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Hernández-Hermoso JA, Nescolarde L, Yañez-Siller F, Calle-García J, Garcia-Perdomo D, Pérez-Andres R. Combined femoral and tibial component total knee arthroplasty device rotation measurement is reliable and predicts clinical outcome. J Orthop Traumatol 2023; 24:40. [PMID: 37535276 PMCID: PMC10400495 DOI: 10.1186/s10195-023-00718-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Accepted: 07/19/2023] [Indexed: 08/04/2023] Open
Abstract
BACKGROUND The optimal total knee arthroplasty (TKA) rotational alignment and how best to obtain and measure it are debatable. The aim was to analyse the reliability of the Berger femoral, three different tibial and four different combined two-dimensional computer tomography (2D-CT) TKA component rotation measurements, and to ascertain which rotational values best predict a successful clinical outcome. METHODS The 2D-CT scans were obtained post-operatively on 60 patients who had TKA. We determined one femoral [Berger's femoral angle (BFA)], three tibial [Berger's tibial angle (BTA), anatomical tibial angle (ATA) and bimalleolar posterior tibial component angle (BM_PTCA)] and four combined [transepicondylar posterior tibial component angle (TE_PTCA), bicondylar posterior tibial component angle (BC_PTCA, transepicondylar bimalleolar angle (TE_BM) and bicondylar bimalleolar angle (BC_BM)] TKA rotation angles. We made all measures in 23 patients twice by three observers and determined inter- and intra-observer agreement using the Bland-Altman plot method. We analysed measures of 55 patients using the area under the ROC curve (AUC) analysis to ascertain the discriminative capacity of BFA, ATA, TE_PTCA and BC_PTCA for predicting a successful clinical outcome according to the Knee Society Score (KSS) threshold. RESULTS ATA showed the smaller inter- and intra-observer average of differences (-0.1° and 1.6°, respectively) of the studied methods followed by BFA (-0.9° and 1.4°), TE_PTCA (-2.1° and 2.7°) and BC_PTCA (-0.5° and 1.8°). BFA (-4° to 2.1° and -6.1° to 8.8°) and BC_PTCA (-4.4° to 3.4° and -7.9° to 4.4°) showed the narrower inter- and intra-observer limits of agreement. A TKA device rotation (BC_PTCA) < 0.8° of external rotation (ER) predicted a KSS and KSS knee successful outcome, and < 3.8° ER for KSS functional (AUC = 0.889; 0.907 and 0.764, respectively). BFA and ATA < 0.9° ER and < 3.9° internal rotation (IR) predicted a successful KSS knee outcome (AUC = 0.796 and 0.889, respectively). CONCLUSION The ATA tibial component rotation measurement was the most reliable of those studied. BFA, TE_PTCA and BC_PTCA were reliable measures for TKA femoral and combined rotation. The presence of a minimal rotation between the TKA components (BC_PTCA) and a small femoral ER or tibial IR predicted a successful KSS outcome. LEVEL OF EVIDENCE II
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Affiliation(s)
- José A Hernández-Hermoso
- Department of Orthopedic Surgery and Traumatology, Hospital Universitari Germans Trias i Pujol, Carretera Canyet s/n, 08916, Badalona, Barcelona, Spain.
- Department of Surgery, Faculty of medicine, Universitat Autònoma de Barcelona, Campus UAB, 08913, Bellaterra, Spain.
| | - Lexa Nescolarde
- Biomedical Engineering, Department of Electronic Universitat Politècnica de Catalunya, Barcelona, Spain
| | - Federico Yañez-Siller
- Department of Orthopedic Surgery and Traumatology, Hospital Universitari Germans Trias i Pujol, Carretera Canyet s/n, 08916, Badalona, Barcelona, Spain
| | - Juan Calle-García
- Department of Orthopedic Surgery and Traumatology, Hospital Universitari Germans Trias i Pujol, Carretera Canyet s/n, 08916, Badalona, Barcelona, Spain
| | - Damian Garcia-Perdomo
- Department of Radiology, Hospital, Universitari Germans Trias i Pujol, Carretera Canyet s/n, 08916, Badalona, Barcelona, Spain
| | - Ricard Pérez-Andres
- Department of Radiology, Hospital, Universitari Germans Trias i Pujol, Carretera Canyet s/n, 08916, Badalona, Barcelona, Spain
- Department of Medicine, Faculty of Medicine, Universitat Autònoma de Barcelona, Campus UAB, 08913, Bellaterra, Spain
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He R, Sun M, Xiong R, Yang J, Guo L, Yang L. Semiactive robotic-arm system versus patient-specific instrumentation in primary total knee arthroplasty: Efficacy and accuracy. Asian J Surg 2023; 46:742-750. [PMID: 35835672 DOI: 10.1016/j.asjsur.2022.06.151] [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: 12/28/2021] [Revised: 04/29/2022] [Accepted: 06/30/2022] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVE To compare the difference in efficacy and accuracy during total knee arthroplasty (TKA) among robotic-arm system, patient-specific instrumentation (PSI) and conventional TKA (COTKA). METHODS Retrospective analysis of 90 advanced knee osteoarthritis (OA) patients in our hospital between June 2019 and December 2020 was conducted. Patients were divided into robotic arm-assisted (RA)TKA (group A), PSITKA (group B) and COTKA (group C), 30 cases in each group. The operation time, intraoperative bleeding, and length of hospital stay were counted. Imaging data of hip-knee-ankle angle (HKA), posterior condylar angle (PCA), lateral distal femoral angle (LDFA), medial proximal tibial angle (MPTA), and sagittal tibial component angle (sTCA) were statistically analyzed. The postoperative recovery of the patients was evaluated by Knee Society Score (KSS) and the Western Ontario Mac Master University Index Score (WOMAC). RESULTS Group A had the least intraoperative bleeding. For operation time, group A was the longest compared with group B and group C (P < 0.05), while group B was longer than group C (P < 0.05). There was no significant difference in HKA, LDFA, and MPTA among the three groups, and the lower limb alignments were all restored to the neutral position. PCA of group A and B were both smaller than that of group C and closer to 0° (P < 0.05), but the difference between group A and B was not statistically significant. The sTCA in group A was significantly better than group B, and group B was significantly better than group C (P < 0.05). There were no significant differences in function scores among the three groups. CONCLUSION Compared to the PSI and CO, RA is more minimally invasive and more accurate in radiographic results.
