shoulder and Elbow Surgery, National Institute of Traumatology and Orthopedics, Rio de Janeiro, Brazil
| | - LL Kropf
- Center for Specialized Care of the Treatment Area of Dysmetry and Deformities of the Locomotor System, National Institute of Traumatology and Orthopedics, Rio de Janeiro, Brazil
| | - GAVA Motta
- Center for Specialized Care of the Treatment Area of Dysmetry and Deformities of the Locomotor System, National Institute of Traumatology and Orthopedics, Rio de Janeiro, Brazil
| | - FS Cerqueira
- Center for Specialized Care of the Treatment Area of Dysmetry and Deformities of the Locomotor System, National Institute of Traumatology and Orthopedics, Rio de Janeiro, Brazil
| | - BD Leonetti
- Center for Specialized Care of the Treatment Area of Dysmetry and Deformities of the Locomotor System, National Institute of Traumatology and Orthopedics, Rio de Janeiro, Brazil
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Chen S, Yan F, Zhong A, Cai L. Effect of Thermal Ablation on Growth Plates: A Study to Explore the Thermal Threshold of Rabbit Growth Plates During Microwave Ablation. Cardiovasc Intervent Radiol 2023; 46:112-119. [PMID: 36053343 DOI: 10.1007/s00270-022-03238-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Accepted: 07/20/2022] [Indexed: 01/06/2023]
Abstract
PURPOSE To explore the temperature threshold of thermal damage to growth plates. METHODS Nine rabbits were divided into three groups for femoral ablation, exposing the growth plate to different temperatures (T1 = 43-45 °C; T2 = 46-48 °C; T3 = 49-51 °C). After 5 weeks, the changes in the femurs were assessed by macroscopic images, micro-CT, haematoxylin and eosin staining, and immunohistochemistry of Col2a1 (type II collagen). At the cellular level, rabbit epiphyseal chondrocytes were exposed to 37 °C, 44 °C, 47 °C and 50 °C for 5 min. Then, proliferation and chondrogenic differentiation were detected. RESULTS The rabbits in the T2 and T3 groups developed length discrepancies and axial deviations of femurs, abnormal newly formed bone in the marrow cavity, disorganized growth plates and decreased Col2a1 expression. At the cellular level, the cells exposed to 47 °C and 50 °C for 5 min showed decreased viability, increased apoptosis, decreased extracellular matrix synthesis and decreased matrix mineralization. However, the changes in rabbits in the T1 group and cells at 44 °C did not show a significant difference. CONCLUSION The ablation of growth plates at temperatures above 45 °C for 5 min results in decreased chondrocyte viability and disorganized growth plates, leading to growth disturbances. Further studies are warranted to confirm these promising initial results.
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Affiliation(s)
- Shiliang Chen
- Department of Orthopedics, Zhongnan Hospital of Wuhan University, No.169, Donghu Road, Wuchang District, Wuhan City, Hubei Province, People's Republic of China
| | - Feifei Yan
- Department of Orthopedics, Zhongnan Hospital of Wuhan University, No.169, Donghu Road, Wuchang District, Wuhan City, Hubei Province, People's Republic of China
| | - Ang Zhong
- Department of Orthopedics, Zhongnan Hospital of Wuhan University, No.169, Donghu Road, Wuchang District, Wuhan City, Hubei Province, People's Republic of China
| | - Lin Cai
- Department of Orthopedics, Zhongnan Hospital of Wuhan University, No.169, Donghu Road, Wuchang District, Wuhan City, Hubei Province, People's Republic of China.
