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Yang HY, Cheon JH, Kang SJ, Seon JK. Effect of tibia-first, restricted functional alignment technique on gap width changes, and component positioning in robotic arm-assisted total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 2024. [PMID: 39324361 DOI: 10.1002/ksa.12487] [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: 08/05/2024] [Revised: 09/13/2024] [Accepted: 09/15/2024] [Indexed: 09/27/2024]
Abstract
PURPOSE This study aims to quantitatively assess the predictability of post-resection gap dimensions and the attainment of balanced gaps using robotic arm-assisted total knee arthroplasty (TKA). METHODS This retrospective cohort study included 100 consecutive patients who underwent robotic arm-assisted TKA for knee osteoarthritis using a restricted functional alignment (FA) technique. Tibial cuts were performed based on preoperative tibial anatomy within predefined boundaries, followed by femoral component adjustments according to tensioned soft tissues to optimise gap balance. The primary outcome was the proportion of balanced gaps, defined as differential laxities of ≤2 mm, across extension, flexion, lateral, and medial gap measurements. Ligament balancing in lateral and medial compartments was assessed using a robotic system at 10° and 90° flexion to evaluate if restricted FA facilitated a balanced knee. Secondary outcomes included implant alignment, resection depth, and patient-reported outcome measures (PROMs). RESULTS Significant increases in both lateral and medial gaps at 10° and 90° flexion were observed following tibial and femoral bone resections (p < 0.001). At extension, average gap changes were 0.9 mm (lateral) and 1.6 mm (medial) after tibial cuts, and 0.5 mm (lateral) and 1.2 mm (medial) after femoral cuts. At 90° flexion, changes were 0.3 mm (lateral) and 1.7 mm (medial) following tibial cuts, and 1.0 mm (lateral) and 1.4 mm (medial) after femoral cuts. Despite these variations, the tibia-first, gap-balancing technique achieved overall balance in 98% of gap measurements. The tibial component was placed at an average of 2.1° varus, while the femoral component was positioned at 0.3° varus and 1.3° external rotation relative to the surgical transepicondylar axis. Significant improvements in PROMs were noted between preoperative and one-year postoperative evaluations (all p < 0.05). CONCLUSIONS The tibia-first, restricted FA technique achieved a well-balanced knee in 98% of cases, despite inconsistent gap increments observed between initial assessments and post-resection. LEVEL OF EVIDENCE Therapeutic Level IV.
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Affiliation(s)
- Hong Y Yang
- Department of Orthopaedic Surgery, Chonnam National University Hwasun Hospital, College of Medicine, Chonnam National University, Hwasun, Chonnam, Republic of Korea
| | - Jae H Cheon
- Department of Orthopaedic Surgery, Chonnam National University Hwasun Hospital, College of Medicine, Chonnam National University, Hwasun, Chonnam, Republic of Korea
| | - Sung J Kang
- Department of Orthopaedic Surgery, Chonnam National University Hwasun Hospital, College of Medicine, Chonnam National University, Hwasun, Chonnam, Republic of Korea
| | - Jong K Seon
- Department of Orthopaedic Surgery, Chonnam National University Hwasun Hospital, College of Medicine, Chonnam National University, Hwasun, Chonnam, Republic of Korea
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Vossen RJM, Ten Noever de Brauw GV, Ruderman LV, Bayoumi T, Kerkhoffs GMMJ, Zuiderbaan HA, Pearle AD. Large variance in a lateral osteoarthritic population prior to and following lateral unicompartmental arthroplasty: An analysis of knee phenotypes. Knee 2024; 49:97-107. [PMID: 38878673 DOI: 10.1016/j.knee.2024.05.010] [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: 03/07/2024] [Revised: 04/30/2024] [Accepted: 05/24/2024] [Indexed: 08/24/2024]
Abstract
BACKGROUND Disagreement exists on the optimal coronal alignment target for lateral unicompartmental knee arthroplasty (UKA). An improved understanding of the distribution of coronal alignment and joint line orientation in lateral osteoarthritis (OA) might prove beneficial. The aim of this study was to evaluate the pre- and postoperative Coronal Plane Alignment of the Knee (CPAK) distribution following lateral UKA and to evaluate the association between phenotypic variation and patient-reported outcome measures (PROMs). METHODS A surgeon's registry was retrospectively reviewed between 2012 and 2022 to identify patients who received primary lateral UKA for advanced, lateral compartment OA. Radiographic measurements were performed, and CPAK phenotypes were determined. The Knee Injury and Osteoarthritis Outcome Score (KOOS), Kujala, and patient satisfaction were analyzed at one-year and two-year follow-up. RESULTS A total of 305 knees were included. Preoperatively, seven phenotypes were observed and CPAK3 (54.1%) was most commonly observed. Postoperatively, all nine phenotypes were observed and CPAK6 (32.8%) was predominant. Preoperatively, 23.6% did not have a prearthritic valgus alignment. No significant differences in PROMs were found between individual phenotypes or between preserved and altered phenotypes. CONCLUSION Coronal alignment and joint line orientation were highly variable within a lateral compartment OA cohort. However, no association was demonstrated between superior postoperative PROMs and phenotype variation or phenotype preservation, which might suggest that there is not one universal optimal alignment target. Interestingly, 23.6% of knees with lateral compartment OA did not have a prearthritic valgus alignment, which may have been affected by joint line orientation.
