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Maeda K, Mochizuki T, Tanifuji O, Katsumi R, Kobayashi K, Kawashima H. Medial cortical bone thickness of the tibial diaphysis in osteoarthritis is related to lower extremity alignment and tibial morphology. J Orthop Surg Res 2024; 19:355. [PMID: 38879553 PMCID: PMC11179327 DOI: 10.1186/s13018-024-04849-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2024] [Accepted: 06/11/2024] [Indexed: 06/19/2024] Open
Abstract
BACKGROUND The purpose of this study was to clarify (1) the differences in cortical bone thickness (CBT) of the tibial diaphysis between healthy and osteoarthritic knees and (2) the influences of the femorotibial angle (FTA) and inclination of the medial compartment of the proximal tibia (MCT) on tibial CBT. METHODS The study assessed 60 subjects with varus knee osteoarthritis (OA) (22 males and 38 females; mean age, 74 ± 7 years) and 53 healthy elderly subjects (28 males and 25 females; mean age, 70 ± 6 years). Three-dimensional estimated CBT of the tibial diaphysis was automatically calculated for 2752-11,296 points using high-resolution measurements from CT. The standardized CBT was assessed in 24 regions by combining six heights and four areas. Additionally, the association between the CBT, each FTA, and MCT inclination was investigated. RESULTS The OA group showed a thicker CBT in the medial areas than in the lateral areas of the proximal tibia, while the healthy group had a thicker lateral CBT. The medial-to-lateral ratio of the proximal tibia was significantly higher in the OA group than in the healthy group. The proximal-medial CBT correlated with FTA and MCT inclinations in the OA group. CONCLUSIONS This study demonstrated that varus osteoarthritic knees showed a different trend of proximal-medial CBT with associations in FTA and MCT inclination from healthy knees, possibly due to medial load concentration.
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Affiliation(s)
- Keisuke Maeda
- Division of Orthopedic Surgery, Niigata University Medical and Dental Hospital, 1-757 Asahimachi-dori Chuo-ku, Niigata City, Niigata, 951-8510, Japan
| | - Tomoharu Mochizuki
- Division of Orthopedic Surgery, Niigata University Medical and Dental Hospital, 1-757 Asahimachi-dori Chuo-ku, Niigata City, Niigata, 951-8510, Japan.
| | - Osamu Tanifuji
- Division of Orthopedic Surgery, Niigata University Medical and Dental Hospital, 1-757 Asahimachi-dori Chuo-ku, Niigata City, Niigata, 951-8510, Japan
| | - Ryota Katsumi
- Division of Orthopedic Surgery, Niigata University Medical and Dental Hospital, 1-757 Asahimachi-dori Chuo-ku, Niigata City, Niigata, 951-8510, Japan
| | - Koichi Kobayashi
- School of Health Sciences, Faculty of Medicine, Niigata University, Niigata, Japan
| | - Hiroyuki Kawashima
- Division of Orthopedic Surgery, Niigata University Medical and Dental Hospital, 1-757 Asahimachi-dori Chuo-ku, Niigata City, Niigata, 951-8510, Japan
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Tomiyama Y, Mochizuki T, Koga H, Omori G, Koga Y, Tanifuji O, Nishino K, Endo K, Endo N, Kawashima H. The Matsudai Knee Osteoarthritis Survey showed the longitudinal changes of knee phenotypes in alignment and structure during 23-28 years. Knee Surg Sports Traumatol Arthrosc 2023; 31:5034-5047. [PMID: 37682319 DOI: 10.1007/s00167-023-07554-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Accepted: 08/24/2023] [Indexed: 09/09/2023]
Abstract
PURPOSE The longitudinal changes in alignment and structure, including the joint line and cortical bone thickness (CBT) of the femur and tibia, and knee phenotype in patients with knee osteoarthritis (OA) remain unknown. The aim of this retrospective study was to clarify the longitudinal changes in matched healthy subjects. METHODS The follow-up Matsudai Knee Osteoarthritis Survey was administered between 23 and 28 years. This study included 285 healthy knees from 235 females with an average age of 53 ± 6 years at baseline. The non-OA individuals, with an average age of 79 ± 4 years, were divided into three groups at baseline according to their follow-up radiographic results [the non-OA (n = 52), early OA (n = 131), and advanced OA groups (n = 102)]. Changes in alignment, joint line, CBT, and knee phenotype were assessed at baseline and at follow-up using standing anteroposterior radiographs. RESULTS This study showed significant varus changes in the alignment (p < 0.001) and tibial and femoral joint line parameters (p < 0.05) in the OA group. Decreased CBT and increased mediolateral CBT ratios were observed in all groups (p < 0.001). The knee phenotypes in the OA groups were changed to varus angles, especially in the alignment and tibial joint line. CONCLUSIONS The longitudinal changes of knee phenotypes in alignment and structure (CBT and joint line) from baseline to follow-up were shown in the OA groups. In addition, alignment and tibial structural factors at baseline are useful in predicting the incidence of knee OA in daily practice. LEVELS OF EVIDENCE III.
