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Giurazza G, Perricone G, Franceschetti E, Campi S, Gregori P, Zampogna B, Cardile UG, Papalia GF, Papalia R. Femorotibial angle on short knee radiographs fails to accurately predict the lower limb mechanical alignment. A systematic review and meta-analysis on different femorotibial angle definitions and short knee radiograph types. Orthop Rev (Pavia) 2024; 16:120053. [PMID: 38947178 PMCID: PMC11213696 DOI: 10.52965/001c.120053] [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: 06/04/2024] [Accepted: 06/04/2024] [Indexed: 07/02/2024] Open
Abstract
Introduction Hip-knee-ankle angle (HKA) on Full Limb Radiographs (FLRs) is the gold standard for coronal knee alignment assessment. Despite the widespread utilization of the more convenient femorotibial angle (FTA) on either antero-posterior (AP) or postero-anterior (PA) short knee radiographs (SKRs), its definition and correlation with HKA remains controversial. This review is the first to systematically investigate FTA-HKA correlation and the effect of different FTA methods and SKRs. Methods Systematic literature search (Pubmed, Scopus, Cochrane Library) followed PRISMA guidelines, to evaluate studies examining the FTA-HKA correlation. Meta-analyses compared the 3 most common FTA methods, knee center determination method and SKR types. Results 17 studies (2597 patients, 3234 knees) were included. The strongest correlation with HKA (r = 0.78) was found for FTA Method 1 (angle formed by lines drawn from the midpoint of tibial spines to points 10 cm above and below the joint line). No significant differences were observed when grouping the FTA methods by knee center assessment (Group I, r = 0.78; Group II, r = 0.77). AP SKRs showed a trend towards stronger FTA-HKA correlation compared to PA SKRs, in both Method 1 (r = 0.79 vs 0.75) and Method 3 (r = 0.80 vs 0.66). Conclusion Irrespective of its definition or type of SKR used, FTA lacks reliable accuracy in predicting the HKA in most knees. FLRs should be used whenever precise estimation of the patient's alignment is necessary. Caution is warranted in interpreting studies investigating knee alignment or knee arthroplasty outcomes based on FTA.
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Affiliation(s)
- Giancarlo Giurazza
- Fondazione Policlinico Universitario Campus Bio-Medico, Via Álvaro del Portillo, 200 - 00128 Roma, Italy
- Research Unit of Orthopaedic and Trauma Surgery, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Roma, Italy
| | - Giovanni Perricone
- Fondazione Policlinico Universitario Campus Bio-Medico, Via Álvaro del Portillo, 200 - 00128 Roma, Italy
- Research Unit of Orthopaedic and Trauma Surgery, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Roma, Italy
| | - Edoardo Franceschetti
- Fondazione Policlinico Universitario Campus Bio-Medico, Via Álvaro del Portillo, 200 - 00128 Roma, Italy
- Research Unit of Orthopaedic and Trauma Surgery, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Roma, Italy
| | - Stefano Campi
- Fondazione Policlinico Universitario Campus Bio-Medico, Via Álvaro del Portillo, 200 - 00128 Roma, Italy
- Research Unit of Orthopaedic and Trauma Surgery, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Roma, Italy
| | - Pietro Gregori
- Fondazione Policlinico Universitario Campus Bio-Medico, Via Álvaro del Portillo, 200 - 00128 Roma, Italy
- Research Unit of Orthopaedic and Trauma Surgery, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Roma, Italy
| | - Biagio Zampogna
- Fondazione Policlinico Universitario Campus Bio-Medico, Via Álvaro del Portillo, 200 - 00128 Roma, Italy
- Research Unit of Orthopaedic and Trauma Surgery, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Roma, Italy
- Department of Biomedical, Dental, Morphological and Functional Images, University of Messina, A.O.U. Policlinico "G.Martino", Via Consolare Valeria, 1 - 98124, Messina, Italy
| | - Umberto Gabriele Cardile
- Fondazione Policlinico Universitario Campus Bio-Medico, Via Álvaro del Portillo, 200 - 00128 Roma, Italy
- Research Unit of Orthopaedic and Trauma Surgery, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Roma, Italy
| | - Giuseppe Francesco Papalia
- Fondazione Policlinico Universitario Campus Bio-Medico, Via Álvaro del Portillo, 200 - 00128 Roma, Italy
- Research Unit of Orthopaedic and Trauma Surgery, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Roma, Italy
| | - Rocco Papalia
- Fondazione Policlinico Universitario Campus Bio-Medico, Via Álvaro del Portillo, 200 - 00128 Roma, Italy
- Research Unit of Orthopaedic and Trauma Surgery, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Roma, Italy
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He L, Wu C, Lang J, Chen L, Wu P. The main cause of tibial prosthesis malalignment after total knee arthroplasty in Southern Chinese population. Heliyon 2024; 10:e25447. [PMID: 38322978 PMCID: PMC10844569 DOI: 10.1016/j.heliyon.2024.e25447] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Revised: 01/25/2024] [Accepted: 01/26/2024] [Indexed: 02/08/2024] Open
Abstract