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Hart DA. Sex differences in musculoskeletal injury and disease risks across the lifespan: Are there unique subsets of females at higher risk than males for these conditions at distinct stages of the life cycle? Front Physiol 2023; 14:1127689. [PMID: 37113695 PMCID: PMC10126777 DOI: 10.3389/fphys.2023.1127689] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Accepted: 03/28/2023] [Indexed: 04/29/2023] Open
Abstract
Sex differences have been reported for diseases of the musculoskeletal system (MSK) as well as the risk for injuries to tissues of the MSK system. For females, some of these occur prior to the onset of puberty, following the onset of puberty, and following the onset of menopause. Therefore, they can occur across the lifespan. While some conditions are related to immune dysfunction, others are associated with specific tissues of the MSK more directly. Based on this life spectrum of sex differences in both risk for injury and onset of diseases, a role for sex hormones in the initiation and progression of this risk is somewhat variable. Sex hormone receptor expression and functioning can also vary with life events such as the menstrual cycle in females, with different tissues being affected. Furthermore, some sex hormone receptors can affect gene expression independent of sex hormones and some transitional events such as puberty are accompanied by epigenetic alterations that can further lead to sex differences in MSK gene regulation. Some of the sex differences in injury risk and the post-menopausal disease risk may be "imprinted" in the genomes of females and males during development and sex hormones and their consequences only modulators of such risks later in life as the sex hormone milieu changes. The purpose of this review is to discuss some of the relevant conditions associated with sex differences in risks for loss of MSK tissue integrity across the lifespan, and further discuss several of the implications of their variable relationship with sex hormones, their receptors and life events.
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Motta DPD, Faria JLRD, Cruz CM, Aguiar DP, Amaral MVG, Kropf LL, Motta GATAD, Cerqueira FDS, Leonetti BD, Cerqueira FDS. Lateral Gradual Opening Osteotomy of the Tibia With Monolateral External Fixator for Correcting the Valgus Deformity of the Tibia. Arthrosc Tech 2022; 11:e2271-e2277. [PMID: 36632387 PMCID: PMC9827065 DOI: 10.1016/j.eats.2022.08.036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Accepted: 08/17/2022] [Indexed: 11/20/2022] Open
Abstract
The valgus deformity in the tibia requires correction because it places increased pressure on the lateral compartment of the knee, intensifying the degenerative process. Correction strategies are diverse and depend on patient profile, age, and soft-tissue conditions as well as the orthopaedic surgeon's experience with different surgical materials. Deformity size and location are the primary factors contributing to material and shape choice, whether gradual or acute. The only gradual correction approach involves the use of a monolateral or circular external fixator. This is the only indication for correction in cases of excellent deformity, soft-tissue involvement, and a history of bone infection. This study aimed to present a gradual correction technique for tibial valgus deformity using a monolateral external fixator as well as its postoperative follow-up. This technique has the advantages of greater patient acceptance, lighter assembly, and briefer distraction owing to the use of a single piece as well as the ability of the operated limb to bear a load the day after the surgical procedure and dynamic outpatient follow-up.
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Affiliation(s)
- Diego Perez da Motta
- Center for Specialized Care of the Treatment Area of Dysmetry and Deformities of the Locomotor System, National Institute of Traumatology and Orthopedics, Rio de Janeiro, Brazil,Address correspondence to Diego Perez da Motta, Instituto Nacional de Traumatologia e Ortopedia Jamil Haddad - Av. Brasil, 500, São Cristovão. CEP: 20940-070.