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Affiliation(s)
- Yasuyuki Tomiyama
- Division of Orthopedic Surgery, Department of Regenerative and Transplant Medicine, Niigata University Graduate School of Medical and Dental Sciences, 1-757 Asahimachi-Dori Chuo-Ku, Niigata, 951-8510, Japan
- Department of Orthopedic Surgery, Niigata Rehabilitation Hospital, Niigata, Japan
| | - Tomoharu Mochizuki
- Division of Orthopedic Surgery, Department of Regenerative and Transplant Medicine, Niigata University Graduate School of Medical and Dental Sciences, 1-757 Asahimachi-Dori Chuo-Ku, Niigata, 951-8510, Japan.
| | - Hiroshi Koga
- Division of Musculoskeletal Science for Frailty, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Go Omori
- Department of Health and Sports, Niigata University of Health and Welfare, Niigata, Japan
| | | | - Osamu Tanifuji
- Division of Orthopedic Surgery, Department of Regenerative and Transplant Medicine, Niigata University Graduate School of Medical and Dental Sciences, 1-757 Asahimachi-Dori Chuo-Ku, Niigata, 951-8510, Japan
| | | | - Kazuo Endo
- Department of Health & Nutrition, Niigata University of Health and Welfare, Niigata, Japan
| | - Naoto Endo
- Division of Orthopedic Surgery, Department of Regenerative and Transplant Medicine, Niigata University Graduate School of Medical and Dental Sciences, 1-757 Asahimachi-Dori Chuo-Ku, Niigata, 951-8510, Japan
- Deputy Hospital Director, orthopedic department, Tsubame Rosai Hospital, Niigata, Japan
| | - Hiroyuki Kawashima
- Division of Orthopedic Surgery, Department of Regenerative and Transplant Medicine, Niigata University Graduate School of Medical and Dental Sciences, 1-757 Asahimachi-Dori Chuo-Ku, Niigata, 951-8510, Japan
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Tomiyama Y, Mochizuki T, Tanifuji O, Nishino K, Tanaka M, Omori G, Yamamoto N, Koga H, Koga Y, Kawashima H. Normal coronal kinematics of dynamic alignment and bony positions relative to the ground in three-dimensional motion analysis during gait: A preliminary study. Biomed Mater Eng 2023; 34:37-49. [PMID: 35694913 DOI: 10.3233/bme-211383] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
BACKGROUND During gait, healthy knee coronal kinematics of each bony axis and lower extremity alignment are important because they could be useful as reference data for several surgeries and provide clarification of the etiology of diseases around the knee in healthy participants; however, it remains unknown. OBJECTIVE The objective of this study was to clarify the kinematics of lower extremity alignment and the bony axes relative to the ground during gait, focused on the coronal plane, in healthy individuals by applying our unique three-dimensional (3D) motion analysis. METHODS The study included 21 healthy individuals, including 9 healthy females and 12 healthy males with an average age of 36 ± 17 years. Knee kinematics were calculated in a gait analysis by combining the data from a motion-capture system and a 3D lower-extremity alignment assessment system on biplanar long-leg radiographs by using a 3D-2D registration technique. The main kinematic parameters were the dynamic position change relative to the ground, applying the femoral anatomical axis (FAA), tibial anatomical axis (TAA), and dynamic alignment in the coronal plane during the stance phase of gait. RESULTS The average changes in FAA, TAA, and dynamic varus alignment were 3.7° ± 1.2°, 3.5° ± 0.8°, and 3.0° ± 1.2°, respectively. The TAA tilted laterally during the loading response and a plateau area appeared afterwards; the FAA gradually inclined laterally until the terminal stance phase, and the dynamic alignment showed varus angular change during the loading response. CONCLUSIONS The tibia and femur were found to change approximately 2-5° of the position of the bony axes relative to the ground. In terms of clinical relevance, our findings can be used to clarify the etiology of diseases around the knee joint and as reference data for surgeries.