Objectives This study aimed to determine the occurrence rate of malalignment of tibial prosthesis and explore the influencing factors. Methods 296 patients from Southern China who underwent total knee arthroplasty (TKA) were selected as the research objects. Their general demographic data were recorded. The tibial bowing angle (TBA), tibial length, medial proximal tibial angle (MPTA), tibial plateau shift angle (TPSA), tibial bone loss, lateral distal tibial angle, and overall width of tibial plateau and widths of medial and lateral tibial plateau were measured before TKA. The tibial component coronal alignment angle (TCCA) was measured after the operation. Malalignment of the tibial prosthesis was defined as TCCA <87° or TCCA >93°. Tibial bowing was indicated by TBA >2°, and lateral bowing was recorded as +. The correlations of TCCA with demographic data and pre-operation imaging measurement parameters were statistically analyzed. Results Bivariate correlation analysis revealed negative correlations between TCCA and TBA (r = -0.602, P < 0.001) and TPSA (r = -0.304, P < 0.001), and a positive correlation with MPTA (r = -0.318, P < 0.001). Multivariate linear regression analysis demonstrated a significant negative correlation between TCCA and TBA (P < 0.001). The occurrence rate of malalignment of tibial prosthesis was 12.37 %. The occurrence rates of malalignment were 22.54 % in the tibial bowing group and 6.87 % in the non-tibial bowing group, showing statistical differences (P < 0.001). Conclusion The malalignment rate of tibial prosthesis among Southern Chinese patients is relatively high, possibly attributed to the tibial anatomy anomalies, particularly the tibial bowing. The entry point should be determined based on tibial morphology.
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Affiliation(s)
- Lili He
- The First Affiliated Hospital of Wenzhou Medical University, Nanbaixiang street, Ouhai district, Wenzhou city, Zhejiang province, 325200, China
| | - Congcong Wu
- The First Affiliated Hospital of Wenzhou Medical University, Nanbaixiang street, Ouhai district, Wenzhou city, Zhejiang province, 325200, China
| | - Junzhe Lang
- The First Affiliated Hospital of Wenzhou Medical University, Nanbaixiang street, Ouhai district, Wenzhou city, Zhejiang province, 325200, China
| | - Lei Chen
- The First Affiliated Hospital of Wenzhou Medical University, Nanbaixiang street, Ouhai district, Wenzhou city, Zhejiang province, 325200, China
| | - Peng Wu
- The First Affiliated Hospital of Wenzhou Medical University, Nanbaixiang street, Ouhai district, Wenzhou city, Zhejiang province, 325200, China
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Prevalence of extra-articular tibia valga morphology in valgus knees and its implications for primary total knee arthroplasty. J Orthop Surg Res 2022; 17:531. [PMID: 36494825 PMCID: PMC9733362 DOI: 10.1186/s13018-022-03418-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Accepted: 11/22/2022] [Indexed: 12/13/2022] Open
Abstract
INTRODUCTION Tibia valga, an extra-articular valgus deformity of the tibia, is common in valgus knees and can result in component misplacement and early total knee arthroplasty (TKA) failure. However, the prevalence and importance of tibia valga in TKA have been seldom reported. This study aims to describe the prevalence and characteristics of tibia valga morphology in valgus knees and describe implications for surgical planning in primary TKA. METHODS We prospectively examined pre-operative weightbearing whole-body EOS digital radiographs of patients with knee osteoarthritis listed for TKA between December 2018 and December 2020. Hip-knee-ankle angle (HKA), mechanical lateral distal femoral angle (mLDFA), mechanical medial proximal tibial angle (mMPTA), joint line convergence angle (JLCA) and tibial morphology with centre of rotation of angulation of tibia (CORA-tibia) were measured and analysed. RESULTS In 830 knees, 253 (30%) and 577 (70%) were classified as valgus and varus, respectively. In valgus knees, 89 knees (35%) had tibia valga. Median CORA-tibia was 2.8° (range 0.2°-10.9°). Tibia valga knees had no difference in mLDFA, higher HKA (5.0o versus 3.0°, p = 0.002) and mMPTA (89.6° versus 88.1°, p < 0.01), and lower JLCA (2.1° versus 2.3°, p < 0.01) compared to non-tibia valga knees. Tibia valga deformity was weakly positively correlated with valgus HKA (ρ = 0.23, p < 0.001) and mMPTA (ρ = 0.38, p < 0.001). In varus knees, there were 52 cases of tibia valga (9%) with median CORA-tibia of 3.0° (range 0.5°-5.5°). Tibia valga knees had higher mMPTA (87.0° versus 85.2°, p < 0.05) and no difference in HKA, mLDFA and JLCA. CORA-tibia was weakly positively correlated with mMPTA. CONCLUSIONS Valgus knees may have an extra-articular deformity of the tibia which might be the primary contributor of the overall valgus HKA deformity rather than the distal femoral anatomy. To detect the deformity, full leg-length radiographs should be acquired pre-operatively. Intramedullary instrumentation should be used cautiously in knees with tibia valga when performing TKA.