| | - José Leonardo Rocha de Faria
- Center for Specialized Care of Knee Surgery, National Institute of Traumatology and Orthopedics, Rio de Janeiro, Brazil
| | | | | | - Marcus Vinicius Galvão Amaral
- Center for Specialized Care Shoulder and Elbow Surgery, National Institute of Traumatology and Orthopedics, Rio de Janeiro, Brazil
| | - Leandro Lemgruber Kropf
- Center for Specialized Care of the Treatment Area of Dysmetry and Deformities of the Locomotor System, National Institute of Traumatology and Orthopedics, Rio de Janeiro, Brazil
| | - Guilherme Augusto Tapado Araújo da Motta
- Center for Specialized Care of the Treatment Area of Dysmetry and Deformities of the Locomotor System, National Institute of Traumatology and Orthopedics, Rio de Janeiro, Brazil
| | - Fernando dos Santos Cerqueira
- Center for Specialized Care of the Treatment Area of Dysmetry and Deformities of the Locomotor System, National Institute of Traumatology and Orthopedics, Rio de Janeiro, Brazil
| | - Bruno Domenico Leonetti
- Center for Specialized Care of the Treatment Area of Dysmetry and Deformities of the Locomotor System, National Institute of Traumatology and Orthopedics, Rio de Janeiro, Brazil
| | - Flavio dos Santos Cerqueira
- Center for Specialized Care of the Treatment Area of Dysmetry and Deformities of the Locomotor System, National Institute of Traumatology and Orthopedics, Rio de Janeiro, Brazil
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Eller K, Scior W, Graichen H. Dynamic gap analysis of valgus knees shows large inter-individual variability of gaps. Knee Surg Sports Traumatol Arthrosc 2022; 31:1398-1404. [PMID: 36083353 DOI: 10.1007/s00167-022-07088-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Accepted: 07/24/2022] [Indexed: 12/01/2022]
Abstract
PURPOSE The purpose of this study was to investigate the dynamic gap widths of valgus knees in extension and flexion to evaluate the influence of deformity on gap differences and to find out whether different ligamentous subtypes in valgus knees exist. METHODS Dynamic gap widths of 1000 consecutive total knee arthroplasty (TKA) patients were measured at different flexion angles by applying a computer-assisted surgery (CAS) technique. 198 knees showed a valgus deformity and were assessed regarding its degree of fulfillment of the following criteria of valgus knee: 1. Medial extension gap greater than lateral; 2. Medial flexion gap greater than lateral; 3. Flexion gap greater than extension gap. A single-factor ANOVA subgroup analysis was performed, based on the amount of deformity. The effect of other patient factors (age, gender, weight) on gap differences was investigated. RESULTS The medial extension gap (3.7 ± 2.2 mm) was significantly (p < 0.01) larger than the lateral extension gap (1.1 ± 2.9 mm). The amount of deformity correlated highly with gap difference in extension (r2 = 0.67) but not in flexion. In 92.4% (183), the flexion gap (6.2 ± 3.1 mm) was significantly (p < 0.01) larger than the extension gap (2.4 ± 2.3 mm). Only 29.3% (58) of patients met all three criteria, this was mainly due to the fact that in flexion the medial gap was larger than the lateral in only 35.4% (70). Patient factors showed no significant influences (NS) on the gap widths. CONCLUSION Valgus knees show large variability in terms of gap widths. The extent of deformity correlates highly with gap difference in extension, but not in other flexion angles. Vast majority of valgus knees were valgus in extension only. Because of this variability, it should be aimed for an individualized balancing technique based on intraoperative gap sizes. LEVEL OF EVIDENCE Level III.
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Affiliation(s)
- Kim Eller
- Department for Arthroplasty, Sports-Traumatology and General Orthopaedics, Asklepios Orthopaedic Hospital Lindenlohe, Lindenlohe 18, 92421, Schwandorf, Germany.
| | - Wolfgang Scior
- Department for Arthroplasty, Sports-Traumatology and General Orthopaedics, Asklepios Orthopaedic Hospital Lindenlohe, Lindenlohe 18, 92421, Schwandorf, Germany
| | - Heiko Graichen
- Department for Arthroplasty, Sports-Traumatology and General Orthopaedics, Asklepios Orthopaedic Hospital Lindenlohe, Lindenlohe 18, 92421, Schwandorf, Germany
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Mullaji A, Bhoskar R, Singh A, Haidermota M. Valgus arthritic knees can be classified into nine phenotypes. Knee Surg Sports Traumatol Arthrosc 2022; 30:2895-2904. [PMID: 34750671 DOI: 10.1007/s00167-021-06796-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Accepted: 10/28/2021] [Indexed: 11/24/2022]
Abstract