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Affiliation(s)
- Rui He
- Center for Joint Surgery, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, 400038, China
| | - Maolin Sun
- Center for Joint Surgery, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, 400038, China
| | - Ran Xiong
- Center for Joint Surgery, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, 400038, China
| | - Junjun Yang
- Center for Joint Surgery, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, 400038, China
| | - Lin Guo
- Center for Joint Surgery, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, 400038, China.
| | - Liu Yang
- Center for Joint Surgery, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, 400038, China.
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Lee OS, Lee J, Lee MC, Han HS. Changes in the femoral varus and rotational profiles are correlated in women with varus osteoarthritic lower limbs. Arch Orthop Trauma Surg 2023; 143:583-590. [PMID: 34341853 DOI: 10.1007/s00402-021-04094-6] [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: 04/17/2021] [Accepted: 07/26/2021] [Indexed: 10/20/2022]
Abstract
INTRODUCTION Previous studies have reported the relationship between coronal alignment of the lower limbs and the rotational profile of the femur and tibia. However, the relationship between coronal alignment of the femur and tibia and their rotational profiles in patients with varus osteoarthritic knees is unclear. METHODS One hundred women with varus osteoarthritic knees (varus OA group) and 50 women with neutrally aligned lower limbs without osteoarthritis (non-OA group) were evaluated retrospectively. The coronal alignment and rotational profile of the femur and tibia were evaluated, and the correlation between coronal alignment and rotational profile was analyzed, respectively. RESULTS The femoral anteversion, posterior condylar angle of the distal femur, and tibial torsion were significantly smaller in the varus OA group than in the non-OA group. In the varus OA group, the femoral anteversion and rotational profile of the distal femur had significantly negative correlations with the degree of femoral varus, while tibial torsion was not related to the degree of tibial varus. In the non-OA group, there was no relationship between coronal alignment and rotational profiles of the femur and tibia in both the varus OA and non-OA groups. CONCLUSION Femoral anteversion and the rotational profile of the distal femur were negatively correlated with the degree of femoral varus in Asian women with varus osteoarthritic knees. This study enhanced the understanding of the relationship between changes in coronal alignment of the femur and tibia and their rotational profiles in patients with varus osteoarthritic lower limbs, although this study was limited by the small sample sizes and methodological quality.
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Affiliation(s)
- O-Sung Lee
- Department of Orthopedic Surgery, Eulji University School of Medicine, Uijeongbu-si, Republic of Korea
| | - Jangyun Lee
- Department of Orthopedic Surgery, National Medical Center, Seoul, Republic of Korea
| | - Myung Chul Lee
- Department of Orthopedic Surgery, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 110-744, Republic of Korea
| | - Hyuk-Soo Han
- Department of Orthopedic Surgery, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 110-744, Republic of Korea.
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Saracco A, Rivière C, Bouchard GR, Villet L. Limb alignment changes with knee flexion: A study based on CAS data. Knee 2023; 41:232-239. [PMID: 36736065 DOI: 10.1016/j.knee.2023.01.004] [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: 06/21/2022] [Revised: 11/12/2022] [Accepted: 01/03/2023] [Indexed: 02/05/2023]
Abstract
BACKGROUND Recent evidence has questioned the value of standing limb alignment for predicting the adduction moment and forces exerted on healthy and prosthetic knees. The purpose of this study was to assess the lower limb alignment of OA knee patients at various knee flexion angles. The main hypothesis was that lower limb alignment measured throughout knee flexion does not significantly differ between patients displaying different extension alignment (neutral, varus or valgus). METHODS 206 arthritic knee patients undergoing computer-assisted total (CAS) knee prosthesis were included. Frontal limb alignment was assessed in a systematic manner by CAS at three knee positions: extension, 90 degrees of flexion and maximal flexion. The HKA angle at each knee position and the change in HKA angle between two knee positions (delta value) were reported and compared. RESULTS A large proportion of OA patients had significant variation in their lower limb alignment (32% with Δ HKA > 5°). The extended limb deformity tended to reduce with knee flexion: mean of 5° and 6° deformity reduction for varus and valgus patients, 40% and 66% of varus and valgus patients progressed to neutral alignment with 90° knee flexion. Forty percent of neutral extended lower limb did not maintain their neutral alignment but rather progressed to either varus or valgus at 90° knee flexion. CONCLUSIONS Limb alignment in extension is a poor predictor of limb alignment in flexion in OA patients. Only considering the traditional frontal alignment of an extended lower limb for planning knee arthroplasty or osteotomy is likely insufficient.