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Affiliation(s)
- Yasuyuki Tomiyama
- Division of Orthopedic Surgery, Department of Regenerative and Transplant Medicine, Niigata University Graduate School of Medical and Dental Science, Niigata, Japan.,Department of Orthopaedic Surgery, Niigata Rehabilitation Hospital, Niitaga, Japan
| | - Tomoharu Mochizuki
- Division of Orthopedic Surgery, Department of Regenerative and Transplant Medicine, Niigata University Graduate School of Medical and Dental Science, Niigata, Japan
| | - Osamu Tanifuji
- Division of Orthopedic Surgery, Department of Regenerative and Transplant Medicine, Niigata University Graduate School of Medical and Dental Science, Niigata, Japan
| | | | - Masaei Tanaka
- Niigata Institute for Health and Sports Medicine, Niigata, Japan
| | - Go Omori
- Department of Health and Sports, Faculty of Health Sciences, Niigata University of Health and Welfare, Niigata, Japan
| | - Noriaki Yamamoto
- Department of Orthopaedic Surgery, Niigata Rehabilitation Hospital, Niitaga, Japan
| | - Hiroshi Koga
- Division of Musculoskeletal Science for Frailty, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Yoshio Koga
- Department of Orthopaedic Surgery, Nioji Onsen Hospital, Niigata, Japan
| | - Hiroyuki Kawashima
- Division of Orthopedic Surgery, Department of Regenerative and Transplant Medicine, Niigata University Graduate School of Medical and Dental Science, Niigata, Japan
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The coronal inclination of the medial tibial plateau affects coronal gait kinematics for varus osteoarthritic knees. Knee Surg Sports Traumatol Arthrosc 2022; 30:4162-4172. [PMID: 35657392 DOI: 10.1007/s00167-022-07019-x] [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: 02/02/2022] [Accepted: 05/15/2022] [Indexed: 10/18/2022]
Abstract
PURPOSE This study aims to (1) measure the kinematics of lower extremity alignment and the bony position relative to the ground during walking, focusing on the coronal plane, and (2) determine the correlation between the kinematics and coronal inclination of the medial tibial plateau (coronal inclination) for healthy and varus knee osteoarthritis (OA). METHODS In this study, 43 women (non-OA, 9 knees; early OA, 13 knees; advanced OA, 21 knees; mean age 58 ± 17 years) were examined. The knee phenotypes in varus knee OA were varied. Three-dimensional (3D) knee kinematics were calculated in gait analysis by combining the motion capture system and the 3D lower extremity alignment assessment system via biplanar long-leg X-rays, applying the 3D-2D registration technique. The main parameters were the kinematics of the bony axes relative to the ground in the coronal plane during the stance phase of the gait. The differences in overall kinematics were assessed using repeated measures ANOVA with Tukey's post hoc test. The association between kinematic parameters and coronal inclination was evaluated by multiple linear regression after univariate analysis. RESULTS The tibia tilted laterally during the loading response, and a plateau area subsequently appeared until the terminal stance phase, whereas the femur slowly tilted laterally until the terminal stance phase. The dynamic alignment showed a relatively large varus angular change during the loading response in all groups. The trend of motion was similar among all groups (p = n.s.), although to varying degrees. The coronal inclination was the more dominant factor than the Kellgren-Lawrence (K-L) grades (β = - 0.423, p = 0.005) when the change in dynamic alignment was determined. CONCLUSIONS The TAA plateau area after the loading response implies that the tibial articular surface may become horizontal. The femur slowly tilted laterally until the terminal stance phase in response to the tibial motion. Consequently, the dynamic alignment showed a varus angular change, in which coronal MCT was more involved than K-L grades.
