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Oh SM, Bin SI, Kim JM, Lee BS, Lee J, Bae K. Limb length change after total knee arthroplasty for valgus deformity does not affect the clinical score and is not affected by fixed flexion deformity. Orthop Traumatol Surg Res 2024; 110:103787. [PMID: 38070733 DOI: 10.1016/j.otsr.2023.103787] [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: 01/25/2023] [Revised: 10/31/2023] [Accepted: 12/05/2023] [Indexed: 12/17/2023]
Abstract
BACKGROUND The limb length change (LLC) after total knee arthroplasty (TKA) is especially significant in valgus deformity. The higher LLC could cause higher incidences of lower limb length discrepancy (LLD) and low clinical score. However, studies about LLC after TKA for valgus deformity are limited, and there are none on the relationship between LLC and fixed flexion deformity (FFD) in valgus deformity. HYPOTHESIS (1) The amount of LLC would affect the postoperative LLD, (2) the improvement of fixed flexion deformity (FFD) would affect the amount of LLC, (3) The amount of LLC would affect the improvement in the clinical score after TKA for valgus deformity. PATIENTS AND METHODS Fifty knees of 50 patients who underwent primary unilateral TKA for valgus-type osteoarthritis between January 2000 and October 2021 were included. A radiological and clinical assessment were performed the day before the operation and at 12 months post-operatively. Full-length standing anteroposterior radiographs were used to measure HKA and LLC. FFD and Hospital for Special Surgery (HSS) score were measured in the outpatient department. RESULTS The incidence of lengthening was 92.0% and the mean LLC was 18.85mm (SD, 19.60mm). Postoperative LLD over 10mm occurred in 26% and the mean of postoperative LLD was 4.21mm (SD, 7.96mm). The LLC was correlated with postoperative LLD (rs=0.357, p=0.011) and the HKA change (rs=0.375, p=0.007), but not with the FFD improvement (rs=0.164, p=0.255) and HSS improvement (rs=0.076, p=0.613) or postoperative HSS (rs=0.094, p=0.528). CONCLUSION LLC was affected by HKA improvement but not by FFD improvement after TKA for patients with valgus deformity. Additionally, LLC did not affect the clinical score. LEVEL OF EVIDENCE III; retrospective cohort study.
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Affiliation(s)
- Sung-Mok Oh
- Department of Orthopedic surgery, Barun Hospital, 145, Yeouidaebang-ro, Yeongdeungpo-gu, Seoul, Korea
| | - Seong-Il Bin
- Department of Orthopedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, 05505 Seoul, Korea.
| | - Jong-Min Kim
- Department of Orthopedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, 05505 Seoul, Korea
| | - Bum-Sik Lee
- Department of Orthopedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, 05505 Seoul, Korea
| | - Jongjin Lee
- Department of Orthopedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, 05505 Seoul, Korea
| | - Kinam Bae
- Department of Orthopedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, 05505 Seoul, Korea
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Pradhan SS, Tripathy SK, Jain M, Behera H, Velagada S, Srinivasan A. Impact of limb length discrepancy on functional outcome in total knee arthroplasty patients: a prospective cohort study. ARTHROPLASTY 2022; 4:22. [PMID: 35650655 PMCID: PMC9161586 DOI: 10.1186/s42836-022-00123-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Accepted: 04/13/2022] [Indexed: 11/15/2022] Open
Abstract
Background Limb length alteration following total knee arthroplasty (TKA) has been under-reported. Few studies have shown a significant association between limb length discrepancy (LLD) and poor functional outcome. This prospective study evaluated the impact of radiographic and perceived LLD on functional outcome in TKA. The variables affecting LLD were also evaluated. Methods The preoperative and postoperative limb lengths of TKA patients (112 knees, 81 patients, KL grade ≥ 3) were measured in full-length digital radiographs. The Hip-Knee-Ankle (HKA) angles were also measured. The functional outcome (Western Ontario and McMaster Universities Arthritis Index) and perception about LLD were evaluated after six months. Results The mean preoperative radiographic LLD in the unilateral and bilateral TKA groups was 0.75 cm ± 0.60 cm and 0.58 cm ± 0.52 cm (P = 0.197), respectively. Similarly, postoperative LLD was 0.76 cm ± 0.85 cm in the unilateral group and was 0.59 cm ± 0.92 cm (P = 0.402) in the bilateral group. Only 19.7% of patients had postoperative radiographic LLD of ≥ 10 mm, and 80.2% of patients had LLD of < 10 mm. The functional outcome was significantly affected when LLD exceeded 10 mm (correlation coefficient 0.54, P < 0.001). Linear regression analysis revealed no significant effects of age, sex, height, weight, BMI, preoperative LLD and difference in deformity between the limbs on postoperative LLD. 34.5% of patients perceived LLD in the preoperative period, which decreased to 3.7% in the postoperative period. Perceived LLD did not correlate to radiographic LLD and functional outcome. Conclusions There is no significant difference in radiographic LLD between unilateral and bilateral TKA. The functional outcome is adversely affected by radiographic LLD of ≥ 10 mm. Age, sex, BMI, preoperative LLD and difference in deformity angle do not affect the LLD. About one-third of patients perceive LLD in the preoperative period, which improves significantly after TKA. Levels of evidence II.