PURPOSE It is not shown whether anatomical variations exist in valgus arthritic limbs as to support individualized component and limb alignment. The null hypothesis was that there was no phenotypic variation of coronal femoro-tibial morphology in valgus knees. The aim was to determine whether distinct phenotypes of valgus knees could be identified to help surgical planning and classifying valgus knees for outcome studies. METHODS Full-leg weight-bearing radiographs of 233 knees (182 preoperative; 51 of contralateral arthritic knee) were measured for HKA (hip-knee-ankle angle), VCA (valgus correction angle), mLDFA (lateral mechanical distal femoral angle), aLDFA (lateral anatomical distal femoral angle), MPTA (medial proximal tibial angle), MNSA (medial neck shaft angle), TAMA (angle between tibial mechanical and anatomical axes), and TBA (tibial bowing angle). RESULTS Nine phenotypes were identified encompassing all 233 knees which could be clubbed into 4 broad types. Type 1 Neutral knees (12.5%) had almost normal values (mean VCA 5.3°, mLDFA 86.9°, aLDFA 81.1°). Type 2 'Intra-articular valgus' (22.7%) showed lateral compartment bone loss (mean mLDFA 83.9°; MPTA 90.2°). Type 3 'Extra-articular valgus' (35.2%) had extra-articular deformity: 3a showed valgus femoral bowing (mean VCA 2.7°); 3b valgus tibial bowing; 3c showed valgus tibial bowing with lateral femoral condyle wear (mean mLDFA 84.3°). Type 4 'Varus' type (29.6%) had features of varus knees: 4a had varus femoral bowing (VCA 8.3°); distal femur in 4b was akin to varus knees (mean mLDFA 89.3°) with lateral tibial bone loss (mean MPTA 91.2°). 4c had varus tibial bowing and deficient lateral femoral condyle (mLDFA 83.7°). 4d had varus tibial bowing and lateral tibial bone loss (mean MPTA 89.8°). CONCLUSIONS The study identified four broad groups of valgus arthritic knees with nine phenotypes based on coronal plane variations in femoro-tibial morphology. This study may be of value in planning and performing corrective osteotomies, and planning the optimal position of femoral and tibial components in unicompartmental and total knee arthroplasty. The classification presented in this study may aid in categorizing valgus knees for outcome studies. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Arun Mullaji
- Consultant Orthopaedic Surgeon, Breach Candy Hospital, and Mullaji Knee Clinic, Bhulabhai Desai Road, Mumbai, 400036, India.
| | - Ritesh Bhoskar
- Associate Orthopaedic Surgeon, Mullaji Knee Clinic, Mumbai, 400036, India
| | - Abhimanyu Singh
- Associate Orthopaedic Surgeon, Mullaji Knee Clinic, Mumbai, 400036, India
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11
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Wang Z, Deng W, Shao H, Zhou Y, Yang D, Li H. Predictors of a forgotten joint after medial fixed-bearing unicompartmental knee arthroplasty. Knee 2022; 37:103-111. [PMID: 35753203 DOI: 10.1016/j.knee.2022.06.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2022] [Accepted: 06/09/2022] [Indexed: 02/02/2023]
Abstract
BACKGROUND A forgotten joint is considered the ultimate goal of joint replacement. We aim to explore the predictive factors of a forgotten joint after fixed-bearing unicompartmental knee arthroplasty (UKA). METHODS This retrospective cohort study used prospectively collected data from 302 cases of medial-compartment UKA with a minimum of 2-year follow-up. The primary outcome was the achievement of a forgotten joint after UKA, according to the Forgotten Joint Score (FJS-12) at the last follow-up. Patients with FJS-12 > 84 were considered to have forgotten UKA. Univariate and multivariate logistic regression analyses were conducted with preoperative patient characteristics and surgery-related factors as potential predictors. RESULTS Of patients, 94 (31.1%) achieved a forgotten joint post-surgery. Multivariate logistic regression analysis revealed that preoperative hip-knee-ankle angle (HKAA), anatomic lateral distal femoral angle (aLDFA), and postoperative HKAA and HKAA changes were independent predictors of a forgotten joint. The probability of achieving a forgotten joint increased by 29% (OR = 1.29, 95% CI: 1.12-1.51) with a 1° increase in aLDFA. Preoperative HKAA, postoperative HKAA, HKAA changes (ΔHKAA), and outcomes exhibited a non-linear relationship. The probability of achieving a forgotten joint was the highest with preoperative HKAA > 172.0°, postoperative HKAA of 176.0-178.5°, and ΔHKAA < 5.5°. CONCLUSION To achieve the forgotten joint state, the ideal HKAA range after medial fixed-bearing UKA is 176.0-178.5° and ΔHKAA should be <5.5°. Patients with smaller preoperative aLDFA and HKAA have a lower probability of achieving a forgotten joint after UKA.