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Huan W, Mochizuki T, Tanifuji O, Kawashima H. Variability of functional knee phenotype for coronal alignment in advanced varus knee osteoarthritis in the Japanese population. Knee Surg Sports Traumatol Arthrosc 2022; 31:1451-1461. [PMID: 36449045 DOI: 10.1007/s00167-022-07248-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Accepted: 11/21/2022] [Indexed: 12/02/2022]
Abstract
PURPOSE New concept of functional knee phenotypes in Caucasians demonstrated the variability of coronal alignment in knee osteoarthritis (OA), but it remains unclear in Japanese. This study aims to analyze the knee phenotype in advanced varus knee OA for Japanese. In addition, the ethnical difference is discussed. METHODS This study analyzed 879 knees involving 186 males (74 years) and 693 females (74 years). The knee phenotypes were assessed by the definition in Hirschmann's group. The hip-knee-ankle angle (HKA), femoral mechanical angle (FMA) and tibial mechanical angle (TMA) were assessed in CT data according to the coordinate system. The neutral angle was 180° in HKA, 93° in FMA and 87° in TMA. The smaller angle means larger varus angles. RESULTS The average angle (males, females) of the HKA (170.9 ± 4.3°, 169.4 ± 5.0°), FMA (91.5 ± 2.7°, 90.6 ± 3.0°), and TMA (82.4 ± 3.6°, 82.7 ± 3.7°) demonstrated varus angles with the sex difference (HKA, p < 0.001; FMA, p = 0.001). The phenotypes were 73 types in males and 150 types in females with a mild correlation between the HKA and the FMA or TMA. In 61.3% of males and 52.2% of females, the TMA was greater than the FMA, while the FMA was greater in 16.7% of males and 23.1% of females. CONCLUSION There were many functional knee phenotypes with sex differences for advanced varus knee OA in Japanese, showing ethnical differences of larger varus angles compared to those for Caucasians in the previous report. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Wang Huan
- Division of Orthopedic Surgery, Niigata University Medical and Dental Hospital, 1-757 Asahimachi-dori Chuo-ku, Niigata City, 951-8510, Japan.,Department of Orthopedic Surgery, The First Affiliated Hospital, Harbin Medical University, Harbin, China
| | - Tomoharu Mochizuki
- Division of Orthopedic Surgery, Niigata University Medical and Dental Hospital, 1-757 Asahimachi-dori Chuo-ku, Niigata City, 951-8510, Japan.
| | - Osamu Tanifuji
- Division of Orthopedic Surgery, Niigata University Medical and Dental Hospital, 1-757 Asahimachi-dori Chuo-ku, Niigata City, 951-8510, Japan
| | - Hiroyuki Kawashima
- Division of Orthopedic Surgery, Niigata University Medical and Dental Hospital, 1-757 Asahimachi-dori Chuo-ku, Niigata City, 951-8510, Japan
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Zhang M, Nie MD, Qi XZ, Ke S, Li JW, Shui YY, Zhang ZY, Wang M, Cheng CK. A Strong Correlation Between the Severity of Flatfoot and Symptoms of Knee Osteoarthritis in 95 Patients. Front Surg 2022; 9:936720. [PMID: 35846950 PMCID: PMC9280043 DOI: 10.3389/fsurg.2022.936720] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Accepted: 06/13/2022] [Indexed: 11/20/2022] Open
Abstract
Objective The purpose of this study is to assess the association between the presence and severity of flatfoot and symptoms of knee OA. Methods 95 participants with knee OA were recruited from a patient cohort at a regional hospital. Symptoms of knee OA, including knee degeneration, femorotibial alignment, pain, stiffness and dysfunction were assessed using the Kellgren-Lawrence (K-L) grading system, femoral-tibial angle (FTA), and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC). Participants were divided into groups with flatfoot (mild, moderate and severe) and without flatfoot based on the Clarke's angle. Linear regression and ordinal logistic regression were used for statistical analysis, as appropriate. Results Having flatfoot was associated with a significantly increased risk of having a higher K-L grade (OR: 20.03; 95% CI, 5.88, 68.27; p < 0.001), smaller FTA (Beta: −2.96; 95% CI, −4.41, −1.50; p < 0.001), higher pain score (Beta: 0.47; 95% CI, 0.24, 0.69; p < 0.001) and greater loss of function (Beta: 0.25; 95% CI, 0.02, 0.48; p = 0.03). Severe grades of flat feet were associated with a higher K-L grade (OR: 0.19; 95% CI, 0.08, 0.44; p < 0.001), smaller FTA (Beta: 1.51; 95% CI, 0.66, 2.35; p = 0.001), higher pain score (Beta: −0.25; 95% CI, −0.39, −0.11; p = 0.001), greater stiffness (Beta: −0.24; 95% CI, −0.38, −0.09; p = 0.002) and greater loss of function (Beta: −0.27; 95% CI, −0.41, −0.14; p < 0.001). Conclusion The results indicated that the severity of flattening is significantly associated with symptoms of knee OA. For the conservative management of knee OA, both flatfoot and its severity should be carefully considered.