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Affiliation(s)
- Alvise Saracco
- Department of Hip & Knee Replacement Surgery - IRCCS San Raffaele Hospital, Milan, Italy; B.A.R.I. (Bordeaux Arthroplasty Research Institute), France.
| | - Charles Rivière
- B.A.R.I. (Bordeaux Arthroplasty Research Institute), France; Clinique du Sport Bordeaux-Mérignac, France
| | - Gabriel R Bouchard
- B.A.R.I. (Bordeaux Arthroplasty Research Institute), France; Clinique du Sport Bordeaux-Mérignac, France
| | - Loïc Villet
- B.A.R.I. (Bordeaux Arthroplasty Research Institute), France; Clinique du Sport Bordeaux-Mérignac, France
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Larrainzar-Garijo R, Molanes-Lopez EM, Murillo-Vizuete D, Garcia-Bogalo R, Escobar-Anton D, Lopez-Rodriguez J, Diez-Fernandez A, Corella-Montoya F. Mechanical Alignment in Knee Replacement Homogenizes Postoperative Coronal Hip-Knee-Ankle Angle in Varus Knees: A Navigation-Based Study. J Knee Surg 2022; 35:1285-1294. [PMID: 33472260 DOI: 10.1055/s-0040-1722694] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
After knee replacement, postoperative lower limb alignment is influenced by the geometry of the prosthesis position and surrounding soft tissue that contributes to the hip-knee-ankle (HKA) angle. The purpose of this study is to determine the dynamic coronal HKA angle after mechanical alignment in total knee replacement using computer navigation. We conducted a pre-post design study of 71 patients with varus osteoarthritic knees on which total knee arthroplasty was performed. The HKA was measured before and at the end of the surgical procedure with the patient in the supine position using a navigation system at 30, 60, and 90 degrees of knee flexion. Postoperative implant position and flexion and extension gaps were assessed. HKA was clustered in three preoperative dynamic patterns (PDPs; Varus-Neutral, Varus-Valgus, and Varus-Varus). There were statistically significant differences in the dynamic coronal HKA between the preoperative and postoperative statuses after mechanically aligned knee replacement (with p < 0.0001) Before the surgical procedure, statistically significant differences were found between patterns at any angle of flexion confirming a well-differentiated preoperative dynamic behavior between the three groups. Postoperatively, 98.6% (71 out of 72) of the knees were within ± 3 degrees of the HKA at full extension. Fifty-eight knees (80.6%) were assessed to a "within-range" postoperative dynamic alignment at any grade of flexion considered. There are differences between the preoperative and postoperative status of the dynamic coronal HKA angle after mechanically aligned knee replacement. We proposed that an excellent dynamic HKA alignment is achieved not only at full extension within the range of 0 ± 3 degrees but also when this alignment is maintained at 30, 60, and 90 degrees.
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Affiliation(s)
- Ricardo Larrainzar-Garijo
- Department of Orthopadic and Trauma, Hospital Universitario Infanta Leonor, Madrid, Spain.,Departamento Cirugía, Facultad de Medicina, Universidad Complutense, Madrid, Spain
| | - Elisa M Molanes-Lopez
- Departamento de Estadística e Investigación Operativa, Unidad Departamental de Bioestadística, Facultad de Medicina, Universidad Complutense, Madrid Spain
| | - David Murillo-Vizuete
- Department of Orthopadic and Trauma, Hospital Universitario Infanta Leonor, Madrid, Spain
| | - Raul Garcia-Bogalo
- Department of Orthopadic and Trauma, Hospital Universitario Infanta Leonor, Madrid, Spain
| | - David Escobar-Anton
- Department of Orthopadic and Trauma, Hospital Universitario Infanta Leonor, Madrid, Spain
| | - Jesus Lopez-Rodriguez
- Department of Orthopadic and Trauma, Hospital Universitario Infanta Leonor, Madrid, Spain
| | - Angel Diez-Fernandez
- Department of Orthopadic and Trauma, Hospital Universitario Infanta Leonor, Madrid, Spain
| | - Fernando Corella-Montoya
- Department of Orthopadic and Trauma, Hospital Universitario Infanta Leonor, Madrid, Spain.,Departamento Cirugía, Facultad de Medicina, Universidad Complutense, Madrid, Spain
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Li C, Ye Y, He S, Xu D, He P. High femoral anteversion in osteoarthritic knees, particularly for severe valgus deformity. J Orthop Traumatol 2022; 23:38. [PMID: 35972661 PMCID: PMC9381675 DOI: 10.1186/s10195-022-00653-8] [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: 02/14/2022] [Accepted: 07/10/2022] [Indexed: 11/30/2022] Open
Abstract
Objective Increased femoral anteversion (FA) has been correlated with less varus deformities in osteoarthritic (OA) knees, but the relationship between FA and the degree of valgus deformity in osteoarthritic (OA) knees is still largely unknown. We aimed to thoroughly analyze the distribution of FA in relation to varus or valgus deformities of the lower extremity in OA knees, and to further clarify the relationship between FA and trochlear morphology. Methods 235 lower extremities with OA knees were divided into five groups according to the mechanical tibiofemoral angle: excessive valgus (< − 10°), moderate valgus (− 10° to − 3°), neutral (− 3° to 3°), moderate varus (3° to 10°), and excessive varus (> 10°). FA (measured using the posterior condylar axis [pFA] and the transepicondylar axis [tFA]) was measured, and the relationships of FA to the mechanical tibiofemoral angle and femoral trochlear morphology were identified. Results Excessive FA (pFA ≥ 20°) was observed in 30.2% of all patients and in 58.8% of patients in the excessive valgus group. pFA showed a strong correlation with mechanical tibiofemoral angle (p = 0.018). Both the pFA and the tFA of patients in the excessive valgus group were greater than those in other four groups (all p ≤ 0.037). There were significant correlations between tFA and trochlear parameters, including the sulcus angle (SA), lateral trochlear slope (LTS), and medial trochlear slope (MTS) (all p ≤ 0.028). Conclusion High FA is prevalent, particularly in severe valgus knees, and FA is significantly related to the femoral trochlear morphology in OA knees. With the aim of improving the patellofemoral prognosis and complications, high FA should be considered during total knee arthroplasty.