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Affiliation(s)
| | - Sujit Kumar Tripathy
- Dept. of Orthopedics, All India Institute of Medical Sciences, Bhubaneswar-751019, India.
| | - Mantu Jain
- Dept. of Orthopedics, All India Institute of Medical Sciences, Bhubaneswar-751019, India
| | - Hrudeswar Behera
- Dept. of Orthopedics, All India Institute of Medical Sciences, Bhubaneswar-751019, India
| | - Sandeep Velagada
- Dept. of Orthopedics, All India Institute of Medical Sciences, Bhubaneswar-751019, India
| | - Anand Srinivasan
- Dept. of Orthopedics, All India Institute of Medical Sciences, Bhubaneswar-751019, India
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Chalmers BP, LaGreca M, Addona J, Sculco PK, Haas SB, Mayman DJ. Characterizing the Magnitude of and Risk Factors for Functional Limb Lengthening in Patients Undergoing Primary Total Knee Arthroplasty. HSS J 2022; 18:271-276. [PMID: 35645637 PMCID: PMC9097002 DOI: 10.1177/15563316211009140] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Accepted: 01/15/2021] [Indexed: 02/07/2023]
Abstract
Background: There is little data on the magnitude and factors for functional leg lengthening after primary total knee arthroplasty (TKA). Questions/Purpose: We sought to determine the incidence of and risk factors for functional leg lengthening after primary TKA. Methods: We retrospectively reviewed consecutive unilateral primary TKAs at a single institution from 2015 to 2018. Of the 782 TKAs included, 430 (55%) were performed in women; the mean age was 66 years, and the mean body mass index was 29 kg/m2. Preoperatively, 541 (69%) knees were varus deformities and 223 (29%) were valgus deformities. Hip to ankle biplanar radiographs were obtained preoperatively and 6 weeks postoperatively for all patients. Two independent researchers measured leg length, coronal plane deformity, lateral knee flexion angle, and overall mechanical alignment on all preoperative and postoperative radiographs. Results: The mean overall ipsilateral functional leg lengthening was 7.0 mm. Seven hundred knees (90%) were overall functionally lengthened, including 462 (59%) knees lengthened >5 mm and 250 (31%) knees lengthened 10 mm or more. A valgus deformity and coronal plane deformity of 10° or more were significant risk factors for increased functional lengthening. Patients with severe valgus deformities (>10°) had the largest amount of functional lengthening, at a mean of 13.5 mm. Conclusion: After primary TKA, 90% of limbs are functionally lengthened, including roughly one-third over a centimeter. Valgus knee deformities and severe deformities (>10°) were significant risk factors for increased limb lengthening.
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Affiliation(s)
- Brian P. Chalmers
- Department of Orthopedic Surgery, Adult
Reconstruction and Joint Replacement, Hospital for Special Surgery, New York, NY,
USA,Brian P. Chalmers, MD, Department of
Orthopedic Surgery, Adult Reconstruction and Joint Replacement, Hospital for
Special Surgery, 535 East 70th Street, New York, NY 10021, USA.