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Affiliation(s)
- Zhaolun Wang
- Department of Orthopaedic Surgery, Beijing Jishuitan Hospital, Fourth Clinical College of Peking University, No. 31 Xinjiekou East Street, Xicheng District, Beijing 100035, China
| | - Wang Deng
- Department of Orthopaedic Surgery, Beijing Jishuitan Hospital, Fourth Clinical College of Peking University, No. 31 Xinjiekou East Street, Xicheng District, Beijing 100035, China
| | - Hongyi Shao
- Department of Orthopaedic Surgery, Beijing Jishuitan Hospital, Fourth Clinical College of Peking University, No. 31 Xinjiekou East Street, Xicheng District, Beijing 100035, China
| | - Yixin Zhou
- Department of Orthopaedic Surgery, Beijing Jishuitan Hospital, Fourth Clinical College of Peking University, No. 31 Xinjiekou East Street, Xicheng District, Beijing 100035, China.
| | - Dejin Yang
- Department of Orthopaedic Surgery, Beijing Jishuitan Hospital, Fourth Clinical College of Peking University, No. 31 Xinjiekou East Street, Xicheng District, Beijing 100035, China
| | - Hua Li
- Department of Orthopedics, General Hospital of Chinese PLA, No. 28 Fuxing Road, Beijing 100853, China; National Clinical Research Center for Orthopedics, Sports Medicine & Rehabilitation, No. 28 Fuxing Road, Beijing 100853, China
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12
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Erard J, Batailler C, Swan J, Sappey-Marinier E, Servien E, Lustig S. Lateral approach total knee arthroplasty achieves equivalent patellar tracking in severe valgus deformity compared to mild valgus deformity. Knee Surg Sports Traumatol Arthrosc 2022; 30:740-752. [PMID: 33492408 DOI: 10.1007/s00167-021-06451-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Accepted: 01/11/2021] [Indexed: 10/22/2022]
Abstract
PURPOSE Patellar tracking problems represent 2-10% of complications of total knee arthroplasties (TKA) in valgus knees. However, there are no studies assessing patellar tracking according to the severity of the valgus deformity. The hypothesis was that lateral approach TKA in severe valgus deformity provides equivalent patellar tracking to that in knees with mild valgus deformity. METHODS Between 1988 and 2016, 77 TKAs were performed via a lateral approach on a severe valgus deformity (HKA > 195°). Forty-three TKAs performed without tibial tubercle osteotomy and with complete radiological data were included in this study. These were compared with 86 matched TKAs performed via a lateral approach with a mild valgus deformity (HKA between 181° and 190°). Patellar tilt and patellar position were assessed by axial view radiographs at the last follow-up. Complications and clinical outcomes were also evaluated. RESULTS The follow-up was mean 52 ± 21 months in the severe valgus group. No significant differences were found between the severe valgus deformity group and the mild valgus deformity groups in patellar tilt (1.6° ± 6.6° versus 1.9° ± 3.2°, respectively) or patellar subluxation. There were complications in 12% (n = 5) and 11% (n = 9) of the severe valgus group and the mild valgus group respectively, without significant difference. There was no significant difference in extensor mechanism complication rate (2.3% versus 4.7%, respectively). CONCLUSION Lateral parapatellar approach, without tibial tubercle osteotomy, for TKA in severe valgus deformity results in good patellar tracking. With this approach, the extensor mechanism complication rate in severe valgus deformity was not higher than for mild valgus deformity. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Julien Erard
- Orthopaedics Surgery and Sports Medicine Department, FIFA Medical Center of Excellence, Hôpital de La Croix Rousse, Hospices Civils de Lyon, Lyon North University Hospital, 103 Grande Rue de la Croix Rousse, 69004, Lyon, France
| | - Cécile Batailler
- Orthopaedics Surgery and Sports Medicine Department, FIFA Medical Center of Excellence, Hôpital de La Croix Rousse, Hospices Civils de Lyon, Lyon North University Hospital, 103 Grande Rue de la Croix Rousse, 69004, Lyon, France. .,Univ Lyon, Claude Bernard Lyon 1 University, IFSTTAR, LBMC UMR_T9406, 69622, Lyon, France.