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Affiliation(s)
- Changzhao Li
- Department of Joint Surgery, Guangdong Provincial Key Laboratory of Orthopedics and Traumatology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, 510080, Guangdong Province, China
| | - Yongheng Ye
- Department of Joint Surgery, Guangdong Provincial Key Laboratory of Orthopedics and Traumatology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, 510080, Guangdong Province, China
| | - Suiwen He
- Department of Joint Surgery, Guangdong Provincial Key Laboratory of Orthopedics and Traumatology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, 510080, Guangdong Province, China
| | - Dongliang Xu
- Department of Joint Surgery, Guangdong Provincial Key Laboratory of Orthopedics and Traumatology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, 510080, Guangdong Province, China.
| | - Peiheng He
- Department of Joint Surgery, Guangdong Provincial Key Laboratory of Orthopedics and Traumatology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, 510080, Guangdong Province, China.
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A Comparison of Dynamic and Static Hip-Knee-Ankle Angle during Gait in Knee Osteoarthritis Patients and Healthy Individuals. Appl Bionics Biomech 2021; 2021:6231406. [PMID: 34853606 PMCID: PMC8629624 DOI: 10.1155/2021/6231406] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Accepted: 11/08/2021] [Indexed: 11/17/2022] Open
Abstract
Malalignment of the lower limbs is the main biomechanical factor for knee osteoarthritis (KOA). The static hip-knee-ankle angle (S-HKAA) measured from radiograph is regarded as the "gold standard" of the malalignment. However, many evidences showed that the S-HKAA has no significant correlation with the knee dynamic-load distribution, unlike the dynamic HKAA (D-HKAA). The purpose of this study was to quantitatively analyze the D-HKAA and investigate the relationship between D-HKAA and S-HKAA for both KOA and healthy participants. In this paper, twenty-five healthy subjects and twenty-five medial compartment KOA (M-KOA) patients were recruited. Three-dimensional motion analysis and standing lower-limbs-full-length radiograph were utilized to obtain the D-HKAA and S-HKAA, respectively. The results showed that the mean D-HKAA was more varus than the S-HKAA (p < 0.05). For the mean D-HKAA, larger varus angle was observed in swing phase than stance phase (p < 0.05). Compared with healthy subjects, the M-KOA patients had remarkably smaller S-HKAA and D-HKAA during gait cycle (p < 0.01). For the relationship between the S-HKAA and mean D-HKAA, no significant correlation was found for both healthy subjects and M-KOA patients (r < 0.357, n = 25, p > 0.05, Spearman correlation analysis). In conclusion, the S-HKAA was limited to predict the D-HKAA for both M-KOA patients and healthy subjects. The D-HKAA should be given more attention to the orthopedist and the designer of knee brace and orthotics.
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Coronal and axial alignment relationship in Caucasian patients with osteoarthritis of the knee. Sci Rep 2021; 11:7836. [PMID: 33837279 PMCID: PMC8035173 DOI: 10.1038/s41598-021-87483-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Accepted: 03/30/2021] [Indexed: 01/26/2023] Open
Abstract
Individualized pre-operative assessment of the patterns of the lower extremity anatomy and deformities in patients undergoing total knee arthroplasty seems essential for a successful surgery. In the present study, we investigated the relationship among the coronal alignment and the rotational profile of the lower extremities in the Caucasian population with end-stage knee osteoarthritis. We conducted a prospective study of 385 knees that underwent a pre-operative three-dimensional computed tomography-based model. The lower extremity alignment was determined (mechanical tibiofemoral or hip-knee-ankle angle, supplementary angle of the femoral lateral distal angle, and proximal medial tibial angle). For each case, the femoral distal rotation (condylar twist angle), the femoral proximal version, and the tibial torsion were determined. As the coronal alignment changed from varus to valgus, the femoral external rotation increased (r = 0.217; p < 0.0005). As the coronal alignment changed from varus to valgus, the external tibial torsion increased (r = 0.248; p < 0.0005). No correlation was found between the global coronal alignment and the femoral version. The present study demonstrates a linear relationship between the coronal alignment and the rotational geometry of the distal femur. This correlation also occurs with the tibial torsion. Perhaps outcomes of total knee arthroplasty surgery might be improved by addressing these deformities as well.