| | - Mark LaGreca
- Department of Medicine, Philadelphia
College of Osteopathic Medicine, Philadelphia, PA, USA
| | | | - Peter K. Sculco
- Department of Orthopedic Surgery, Adult
Reconstruction and Joint Replacement, Hospital for Special Surgery, New York, NY,
USA
| | - Steve B. Haas
- Department of Orthopedic Surgery, Adult
Reconstruction and Joint Replacement, Hospital for Special Surgery, New York, NY,
USA
| | - David J. Mayman
- Department of Orthopedic Surgery, Adult
Reconstruction and Joint Replacement, Hospital for Special Surgery, New York, NY,
USA
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Lee HJ, Kim SH, Pujol N, Park YB. Total Knee Arthroplasty after Previous Ipsilateral Hip Arthroplasty Showed Lower Clinical Outcomes and Higher Leg Length Discrepancy Perception. J Knee Surg 2022; 35:375-383. [PMID: 32838456 DOI: 10.1055/s-0040-1715447] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
The purpose of this study is to compare perception of leg length discrepancy (LLD) and clinical results of total knee arthroplasties (TKA) in patients with or without previous ipsilateral hip arthroplasty. Between 2008 and 2015, navigation-assisted TKA was performed in 43 patients with previous hip arthroplasty after hip fracture. After 1:3 propensity score matching was performed, 108 patients of primary navigation-assisted TKA (group 1) and 36 patients with hip arthroplasty (group 2) were included. Knee Society (KS) scores, Western Ontario and McMaster Universities Index (WOMAC) scores, and patients' satisfaction including perception of LLD were evaluated. Radiographic evaluation included mechanical axis, component position, and LLD. Logistic regression analysis was performed to find the factors that affect the clinical outcomes. No significant differences in radiologic and clinical evaluations, except for KS function score, patient's satisfaction and LLD (p< 0.001), were detected between the groups. LLD and its perception were significantly higher in group 2 (1.8 ± 3.4 mm in group 1 and 9.7 ± 4.1 mm in group 2, p = 0.000). Risk factors for the low KS function score were found as LLD (odds ratio [OR]: 1.403, p = 0.008) and previous hip arthroplasty itself (OR: 15.755, p = 0.002), but much higher OR was found in previous hip arthroplasty. Although the outcomes of TKA in patients with ipsilateral hip arthroplasty are comparable to those of primary TKA, LLD was high and patient's satisfaction and functional outcomes were low in patients with previous ipsilateral hip arthroplasty. Care should be taken when considering TKA in patients with previous hip arthroplasty. This is a Level III, case control study.
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Affiliation(s)
- Han-Jun Lee
- Department of Orthopedic Surgery, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Dongjak-gu, Seoul, South Korea
| | - Seong Hwan Kim
- Department of Orthopedic Surgery, Hyundae General Hospital, Chung-Ang University College of Medicine, Namyangju-si, Gyeonggi-do, South Korea
| | - Nicolas Pujol
- Department of Orthopedic, Centre Hospitalier de Versailles, Le Chesnay, France
| | - Yong-Beom Park
- Department of Orthopedic Surgery, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Dongjak-gu, Seoul, South Korea
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Tripathy SK, Pradhan SS, Varghese P, Purudappa PP, Velagada S, Goyal T, Panda BB, Vanyambadi J. Limb length discrepancy after total knee arthroplasty: A systematic review and meta-analysis. World J Clin Cases 2021; 9:357-371. [PMID: 33521103 PMCID: PMC7812892 DOI: 10.12998/wjcc.v9.i2.357] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Revised: 11/14/2020] [Accepted: 12/10/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Limb length discrepancy (LLD) after total knee arthroplasty (TKA) has been considered as one of the reasons for the unsatisfactory outcome. However, there is no consensus about the extent of LLD that can be considered as clinically relevant.
AIM To evaluate the incidence of radiographic LLD and its impact on functional outcome following TKA.
METHODS All randomized-controlled trial and observational studies on LLD in TKA, published till 22nd June 2020, were systematically searched and reviewed. The primary outcome was “limb lengthening or LLD after TKA”. The secondary outcomes included “assessment of LLD in varus/valgus deformity” and “impact of LLD on the functional outcome”.