| | - John Swan
- Orthopaedics Surgery and Sports Medicine Department, FIFA Medical Center of Excellence, Hôpital de La Croix Rousse, Hospices Civils de Lyon, Lyon North University Hospital, 103 Grande Rue de la Croix Rousse, 69004, Lyon, France
| | - Elliot Sappey-Marinier
- Orthopaedics Surgery and Sports Medicine Department, FIFA Medical Center of Excellence, Hôpital de La Croix Rousse, Hospices Civils de Lyon, Lyon North University Hospital, 103 Grande Rue de la Croix Rousse, 69004, Lyon, France
| | - Elvire Servien
- Orthopaedics Surgery and Sports Medicine Department, FIFA Medical Center of Excellence, Hôpital de La Croix Rousse, Hospices Civils de Lyon, Lyon North University Hospital, 103 Grande Rue de la Croix Rousse, 69004, Lyon, France.,LIBM-EA 7424, Interuniversity Laboratory of Biology of Mobility, Claude Bernard Lyon 1 University, Lyon, France
| | - Sébastien Lustig
- Orthopaedics Surgery and Sports Medicine Department, FIFA Medical Center of Excellence, Hôpital de La Croix Rousse, Hospices Civils de Lyon, Lyon North University Hospital, 103 Grande Rue de la Croix Rousse, 69004, Lyon, France.,Univ Lyon, Claude Bernard Lyon 1 University, IFSTTAR, LBMC UMR_T9406, 69622, Lyon, France
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13
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Zhou Y, Tan Q, Liu K, Liu Y, Zhu G, Mei H, Yang G. Epidemiological and clinical characteristics of congenital pseudarthrosis of the tibia in China. Front Pediatr 2022; 10:943917. [PMID: 36090554 PMCID: PMC9452726 DOI: 10.3389/fped.2022.943917] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2022] [Accepted: 07/29/2022] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Congenital pseudarthrosis of the tibia (CPT) is a refractory and rare disease. Because of its extremely low incidence, little is known about its clinical features. In this retrospective study, we aim to analyze the clinical characteristics of patients with CPT. MATERIALS AND METHODS This is a retrospective study of children with CPT identified by the radiological review. Investigations of CPT included general conditions, the characteristics of CPT, treatment methods, and surgical complications. RESULTS We collected 514 CPT cases from March 1999 to March 2020 in our hospital, such as 317 (61.67%) boys, 197 (38.33%) girls; 330 (62.86%) in Crawford IV; 510 (97.14%) in mid and distal 1/3 tibia; 481 (93.58%) in less than 3 years at onset age; 297 (57.78%) in less than 3 years at the first outpatient visit. The most common post-operative complication was ankle valgus (101, 39.60%), followed by limb length discrepancy (91, 35.69%), refracture (38, 14.90%), osteomyelitis (15, 5.88%), and removal of internal fixation (10, 3.93%). CONCLUSIONS CPT with a higher incidence of Crawford IV frequently occurs in boys and the middle or distal part of the tibia; most patients have the onset age and first outpatient visit before 3 years; the major surgical complications are ankle valgus and limb length discrepancy.