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Lu Y, Zheng ZL, Lv J, Hao RZ, Yang YP, Zhang YZ. Relationships between Morphological Changes of Lower Limbs and Gender During Medial Compartment Knee Osteoarthritis. Orthop Surg 2020; 11:835-844. [PMID: 31663282 PMCID: PMC6819278 DOI: 10.1111/os.12529] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2019] [Revised: 08/06/2019] [Accepted: 08/15/2019] [Indexed: 12/26/2022] Open
Abstract
Objectives To evaluate the dynamic changes of key morphology indicators of the lower extremities in the coronal plane with progressing medial compartment knee osteoarthritis (KOA) with an emphasis on gender‐dependent regional differences. Methods The radiographs of patients with non‐traumatic knee pain and varying degrees of genu varus were reviewed. Radiographs were studied in 1538 lower limbs of 883 consecutive patients who visited our hospital from January to July 2017; all patients had long‐standing anteroposterior image‐splicing radiographs taken of their lower limbs. Morphological indicators of bones and joints that can change the alignment of lower limbs or reflect cartilage wear and soft‐tissue relaxation were selected and measured with the help of picture archiving and communication systems. After comparing the data of different genders, the data of males and females was separated into three age groups, <40 years, 40–60 years, >60 years respectively, and then compared among age groups using the Kruskal‐Wallis and Mann–Whitney U tests. Scatterplots of age and all the measurements were drawn to determine the strength of the relations. The Pearson correlation test was performed to reveal correlations of measurements and age. Results Femoral bowing angle (FBA) and joint line convergence angle (JLCA) have obvious differences between different genders (P = 0.001, 0.000, respectively). This suggests that females have greater femoral curvature and joint space angle than males. Significant differences were found in hip‐knee‐ankle angle (HKA), FBA, distal femoral valgus resection angle (DFVRA), medial proximal tibial angle (MPTA), JLCA, and minimum joint space width (min‐JSW) by age groups in females (P = 0.000, 0.000, 0.000, 0.000, 0.003, 0.002, respectively). The difference of mechanical medial distal femoral angle (mMDFA) was significant with P values less than 0.05 deemed significant (P = 0.030). Significant correlations were found between age and all measurements (r = −0.166, 0.253, 0.270, −0.147, 0.089, −0.105, −0.076, respectively, P < 0.01). Whereas, the difference in min‐JSW by age group was the only significant one in males (P = 0.001), and no significant correlation was found between age and measurements (r = −0.107, 0.041, 0.134, −0.067, 0.079, −0.134, −0.098, respectively, P > 0.01). Conclusions As KOA progressed, both dynamic deformation of lower extremities and degeneration of articular cartilage could be found in females, while no obvious dynamic deformations were found in males. Dynamic deformation of lower extremities was the important feature and the major causative factor of KOA in females.
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Affiliation(s)
- Yang Lu
- Department of Orthopaedic Surgery, The Third Hospital of Hebei Medical University, Shijiazhuang, China
| | - Zhan-le Zheng
- Department of Orthopaedic Surgery, The Third Hospital of Hebei Medical University, Shijiazhuang, China
| | - Ji Lv
- Department of Emergency Surgery, The First Hospital of Qinhuangdao Affiliated to Hebei Medical University, Qinhuangdao, China
| | - Rui-Zheng Hao
- Department of Orthopaedics, The Second Hospital of Tangshan, Tangshan, China
| | - Yi-Ping Yang
- Department of Emergency Surgery, The First Hospital of Qinhuangdao Affiliated to Hebei Medical University, Qinhuangdao, China
| | - Ying-Ze Zhang
- Department of Orthopaedic Surgery, The Third Hospital of Hebei Medical University, Shijiazhuang, China
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Lu Y, Zheng Z, Chen W, Lv H, Lv J, Zhang Y. Dynamic deformation of femur during medial compartment knee osteoarthritis. PLoS One 2019; 14:e0226795. [PMID: 31860687 PMCID: PMC6924647 DOI: 10.1371/journal.pone.0226795] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2019] [Accepted: 12/04/2019] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVES The aim of this study was to evaluate the morphological changes of the femur in the coronal plane in progressing varus gonarthrosis and to explore the interrelation of each component. PATIENTS AND METHODS From January to July 2017, radiographic images of 1538 knees of 883 consecutive patients were collected and analyzed. We drew the alignments and measured the orientation angles of the lower extremities and compared the results among age groups for each sex. Correlation and regression tests were used to analyze the measurements. RESULTS There were significant differences in the neck-shaft angle (NSA), femoral bowing angle (FBA) and anatomic medial distal femoral angle (aMDFA) by age group in females, whereas the differences were not significant in males. In females, a positive correlation was found between age and the FBA and aMDFA (r = 0.253, 0.141, p<0.01), and a negative correlation was found between age and the NSA while the FBA was controlled (r = -0.065, p<0.05). The FBA was positively correlated with the NSA (r = 0.312, p<0.01) and aMDFA (r = 0.233, p<0.01). The NSA, FBA, and aMDFA together affected 72.2% of the mechanical medial distal femoral angle (mMDFA) (β = 0.071, -0.528, 0.803, p<0.01). CONCLUSION As knee osteoarthritis (KOA) progressed, dynamic deformation of the femur was found in females, while no obvious changes were found in males. Femoral mechanical axis varus (mMDFA decrease) was the result of changes in the NSA, FBA and aMDFA. The deformation was throughout the femur rather than in a local area, as femur bowing can lead to corresponding changes in both ends of the femur. We provided a theoretical basis for TKA and knee-salvage treatment, and more attention should be paid to aging patients, especially females, in the preoperative protocol for orthomorphia.