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Affiliation(s)
- Min Zhang
- Advanced Innovation Center for Biomedical Engineering, School of Biological Science and Medical Engineering, Beihang University, Beijing, China
| | - Mao-dan Nie
- Advanced Innovation Center for Biomedical Engineering, School of Biological Science and Medical Engineering, Beihang University, Beijing, China
- School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, China
| | - Xin-zheng Qi
- Advanced Innovation Center for Biomedical Engineering, School of Biological Science and Medical Engineering, Beihang University, Beijing, China
| | - Song Ke
- Department of Orthopedics, Xinqiao Hospital, Third Military Medical University, Chongqing, China
| | - Jun-wei Li
- Advanced Innovation Center for Biomedical Engineering, School of Biological Science and Medical Engineering, Beihang University, Beijing, China
| | - Yang-yang Shui
- Advanced Innovation Center for Biomedical Engineering, School of Biological Science and Medical Engineering, Beihang University, Beijing, China
| | - Zhuo-yue Zhang
- Advanced Innovation Center for Biomedical Engineering, School of Biological Science and Medical Engineering, Beihang University, Beijing, China
| | - Min Wang
- Department of Orthopedics, Xinqiao Hospital, Third Military Medical University, Chongqing, China
- Correspondence: Min Wang Cheng-Kung Cheng
| | - Cheng-Kung Cheng
- Advanced Innovation Center for Biomedical Engineering, School of Biological Science and Medical Engineering, Beihang University, Beijing, China
- School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, China
- Correspondence: Min Wang Cheng-Kung Cheng
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Beckers L, Müller JH, Daxhelet J, Saffarini M, Aït-Si-Selmi T, Bonnin MP. Sexual dimorphism and racial diversity render bone-implant mismatch inevitable after off-the-shelf total knee arthroplasty: a systematic review and meta-analysis. Knee Surg Sports Traumatol Arthrosc 2022; 30:809-821. [PMID: 33512544 DOI: 10.1007/s00167-021-06447-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Accepted: 01/11/2021] [Indexed: 01/15/2023]
Abstract
PURPOSE The purpose of this systematic review and meta-analysis was to investigate the variability in femoral geometric ratios among knees of different sexes and races, and to appreciate whether the observed variability is accommodated by commonly implanted total knee arthroplasty (TKA) components. The hypothesis was that the anthropometric studies report considerable variability of femoral geometric ratios among sexes and races. METHODS This systematic review and meta-analysis was performed according to the Preferred Reporting Items for Systematic reviews and Meta-analyses (PRISMA) criteria. Two authors independently conducted an electronic search using MEDLINE® and Embase® on 6 July 2020 for clinical studies reporting on femoral geometric ratios among sexes and races. Femoral geometric ratios were graphically represented as means and 2 standard deviations, and compared to those of 13 commonly implanted femoral components. RESULTS A total of 15 studies were identified that reported on a combined total of 2627 knees; all reported the aspect ratio, and 2 also reported the asymmetry ratio and trapezoidicity ratio. Men had wider knees than women, and compared to Caucasian knees, Arabian and Indian knees were wider, while East Asian were narrower. There were no differences in asymmetry ratio between men and women, nor among Caucasian and East Asian knees. Men had more trapezoidal knees than women, and East Asian knees were more trapezoidal than Caucasian knees. The commonly implanted femoral components accommodated less than a quarter of the geometric variability observed among sexes and races. CONCLUSION Anthropometric studies reported considerable sexual dimorphism and racial diversity of femoral geometric ratios. Since a surgeon generally only uses one or a few TKA brands, bone-implant mismatch remains unavoidable in a large proportion of knees. These findings support the drive towards personalized medicine, and accurate bone-implant fit may only be achievable through customisation of implants, though the clinical benefits of custom TKA remain to be confirmed. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Lucas Beckers
- Ramsay Santé, Centre Orthopédique Santy, Hôpital Privé Jean Mermoz, Lyon, France
| | | | - Jeremy Daxhelet
- Ramsay Santé, Centre Orthopédique Santy, Hôpital Privé Jean Mermoz, Lyon, France
| | - Mo Saffarini
- ReSurg SA, Rue Saint-Jean 22, 1260, Nyon, Switzerland.