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Cooperman C, Wiznia D, Kunsel K, Roytman G, Ani L, Pratola D, Lee GC, Tommasini S, Bernstein J. Personalizing Revision Tibial Baseplate Position and Stem Trajectory With Custom Implants Using 3D Modeling to Optimize Press-fit Stem Placement. Arthroplast Today 2022; 18:45-51. [PMID: 36267389 PMCID: PMC9576531 DOI: 10.1016/j.artd.2022.08.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Revised: 08/07/2022] [Accepted: 08/10/2022] [Indexed: 11/07/2022] Open
Abstract
Background A common tibial construct for revision total knee arthroplasty includes a long diaphyseal engaging press-fit stem. Due to tibial canal bowing, compromises are often necessary to match patient anatomy when choosing stemmed implants. The objective of this study is to determine through 3-D modeling whether current implant press-fit options appropriately fit patient anatomy, or whether an alternative angle between the stem and baseplate could increase the cortical engagement of long press-fit tibial stems. Methods Preoperative computerized tomography scans from 100 patients undergoing TKA were imported into an image-processing software program. Three-dimensional models were created with tibial stems placed at a fixed perpendicular angle and a custom angle to the revision tibial baseplate. Stem diameter, depth, offset, and contact surface area were measured and analyzed between the 2 groups. Results Significantly more cortical contact, larger stem diameter, and smaller offset of the custom keel from the center of the baseplate were associated with free custom tibial stem placement vs a fixed perpendicular baseplate-stem interface (P < .001). Statistically significant differences were also found between different patient demographics. Conclusions Custom free-angle stem placement allows for increased stem diameter and cortical contact of press-fit tibial stems compared to existing constructs that must interface with the baseplate at a 90-degree angle. Current revision tibia implants limit fixation of tibial press-fit stems and often mismatch with patient anatomy. Alternative ways to fit patient anatomy may be beneficial for patients with extreme mismatch. In the future, custom keel angles may help to resolve this problem.
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Affiliation(s)
- Charlotte Cooperman
- Yale University, New Haven, CT, USA
- Corresponding author. Yale University, 900 Chapel Street, New Haven, CT 06510, USA. Tel.: +1 508 596 4868.
| | - Daniel Wiznia
- Yale University School of Medicine, New Haven, CT, USA
| | | | | | - Lidia Ani
- Yale University School of Medicine, New Haven, CT, USA
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Tucker NJ, Hadeed MM, Mauffrey C, Parry JA. Native tibia valga: a potential source of varus malreduction during intramedullary tibial nail fixation of tibial shaft fractures. INTERNATIONAL ORTHOPAEDICS 2022; 46:1165-1173. [PMID: 35246719 DOI: 10.1007/s00264-022-05356-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Accepted: 02/22/2022] [Indexed: 11/26/2022]
Abstract
PURPOSE To determine the effect of native tibia valga on intramedullary nail (IMN) fixation of tibial shaft fractures. METHODS Retrospective comparative cohort analysis of 110 consecutive patients with tibial shaft fractures undergoing IMN fixation at an urban level one trauma centre was performed. Medical records and radiographs were reviewed for demographics, tibia centre of rotation of angulation (CORA), nail starting point, incidence of varus malreduction, and nail/canal proportional fit. RESULTS Tibia valga (CORA of ≥ 3 degrees) was present in 37 (33.6%) patients. The anatomic nail starting point distance (in relation to the lateral tibial spine) was significantly greater in the tibia valga group (12.0 mm vs. 5.0 mm, mean difference: 7.1 mm, 95% CI: 5.8 to 8.3 mm, p < 0.0001). Varus malreduction was more common in the tibia valga group (10.8% vs. 1.4%, proportional difference: 9.4%, 95% CI: - 1.0 to 21.3%, p = 0.04). Varus malreduction in the tibia valga group was associated with a decreased nail width/inner canal width proportion on multivariate analysis (OR = 0.683, 95% CI: 0.468 to 0.995, p = 0.0004). CONCLUSION Native tibia valga is common, and the use of a standard coronal IMN starting point with poor nail fit can lead to iatrogenic varus malreduction. In patients with tibia valga, maximizing nail fit or utilization of a medial starting point should be considered.
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Affiliation(s)
- Nicholas J Tucker
- Department of Orthopedics, Denver Health Medical Center, Denver Health, 777 Bannock St, MC 0188, Denver, CO, 80204, USA
| | - Michael M Hadeed
- Department of Orthopaedic Surgery, University of Virginia School of Medicine, Charlottesville, VA, USA
| | - Cyril Mauffrey
- Department of Orthopedics, Denver Health Medical Center, Denver Health, 777 Bannock St, MC 0188, Denver, CO, 80204, USA
- University of Colorado School of Medicine, Aurora, CO, USA
| | - Joshua A Parry
- Department of Orthopedics, Denver Health Medical Center, Denver Health, 777 Bannock St, MC 0188, Denver, CO, 80204, USA.
- University of Colorado School of Medicine, Aurora, CO, USA.
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