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Affiliation(s)
- Yang Lu
- Department of Emergency Surgery, The First Hospital of Qinhuangdao Affiliated to Hebei Medical University, Haigang District, Qinhuangdao, Hebei Province, People’s Republic of China
- Department of Orthopedic Surgery, The Third Hospital of Hebei Medical University, Qiaoxi District, Shijiazhuang, People’s Republic of China
| | - Zhanle Zheng
- Department of Orthopedic Surgery, The Third Hospital of Hebei Medical University, Qiaoxi District, Shijiazhuang, People’s Republic of China
| | - Wei Chen
- Department of Orthopedic Surgery, The Third Hospital of Hebei Medical University, Qiaoxi District, Shijiazhuang, People’s Republic of China
| | - Hongzhi Lv
- Department of Orthopedic Surgery, The Third Hospital of Hebei Medical University, Qiaoxi District, Shijiazhuang, People’s Republic of China
| | - Ji Lv
- Department of Emergency Surgery, The First Hospital of Qinhuangdao Affiliated to Hebei Medical University, Haigang District, Qinhuangdao, Hebei Province, People’s Republic of China
| | - Yingze Zhang
- Department of Orthopedic Surgery, The Third Hospital of Hebei Medical University, Qiaoxi District, Shijiazhuang, People’s Republic of China
- * E-mail:
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Chang MJ, Jeong HJ, Kang SB, Chang CB, Yoon C, Shin JY. Relationship Between Coronal Alignment and Rotational Profile of Lower Extremity in Patients With Knee Osteoarthritis. J Arthroplasty 2018; 33:3773-3777. [PMID: 30126713 DOI: 10.1016/j.arth.2018.07.022] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2018] [Revised: 07/13/2018] [Accepted: 07/24/2018] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND We aimed at determining whether the coronal alignment of lower extremity was related to rotational geometry of distal femur, femoral anteversion, and tibial torsion in patients with knee osteoarthritis. METHODS A total of 422 lower extremities were divided into 3 groups according to the coronal alignment: valgus (n = 31), neutral (n = 78), and varus group (n = 313). Condylar twisting angle was measured to determine rotational geometry of distal femur as the angle between the clinical transepicondylar axis and the posterior condylar line. Femoral anteversion was assessed using the angle between a line intersecting the femoral neck and the posterior condylar line (pFeAV) and the angle between the same line and transepicondylar axis that is not affected by posterior condylar variations (tFeAV). Tibial torsion was evaluated by measuring the angle between the posterior condyles of the proximal tibia and the transmalleolar axis. RESULTS As the coronal alignment changed from varus to valgus, the condylar twisting angle increased (r = 0.253, P < .001; 6.6° in varus, 7.4° in neutral, and 10.2° in valgus group). Although the pFeAV also increased (r = 0.145, P = .003), the tFeAV did not change significantly (P = .218). Mean tFeAV was 4.3° in varus, 4.7° in neutral, and 6.5° in valgus group. In contrast, as the coronal alignment changed from varus to valgus, the external tibial torsion increased (r = 0.374, P < .001; 22.6° in varus, 26.3° in neutral, and 32.6° in valgus group). CONCLUSION The change patterns of the rotational profiles of the lower extremity according to the coronal alignment should be considered in order to obtain satisfactory rotational alignment after TKA.