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Affiliation(s)
- Yijun Zhou
- The First Affiliated Hospital of Ji'nan University (Guangzhou Overseas of Chinese Hospital), Guangzhou, China.,The First People's Hospital of Changde, Guangde Clinical Institute of Xiangya Medical College of South Central University, Changde, China
| | - Qian Tan
- Department of Orthopedic Surgery, The Hunan Children's Hospital, Changsha, China
| | - Kun Liu
- Department of Orthopedic Surgery, The Hunan Children's Hospital, Changsha, China
| | - Yaoxi Liu
- Department of Orthopedic Surgery, The Hunan Children's Hospital, Changsha, China
| | - Guanghui Zhu
- Department of Orthopedic Surgery, The Hunan Children's Hospital, Changsha, China
| | - Haibo Mei
- Department of Orthopedic Surgery, The Hunan Children's Hospital, Changsha, China
| | - Ge Yang
- Department of Orthopedic Surgery, The Hunan Children's Hospital, Changsha, China
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14
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Mao L, Wu W, Wang M, Guo J, Li H, Zhang S, Xu J, Zou J. Targeted treatment for osteoarthritis: drugs and delivery system. Drug Deliv 2021; 28:1861-1876. [PMID: 34515606 PMCID: PMC8439249 DOI: 10.1080/10717544.2021.1971798] [Citation(s) in RCA: 33] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
The management of osteoarthritis (OA) is a clinical challenge due to the particular avascular, dense, and occluded tissue structure. Despite numerous clinical reports and animal studies, the pathogenesis and progression of OA are still not fully understood. On the basis of traditional drugs, a large number of new drugs have been continuously developed. Intra-articular (IA) administration for OA hastens the development of targeted drug delivery systems (DDS). OA drugs modification and the synthesis of bioadaptive carriers contribute to a qualitative leap in the efficacy of IA treatment. Nanoparticles (NPs) are demonstrated credible improvement of drug penetration and retention in OA. Targeted nanomaterial delivery systems show the prominent biocompatibility and drug loading-release ability. This article reviews different drugs and nanomaterial delivery systems for IA treatment of OA, in an attempt to resolve the inconsonance between in vitro and in vivo release, and explore more interactions between drugs and nanocarriers, so as to open up new horizons for the treatment of OA.
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Affiliation(s)
- Liwei Mao
- School of Kinesiology, Shanghai University of Sport, Shanghai, China
| | - Wei Wu
- School of Kinesiology, Shanghai University of Sport, Shanghai, China
| | - Miao Wang
- School of Kinesiology, Shanghai University of Sport, Shanghai, China
| | - Jianmin Guo
- School of Kinesiology, Shanghai University of Sport, Shanghai, China
| | - Hui Li
- School of Kinesiology, Shanghai University of Sport, Shanghai, China
| | - Shihua Zhang
- School of Kinesiology, Shanghai University of Sport, Shanghai, China
| | - Jiake Xu
- School of Biomedical Sciences, The University of Western Australia, Perth, Australia
| | - Jun Zou
- School of Kinesiology, Shanghai University of Sport, Shanghai, China
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15
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Grammens J, Van Haver A, Danckaers F, Booth B, Sijbers J, Verdonk P. Small medial femoral condyle morphotype is associated with medial compartment degeneration and distinct morphological characteristics: a comparative pilot study. Knee Surg Sports Traumatol Arthrosc 2021; 29:1777-1789. [PMID: 32797248 PMCID: PMC8126545 DOI: 10.1007/s00167-020-06218-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Accepted: 08/06/2020] [Indexed: 01/17/2023]
Abstract
PURPOSE Early-onset degeneration of the knee is linked to genetics, overload, injury, and potentially, knee morphology. The purpose of this study is to explore the characteristics of the small medial femoral condyle, as a distinct knee morphotype, by means of a landmark-based three-dimensional (3D) analysis and statistical parametric mapping. METHODS Sixteen knees with a small medial femoral condyle (SMC) were selected from a database of patients with distinct knee joint anatomy and 16 gender-matched knees were selected from a control group database. 3D models were generated from the medical imaging. After normalization for size, a set of pre-defined landmark-based parameters was analysed for the femur and tibia. Local shape differences were evaluated by matching all bone surfaces onto each other and comparing the distances to the mean control group bone shape. RESULTS The small medial condyle group showed a significant association with medial compartment degeneration and had a 4% and 13% smaller medial condyle anteroposteriorly and mediolaterally, whereas the distal femur was 3% wider mediolaterally. The lateral condyle was 2% smaller anteroposteriorly and 8% wider mediolaterally. The complete tibial plateau was 3% smaller mediolaterally and the medial tibial plateau was 6% smaller. CONCLUSION A new knee morphotype demonstrated an increased risk for medial compartment degeneration and was differentiated from a healthy control group based on the following morphological characteristics: a smaller medial femoral condyle and medial tibial plateau, a wider lateral femoral condyle and a wider distal femur on a smaller tibial plateau. This pilot study suggests a role for the SMC knee morphotype in the multifactorial process of medial compartment degeneration. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Jonas Grammens
- Antwerp Surgical Training, Anatomy and Research Centre (ASTARC), University of Antwerp, Universiteitsplein 1, 2610, Wilrijk, Belgium. .,imec-VisionLab, Department of Physics, University of Antwerp, Universiteitsplein 1, 2610, Wilrijk, Belgium.