| | - Tarik Aït-Si-Selmi
- Ramsay Santé, Centre Orthopédique Santy, Hôpital Privé Jean Mermoz, Lyon, France
| | - Michel P Bonnin
- Ramsay Santé, Centre Orthopédique Santy, Hôpital Privé Jean Mermoz, Lyon, France
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Müller JH, Liebensteiner M, Kort N, Stirling P, Pilot P, Demey G. No significant difference in early clinical outcomes of custom versus off-the-shelf total knee arthroplasty: a systematic review and meta-analysis. Knee Surg Sports Traumatol Arthrosc 2021; 31:1230-1246. [PMID: 34432095 DOI: 10.1007/s00167-021-06678-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Accepted: 07/18/2021] [Indexed: 01/25/2023]
Abstract
PURPOSE The purpose of this systematic review and meta-analysis was to collect, synthesise and critically appraise findings of clinical studies that report outcomes of custom total knee arthroplasty (TKA). The hypothesis was that, compared to off-the-shelf (OTS) TKA, custom TKA would yield better surgical, clinical and radiographic outcomes. METHODS This systematic review and meta-analysis was performed in accordance with the guidelines of Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). On 8 February 2021, two authors independently searched and screened articles using MEDLINE®, Embase® and the Cochrane Library without restriction on date of publication. Findings from eligible articles were narratively synthesised and tabulated, and when ≥ 3 comparative studies reported the same outcome, results were pooled and summarised in forest plots. Quality assessments of the studies were done according to the guidelines of the Joanna Briggs Institute (JBI) Checklists. RESULTS A total of 15 articles were eligible for data extraction, of which 9 were case-control studies reporting on 929 custom versus 998 OTS TKA, 5 were case series reporting on results of 587 custom TKA, and 1 was a cross-sectional study reporting on results of 44 custom versus 132 OTS TKA. Five studies that compared early revision rates found the overall effect in favour of OTS TKA (odds ratio (OR), 0.4; p = n.s.) but the result did not reach statistical significance. Four studies found no statistically significant difference in KSS knee (standardised mean difference (SMD), - 0.10; p = n.s.) and function (SMD, 0.03; p = n.s.), and five studies found no statistically significant difference in range of motion (SMD, 0.02; p = n.s.). One study that compared bone-implant fit between custom and three OTS tibial components found no overhang but revealed under-coverage of up to 18% in knees with custom tibial baseplates. CONCLUSION Custom TKA demonstrated no significant benefits compared to OTS TKA in terms of pooled clinical outcomes, but had considerably higher early revision rates. The findings of the present systematic review and meta-analysis suggest the need for studies with better comparable groups and standardisation of reporting outcomes amongst studies, that could increase the quality of evidence and enable pooling of results in future meta-analyses. LEVEL OF EVIDENCE Level IV.
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Affiliation(s)
| | - Michael Liebensteiner
- Department of Orthopaedics and Traumatology, Medical University of Innsbruck, Anichstraße 35, 6020, Innsbruck, Austria
| | - Nanne Kort
- CortoClinics, Schijndel, The Netherlands
| | | | | | - Guillaume Demey
- Lyon-Ortho-Clinic, Clinique de la Sauvegarde, Ramsay Santé, 29 Avenue des Sources, 69009, Lyon, France
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Mochizuki T, Sato T, Katsumi R. Association between the toe angle and bony factors in the transverse plane for osteoarthritic knees compared with healthy knees. Biomed Mater Eng 2021; 32:359-373. [PMID: 34250927 DOI: 10.3233/bme-211245] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND The association between the toe angle and bony rotational factors is critical to explain issues related to the onset and progression of knee osteoarthritis (OA). OBJECTIVE The study aimed to clarify the association between the toe angle and each of the femoral and tibial transvers direction relative to gait direction, rotational knee alignment, and bony torsional deformity for the subjects with knee OA. METHODS This study evaluated 58 knees in 24 healthy elderly (72 ± 5 years) and 34 varus knee OA (72 ± 6 years). A three-dimensional (3D) assessment system was used on 3D models and biplanar long-leg radiographs with the toe angle reflecting gait direction, applying a 3D-to-2D image registration technique. The main parameters on the transverse plane were: (1) toe angle, (2) transverse direction of the femur and tibia relative to the gait direction, (3) femoral neck anteversion, (4) condylar twist angle, (5) tibial torsion, and (6) rotational knee alignment. RESULTS The alignment parameters, except for the tibial transverse direction, were different between healthy and osteoarthritic knees. In knee OA, the femoral neck anteversion - femoral transverse direction (p = 0.001), femoral transverse direction - tibial transverse direction (p < 0.001), and tibial transverse direction - toe angle (p < 0.001) were associated. CONCLUSIONS The osteoarthritic knees showed that the femoral neck anteversion was associated with the femoral transverse direction, which determined the tibial transverse direction by adjusting the rotational knee alignment, leading to the toe angle.