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Affiliation(s)
- Moon Jong Chang
- Department of Orthopaedic Surgery, Seoul National University College of Medicine, SMG-SNU Boramae Medical Center, Seoul, South Korea
| | - Hyeon Jang Jeong
- Department of Orthopaedic Surgery, Bundang Jesaeng General Hospital, Seongnam, South Korea
| | - Seung-Baik Kang
- Department of Orthopaedic Surgery, Seoul National University College of Medicine, SMG-SNU Boramae Medical Center, Seoul, South Korea
| | - Chong Bum Chang
- Department of Orthopaedic Surgery, Seoul National University College of Medicine, SMG-SNU Boramae Medical Center, Seoul, South Korea
| | - Chan Yoon
- Department of Orthopaedic Surgery, Seoul National University College of Medicine, SMG-SNU Boramae Medical Center, Seoul, South Korea
| | - Joung Youp Shin
- Department of Orthopaedic Surgery, Seoul National University College of Medicine, SMG-SNU Boramae Medical Center, Seoul, South Korea
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12
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Lin SJ, Lee CY, Huang KC, Peng KT, Huang TW, Lee MS, Hsu RWW, Shen WJ. Improved femoral component rotation in advanced genu valgum deformity using computer-assisted measured resection total knee arthroplasty. J Orthop Surg Res 2015; 10:135. [PMID: 26328925 PMCID: PMC4557226 DOI: 10.1186/s13018-015-0279-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2015] [Accepted: 08/16/2015] [Indexed: 11/15/2022] Open
Abstract
Background Accurate femoral rotational alignment is of vital importance for successful total knee arthroplasty (TKA). The value of computer-assisted surgery TKA (CAS-TKA) in increasing the accuracy of femoral rotational alignment remains controversial. We hypothesize that outcomes are related to the severity of preoperative varus and valgus deformity and that CAS-TKA may be beneficial under certain circumstances. Methods Between January 2007 and December 2013, patients with osteoarthritis and varus angulation in the mechanical axis (MA) ≥ 15° and valgus angulation in the MA ≥ 10° (based on hip-to-ankle standing radiography) who underwent TKA were divided into four groups. CAS-TKA and conventional TKA outcomes were compared in patients who had preoperative advanced genu varum and advanced genu valgum deformities. The accuracy of component alignment and postoperative limb alignment was determined using radiographic parameters and computed tomography (CT). Results One hundred and eight patients (144 knees) were included in the analysis. For patients with preoperative advanced genu varum deformity, a significant difference was detected in the sagittal femoral angle (p < 0.001), but no significant improvement of femoral rotational alignment was noted (p = 0.127). In patients with preoperative advanced genu valgum deformity, a significant difference was found in the sagittal femoral angle (p = 0.034). The femoral rotational angle was significantly closer to the proper position in the CAS-TKA group (p < 0.001). When comparing the percentage of knees achieving the proper alignment, there was a decrease in the amount of outlier for the femoral rotational angle for CAS-TKA in advanced genu valgum deformity (p = 0.011). Conclusions Our data demonstrate that CAS-TKA is beneficial in obtaining proper femoral rotational alignment in patients with advanced genu valgum deformity (preoperative MA ≥ 10° valgus). In patients with advanced genu varum deformity (preoperative MA ≥ 15° varus), CAS-TKA did not improve the femoral rotational alignment.
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Affiliation(s)
- Shih-Jie Lin
- Department of Orthopaedic Surgery, Chang Gung Memorial Hospital, Chiayi, 6, West Section, Chia-Pu Road, Pu-Tz City, 613, Chia-Yi Hsien, Taiwan.
| | - Chien-Ying Lee
- Department of Orthopaedic Surgery, Chang Gung Memorial Hospital, Chiayi, 6, West Section, Chia-Pu Road, Pu-Tz City, 613, Chia-Yi Hsien, Taiwan.
| | - Kuo-Chin Huang
- Department of Orthopaedic Surgery, Chang Gung Memorial Hospital, Chiayi, 6, West Section, Chia-Pu Road, Pu-Tz City, 613, Chia-Yi Hsien, Taiwan. .,Chang Gung University, Taoyuan, Taiwan, 259 Wen-Hwa 1st Road, Kwei-Shan Tao-Yuan, 333, Taiwan.
| | - Kuo-Ti Peng
- Department of Orthopaedic Surgery, Chang Gung Memorial Hospital, Chiayi, 6, West Section, Chia-Pu Road, Pu-Tz City, 613, Chia-Yi Hsien, Taiwan. .,Chang Gung University, Taoyuan, Taiwan, 259 Wen-Hwa 1st Road, Kwei-Shan Tao-Yuan, 333, Taiwan.
| | - Tsan-Wen Huang
- Department of Orthopaedic Surgery, Chang Gung Memorial Hospital, Chiayi, 6, West Section, Chia-Pu Road, Pu-Tz City, 613, Chia-Yi Hsien, Taiwan. .,Chang Gung University, Taoyuan, Taiwan, 259 Wen-Hwa 1st Road, Kwei-Shan Tao-Yuan, 333, Taiwan.
| | - Mel S Lee
- Department of Orthopaedic Surgery, Kaohsiung Chang Gung Memorial Hospital, No. 123, DAPI Rd. Niaosng Dist., Kaohsiung City, 83301, Taiwan. .,Chang Gung University, Taoyuan, Taiwan, 259 Wen-Hwa 1st Road, Kwei-Shan Tao-Yuan, 333, Taiwan.
| | - Robert Wen-Wei Hsu
- Department of Orthopaedic Surgery, Chang Gung Memorial Hospital, Chiayi, 6, West Section, Chia-Pu Road, Pu-Tz City, 613, Chia-Yi Hsien, Taiwan. .,Chang Gung University, Taoyuan, Taiwan, 259 Wen-Hwa 1st Road, Kwei-Shan Tao-Yuan, 333, Taiwan.
| | - Wun-Jer Shen
- Po-Cheng Orthopedic Institute, 100 Bo-ai, 2nd Road, Zuoying District, Kaohsiung, Taiwan.