| | - Annemieke Van Haver
- Antwerp Surgical Training, Anatomy and Research Centre (ASTARC), University of Antwerp, Universiteitsplein 1, 2610 Wilrijk, Belgium ,MoRe Institute, Stevenslei 20, 2100 Deurne, Belgium
| | - Femke Danckaers
- imec-VisionLab, Department of Physics, University of Antwerp, Universiteitsplein 1, 2610 Wilrijk, Belgium
| | - Brian Booth
- imec-VisionLab, Department of Physics, University of Antwerp, Universiteitsplein 1, 2610 Wilrijk, Belgium
| | - Jan Sijbers
- imec-VisionLab, Department of Physics, University of Antwerp, Universiteitsplein 1, 2610 Wilrijk, Belgium
| | - Peter Verdonk
- Antwerp Surgical Training, Anatomy and Research Centre (ASTARC), University of Antwerp, Universiteitsplein 1, 2610 Wilrijk, Belgium ,Antwerp Orthopaedic Centre Monica Hospitals, Stevenslei 20, 2100 Deurne, Belgium
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16
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Nodzo SR, Staub TM, Jancuska JM, Cobler-Lichter MD, Boyle KK, Rachala S. Flexion Space Balancing Through Component Positioning and Its Relationship to Traditional Anatomic Rotational Landmarks in Robotic Total Knee Arthroplasty. J Arthroplasty 2020; 35:1569-1575. [PMID: 32057599 DOI: 10.1016/j.arth.2020.01.051] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2019] [Revised: 12/26/2019] [Accepted: 01/20/2020] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND The use of the femoral component position to balance the flexion space and its relationship to the transepicondylar axis (TEA) and posterior condylar angle (PCA) has not been thoroughly evaluated. METHODS A total of 233 patients undergoing robotic arm-assisted total knee arthroplasty were evaluated. Native TEA and PCA were established on preoperative computed tomography scans. Femoral component rotation was set in the axial plane to match the native trochlea and native medial femoral condyle to set the flexion gap. Knee flexion space gaps and component position were recorded. The relationship of the femoral component to the native TEA, PCA, and preoperative radiographic landmarks was evaluated. RESULTS The intraoperative measured medial flexion space gap did not significantly correlate with the relationship of the femoral component to the PCA or TEA in varus or valgus knees. In varus knees, the preoperative mechanical axis alignment had a positive relationship to femoral component position when compared to the PCA (P = .04) and TEA (P = .002). In valgus knees, there was a positive correlation between the preoperative lateral distal femoral angle and component position when compared to the PCA (P = .04) only. CONCLUSION Intraoperative measured flexion space balance through femoral component positioning did not correlate with its relationship to the native TEA or PCA. In varus knees, the preoperative mechanical axis alignment correlated with an increase in femoral component external rotation to the TEA and PCA. In valgus knees, the severity of preoperative lateral distal femoral angle correlated with the rotational relationship of the femoral component to the PCA only.
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Affiliation(s)
- Scott R Nodzo
- Department of Orthopedics, University at Buffalo, Buffalo, New York
| | - Trevor M Staub
- Department of Orthopedics, University at Buffalo, Buffalo, New York
| | | | | | - K Keely Boyle
- Department of Orthopedics, University at Buffalo, Buffalo, New York
| | - Sridhar Rachala
- Department of Orthopedics, University at Buffalo, Buffalo, New York
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