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Affiliation(s)
- Tomoharu Mochizuki
- Division of Orthopedic Surgery, Department of Regenerative and Transplant Medicine, Niigata University Graduate School of Medical and Dental Science, Niigata, Japan
| | - Takashi Sato
- Department of Orthopaedic Surgery, Niigata Medical Center, Niigata, Japan
| | - Ryota Katsumi
- Division of Orthopedic Surgery, Department of Regenerative and Transplant Medicine, Niigata University Graduate School of Medical and Dental Science, Niigata, Japan
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Beckers L, Müller JH, Daxhelet J, Ratano S, Saffarini M, Aït-Si-Selmi T, Bonnin MP. Considerable inter-individual variability of tibial geometric ratios renders bone-implant mismatch unavoidable using off-the-shelf total knee arthroplasty: a systematic review and meta-analysis. Knee Surg Sports Traumatol Arthrosc 2021; 31:1284-1298. [PMID: 34075491 DOI: 10.1007/s00167-021-06623-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Accepted: 05/21/2021] [Indexed: 01/25/2023]
Abstract
PURPOSE The purpose of this systematic review and meta-analysis was to investigate the variability in tibial geometric ratios among knees of different sexes and races to determine whether commercially-available tibial baseplates accommodate the morphologic diversity. The hypothesis was that anthropometric studies report considerable variability of tibial geometric ratios among sexes and races. METHODS This systematic review and meta-analysis was performed according to the preferred reporting items for systematic reviews and meta-analyses (PRISMA) criteria. Two authors independently conducted an electronic search using MEDLINE® and Embase® on 28 January 2021 for clinical studies reporting on tibial geometric ratios. Tibial geometric ratios, as reported by the clinical studies, were represented by plotting their means and two standard deviations for comparison to two symmetric and two asymmetric commercially-available tibial baseplates. RESULTS A total of 27 articles that reported on a combined total of 20,944 knees were eligible for data extraction. Variation in tibial aspect ratios was equal among sexes. The greatest variation in aspect ratio was observed among East Asians, followed by Caucasians, African-Americans, Indian and Middle Easterns. The variation in tibial asymmetry ratio was larger among men compared to women. The greatest variation in asymmetry ratio was observed among African-Americans, followed by Caucasians, East Asians, Indian and Middle Easterns. Bone-implant mismatch of > 3 mm overhang or > 4 mm under-coverage with four commercially-available tibial baseplates occurred in large proportions of knees due to variations in aspect ratio (in 17-100% of knees) and asymmetry ratio (in 7-100% of knees). CONCLUSION Anthropometric studies reported considerable inter-individual variability of tibial geometric ratios, which exceeded effects of sexual dimorphism and racial diversity. Bone-implant mismatch may be unavoidable in a large proportion of knees, when considering that a surgeon generally only uses one or a few TKA brands. These findings support the drive towards patient-specific implants to potentially achieve accurate bone-implant fit by implant customisation. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Lucas Beckers
- Centre Orthopédique Santy, Ramsay Santé, Hôpital Privé Jean Mermoz, Lyon, France
| | | | - Jeremy Daxhelet
- Centre Orthopédique Santy, Ramsay Santé, Hôpital Privé Jean Mermoz, Lyon, France
| | - Salvatore Ratano
- Centre Orthopédique Santy, Ramsay Santé, Hôpital Privé Jean Mermoz, Lyon, France
| | - Mo Saffarini
- ReSurg SA, Rue Saint-Jean 22, 1260, Nyon, Switzerland.