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Figueroa J, Guarachi JP, Matas J, Arnander M, Orrego M. Is computed tomography an accurate and reliable method for measuring total knee arthroplasty component rotation? INTERNATIONAL ORTHOPAEDICS 2015. [DOI: 10.1007/s00264-015-2917-1] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Forster-Horvath C, Kremo V, Müller-Gerbl M, Nowakowski AM. Using the anatomical tibial axis for total knee arthroplasty alignment may lead to an internal rotation error. INTERNATIONAL ORTHOPAEDICS 2015; 39:2347-53. [PMID: 26156716 DOI: 10.1007/s00264-015-2858-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/15/2015] [Accepted: 04/15/2015] [Indexed: 10/23/2022]
Abstract
INTRODUCTION Despite intensive research, current total knee arthroplasty (TKA) designs do not always provide the correct kinematics for the native joint and thus further optimisation is necessary. Several studies support the importance of malrotation of the tibial components in the failure of TKA. We hypothesise that using the anatomical tibial axis (ATA) to align tibial component rotation on the resected tibial surface may lead to an internal rotation error due to relative anterior shift of the lateral articular surface centre compared to the medial one. The aim of this study was to compare the anatomical tibial axis of the physiological tibial joint surface to the resected one. METHOD Twenty formalin-fixed cadaveric knees were obtained for study. After computed tomography scanning the data of each specimen were entered into a standardised coordinate system and virtual bone cuts were performed with 6, 8 and 10 mm resection depths. The positions of the articular surface centres were determined at each resection depth. RESULTS The lateral articular surface centre had moved anteriorly after the resection by a mean 1.475 mm, while the medial one had not changed significantly. Resecting the tibia at a 6-mm cut and using the transverse tibial axis to align the prosthetic tibial plateau will result in a mean 4.0° (95 % confidence interval, 2.5-5.5°) of internal rotation compared to the uncut tibia. DISCUSSION The ATA lies in 6 degrees of external rotation compared to the perpendicular to the posterior tibial condylar axis (PTCA). Graw et al. suggest aligning the tibial component in 10 degrees of external rotation to the latter. Thus, if we accept the above suggestion, the ATA is 4 degrees internally rotated compared to the same line on the resected proximal tibia. These prior studies appear to be in accordance with our findings. CONCLUSIONS We conclude that using the ATA on the resected tibial surface may contribute to an internal rotation error.
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Affiliation(s)
- Csaba Forster-Horvath
- Orthopaedic Department, University of Basel, Spitalstrasse 21, 4031, Basel, Switzerland
| | - Valerie Kremo
- Institute of Anatomy, University of Basel, Pestalozzistrasse 20, 4056, Basel, Switzerland
| | - Magdalena Müller-Gerbl
- Institute of Anatomy, University of Basel, Pestalozzistrasse 20, 4056, Basel, Switzerland
| | - Andrej Maria Nowakowski
- Orthopaedic Department, University of Basel, Spitalstrasse 21, 4031, Basel, Switzerland. .,Institute of Anatomy, University of Basel, Pestalozzistrasse 20, 4056, Basel, Switzerland.
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Fujimoto E, Sasashige Y, Tomita T, Sasaki H, Touten Y, Fujiwara Y, Ochi M. Intra-operative gaps affect outcome and postoperative kinematics in vivo following cruciate-retaining total knee arthroplasty. INTERNATIONAL ORTHOPAEDICS 2015; 40:41-9. [PMID: 26133289 DOI: 10.1007/s00264-015-2847-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/26/2015] [Accepted: 04/30/2015] [Indexed: 12/30/2022]
Abstract
PURPOSE The following investigation evaluates the effect of intra-operative gaps after posterior cruciate ligament-retaining total knee arthroplasty using two-dimensional/three-dimensional registration and the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC). METHODS Patients were divided into two groups according to their 90°-0° component gap changes using a device designed by our laboratory. The wide gap group was defined as more than 3 mm (4.3 ± 0.7 mm), and the narrow gap group was defined as less than 3 mm (1.3 ± 1.3 mm). RESULTS Under non-WB (weight bearing) conditions, the wide flexion gap group (N = 10) showed a significant anterior displacement of the medial femoral condyle as compared with the narrow flexion gap group (N = 20). Despite no significant differences observed under WB conditions, both femoral condyle positions during flexion were significantly more posterior than during extension. WOMAC of the tight gap group showed worse scores for two functional items demanding knee flexion (bending to floor and getting on/off toilet). CONCLUSION The large flexion gap could influence the late rollback under non-WB conditions and better WOMAC functional scores in the flexion items. Three to four millimetre laxity at 90°-0° component gaps may be adequate and might be necessary to carry out daily life activities.
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Affiliation(s)
- Eisaku Fujimoto
- Department of Orthopaedic Surgery, Chugoku Rousai Hospital, 1-5-1 Hirotagaya, Kure, Hiroshima, 737-0193, Japan.
| | - Yoshiaki Sasashige
- Department of Orthopaedic Surgery, Chugoku Rousai Hospital, 1-5-1 Hirotagaya, Kure, Hiroshima, 737-0193, Japan
| | - Tetsuya Tomita
- Department of Orthopaedic Biomaterial Science, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
| | - Hirofumi Sasaki
- Department of Orthopaedic Surgery, Chugoku Rousai Hospital, 1-5-1 Hirotagaya, Kure, Hiroshima, 737-0193, Japan
| | - Yoriko Touten
- Department of Orthopaedic Surgery, Chugoku Rousai Hospital, 1-5-1 Hirotagaya, Kure, Hiroshima, 737-0193, Japan
| | - Yuusuke Fujiwara
- Department of Orthopaedic Surgery, Chugoku Rousai Hospital, 1-5-1 Hirotagaya, Kure, Hiroshima, 737-0193, Japan
| | - Mitsuo Ochi
- Department of Orthopaedic Surgery, Hiroshima University, Hiroshima, Japan
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