RESULTS Of 45 retrieved studies, qualitative and quantitative assessment of data was performed from eight studies and six studies, respectively. Five studies (n = 1551) reported the average limb lengthening of 5.98 mm. The LLD after TKA was ranging from 0.4 ± 10 mm to 15.3 ± 2.88 mm. The incidence of postoperative radiographic LLD was reported in 44% to 83.3% of patients. There was no difference in the preoperative and postoperative LLD (MD -1.23; 95%CI: -3.72, 1.27; P = 0.34). Pooled data of two studies (n = 219) revealed significant limb lengthening in valgus deformity than varus (MD -2.69; 95%CI: -5.11, 0.27; P = 0.03). The pooled data of three studies (n = 611) showed significantly worse functional outcome in patients with LLD of ≥ 10 mm compared to < 10 mm (standard MD 0.58; 95%CI: 0.06, 1.10; P = 0.03).
CONCLUSION Limb lengthening after TKA is common, and it is significantly more in valgus than varus deformity. Significant LLD (≥ 10 mm) is associated with suboptimal functional outcome.
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Affiliation(s)
- Sujit Kumar Tripathy
- Department of Orthopaedics, All India Institute of Medical Sciences, Bhubaneswar 751019, Odisha, India
| | | | - Paulson Varghese
- Department of Orthopaedics, All India Institute of Medical Sciences, Bhubaneswar 751019, Odisha, India
| | | | - Sandeep Velagada
- Department of Orthopaedics, All India Institute of Medical Sciences, Bhubaneswar 751019, Odisha, India
| | - Tarun Goyal
- Department of Orthopaedics, All India Institute of Medical Sciences, Bathinda 209201, India
| | | | - Jagadeesh Vanyambadi
- Department of Orthopaedics, Salford Royal NHS Foundation Trust, Salford M6 8HD, United Kingdom
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Khalifa AA, Mullaji AB, Gendy AN, Ahmed AM, Bakr HM, Khalifa YE, Abdelaal AM. Prediction of leg length change (LLC) after correcting varus and flexion deformity in patients undergoing TKA. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2021; 31:1199-1205. [PMID: 33423113 DOI: 10.1007/s00590-020-02853-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Accepted: 12/14/2020] [Indexed: 10/22/2022]
Abstract
PURPOSE Patients with varus and fixed flexion deformity (FFD) undergoing TKA may have a significant leg length change (LLC) after surgery. We aimed to determine the correlation between changes in HKA or FFD and leg length in patients undergoing TKA, the combined effect of coronal and sagittal plane deformity correction on LLC, and the possibility of estimating LLC mathematically. MATERIALS AND METHODS This was a prospective radiographic evaluation of 242 knees, which had undergone primary unilateral TKA for advanced OA with varus and FFD. Full-length standing calibrated anteroposterior radiographs were used to measure the hip-knee-ankle axis (HKA) and functional leg length after adjusting for magnification. Clinical evaluation of FFD was done using a handheld goniometer. RESULTS 224 knees (92.6%) showed increased limb length after TKA averaging 10.7 mm (SD 9.5 mm, P = .000). There was a significant correlation between the change in HKA and FFD from preoperatively to postoperatively with the amount of LLC (ρ 0.326 and 0.346, respectively, P = .000). FFD improvement from preoperatively to postoperatively was 8.1° to 1° (P = .000), respectively. A linear relationship was established between LLC and changes in HKA and FFD, where 10° improvement in HKA would result in an LLC of nearly 4 mm, and 10° improvement in FFD would result in a LLC of nearly 8 mm. CONCLUSION LLC may be substantial after correcting varus and FFD with unilateral TKA, it correlates with the change in HKA and FFD and can be mathematically estimated. CLINICAL TRIALS . GOV IDENTIFIER NCT03502382.
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Affiliation(s)
- Ahmed A Khalifa
- Orthopaedic Department, Qena Faculty of Medicine and University Hospital, South Valley University, Qena, Egypt. .,Orthopaedic and Traumatology Department, Assiut University Hospital, Assiut, Egypt.
| | | | - Abanoub Nagaty Gendy
- Orthopaedic and Traumatology Department, Assiut University Hospital, Assiut, Egypt
| | - Ahmed M Ahmed
- Orthopaedic Department, Qena Faculty of Medicine and University Hospital, South Valley University, Qena, Egypt
| | - Hatem M Bakr
- Orthopaedic and Traumatology Department, Assiut University Hospital, Assiut, Egypt
| | - Yaser E Khalifa
- Orthopaedic and Traumatology Department, Assiut University Hospital, Assiut, Egypt
| | - Ahmed M Abdelaal
- Orthopaedic and Traumatology Department, Assiut University Hospital, Assiut, Egypt
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