| | - Tarik Aït-Si-Selmi
- Centre Orthopédique Santy, Ramsay Santé, Hôpital Privé Jean Mermoz, Lyon, France
| | - Michel P Bonnin
- Centre Orthopédique Santy, Ramsay Santé, Hôpital Privé Jean Mermoz, Lyon, France
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Deng XT, Hu HZ, Zhu J, Chen W, Wang ZZ, Wang YC, Ye ZP, Yang SA, Zhang YZ. Associations Between Periosteal Reaction of Proximal Tibial and Medial Compartment Knee Osteoarthritis. Orthop Surg 2021; 13:1327-1335. [PMID: 33961333 PMCID: PMC8274206 DOI: 10.1111/os.12963] [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: 10/26/2020] [Revised: 01/18/2021] [Accepted: 01/28/2021] [Indexed: 11/30/2022] Open
Abstract
Objective To evaluate and analyze the potential relationship between periosteal reaction and medial compartment knee osteoarthritis (KOA), and to assess the independent risk factors for the development of periosteal reaction associated with medial compartment KOA. Methods This is a retrospective comparative study. From January 2019 to December 2019 at the Third Hospital of Hebei Medical University, a total of 363 patients (726 knees) with medial compartment KOA were enrolled in this study according to our inclusion and exclusion criteria, including 91 males and 272 females, with an mean age of 57.9 ± 12.8 years (range, 18–82 years). Among these patients, 206 patients (412 knees) were allocated to the periosteal reaction group (44 males and 162 females) and 157 patients (314 knees) were allocated to the non‐periosteal reaction group (47 males and 110 females). The classification of KOA severity was based on Kellgren and Lawrence (K‐L) grading system. The malalignment of the lower extremities in coronal plane was evaluated as medial proximal tibial angle (MPTA), hip‐knee‐ankle angle (HKA), and lateral distal femoral angle (LDFA). Patients demographics and radiographic parameters were recorded in the two groups. Intra‐observer and inter‐observer reliabilities of all radiological measurements were analyzed by intraclass correlation coefficients (ICCs). Univariate analyses were conducted for comparison of differences with continuous variables between patients with periosteal reaction and without periosteal reaction. Multivariate logistical regression analysis was performed to determine the independent risk factors of radiographic parameters for periosteal reaction. Results The overall incidence of periosteal reaction associated with medial compartment KOA was 56.7%. Furthermore, we observed that the incidence of periosteal reaction significantly increased with age and correlated with K‐L grade progression (P < 0.05). There was a statistically significant difference between the two groups. In the multivariate logistical regression analysis, HKA and JLCA were identified as independent risk factors of the development of periosteal reaction in patients with medial compartment KOA (odds ratio [OR], 0.594; 95% confidence interval [CI] 0.544–0.648; P < 0.05; OR, 0.851; 95% confidence interval CI 0.737–0.983; P < 0.05; respectively), with other radiographic parameters including MTPA (OR 0.959; 95% CI 0.511–0.648; P > 0.05), LDFA (OR 0.990; 95% CI 0.899–1.089; P > 0.05), and JSW (OR 1.005; 95% CI 0.865–1.167; P > 0.05). Conclusions In this retrospective study, patients with lower HKA and higher JLCA were identified as independent risk factors for the development of periosteal reaction, which occurred most commonly adjacent to the lateral of proximal tibia diaphysis, and thus we concluded that periosteal reaction may be an anatomical adaptation for medial compartment KOA based upon these results.
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Affiliation(s)
- Xiang-Tian Deng
- School of Medicine, Nankai University, Tianjin, China.,Department of Orthopaedic Surgery of Hebei Province, Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, People's Republic of China.,NHC Key Laboratory of Intelligent Orthopeadic Equipment, Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, People's Republic of China
| | - Hong-Zhi Hu
- Department of Orthopedics, Union Hospital of Tongji Medical College of Huazhong University of Science and Technology, Wuhan, China
| | - Jian Zhu
- School of Medicine, Nankai University, Tianjin, China.,Department of Orthopaedic Surgery of Hebei Province, Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, People's Republic of China.,NHC Key Laboratory of Intelligent Orthopeadic Equipment, Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, People's Republic of China
| | - Wei Chen
- Department of Orthopaedic Surgery of Hebei Province, Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, People's Republic of China.,NHC Key Laboratory of Intelligent Orthopeadic Equipment, Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, People's Republic of China
| | - Zhong-Zheng Wang
- Department of Orthopaedic Surgery of Hebei Province, Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, People's Republic of China.,NHC Key Laboratory of Intelligent Orthopeadic Equipment, Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, People's Republic of China
| | - Yu-Chuan Wang
- Department of Orthopaedic Surgery of Hebei Province, Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, People's Republic of China.,NHC Key Laboratory of Intelligent Orthopeadic Equipment, Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, People's Republic of China
| | - Zhi-Peng Ye
- School of Medicine, Nankai University, Tianjin, China.,Department of Orthopaedic Surgery of Hebei Province, Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, People's Republic of China.,NHC Key Laboratory of Intelligent Orthopeadic Equipment, Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, People's Republic of China
| | - Sif-An Yang
- Department of Orthopaedic Surgery of Hebei Province, Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, People's Republic of China.,NHC Key Laboratory of Intelligent Orthopeadic Equipment, Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, People's Republic of China
| | - Ying-Ze Zhang
- School of Medicine, Nankai University, Tianjin, China.,Department of Orthopaedic Surgery of Hebei Province, Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, People's Republic of China.,NHC Key Laboratory of Intelligent Orthopeadic Equipment, Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, People's Republic of China
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