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Affiliation(s)
- Roderick J M Vossen
- Hospital for Special Surgery, Department of Sports Medicine and Computer Assisted Surgery, 535 East 70th Street, New York, NY 10021, United States; Amsterdam UMC Location University of Amsterdam, Department of Orthopaedic Surgery and Sports Medicine, Meibergdreef 9, 1105 AZ Amsterdam, the Netherlands.
| | - Gaby V Ten Noever de Brauw
- Hospital for Special Surgery, Department of Sports Medicine and Computer Assisted Surgery, 535 East 70th Street, New York, NY 10021, United States; Amsterdam UMC Location University of Amsterdam, Department of Orthopaedic Surgery and Sports Medicine, Meibergdreef 9, 1105 AZ Amsterdam, the Netherlands
| | - Lindsey V Ruderman
- Hospital for Special Surgery, Department of Sports Medicine and Computer Assisted Surgery, 535 East 70th Street, New York, NY 10021, United States
| | - Tarik Bayoumi
- Hospital for Special Surgery, Department of Sports Medicine and Computer Assisted Surgery, 535 East 70th Street, New York, NY 10021, United States; Amsterdam UMC Location University of Amsterdam, Department of Orthopaedic Surgery and Sports Medicine, Meibergdreef 9, 1105 AZ Amsterdam, the Netherlands
| | - G M M J Kerkhoffs
- Amsterdam UMC Location University of Amsterdam, Department of Orthopaedic Surgery and Sports Medicine, Meibergdreef 9, 1105 AZ Amsterdam, the Netherlands
| | - Hendrik A Zuiderbaan
- Medische Kliniek Velsen, Department of Orthopaedic Surgery and Sports Medicine, Leeghwaterweg 1B, 1951 NA Velsen-Noord, the Netherlands
| | - Andrew D Pearle
- Hospital for Special Surgery, Department of Sports Medicine and Computer Assisted Surgery, 535 East 70th Street, New York, NY 10021, United States
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Coetzee K, Charilaou J, Burger M, Jordaan J. Increased prevalence of valgus constitutional alignment subtypes in a South African arthritic population group using the coronal plane alignment of the knee (CPAK) classification. Knee 2024; 49:158-166. [PMID: 38972223 DOI: 10.1016/j.knee.2024.04.010] [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: 09/18/2023] [Revised: 03/25/2024] [Accepted: 04/29/2024] [Indexed: 07/09/2024]
Abstract
BACKGROUND Knee alignment philosophies and patient specific models to improve patient reported outcomes are gaining increasing attention. The coronal plane alignment of the knee (CPAK) classification describes nine knee phenotypes and then proposes surgical alignment strategies to achieve constitutional alignment. The CPAK classification has been validated in Australian, European, Asian and North American population groups. To date no African data has been analyzed using CPAK. METHODS A total of 344 arthritic patients (608 knees) with appropriate long leg radiographs were classified based on the CPAK type. Measurements included mechanical hip-knee-angle(mHKA), medial proximal tibial angle (mMPTA) and lateral distal femoral angle (mLDFA) and the derived calculations of joint line obliquity (JLO) and arithmetic hip-knee-angle (aHKA). RESULTS The sample population was 77.9% (n = 268) female with a mean age of 68.4 ± 9.2 years. The most common CPAK types in order were type 3 (n = 174; 28.6%), type 2 (n = 155; 25.5%), type 1 (n = 94; 15.5%) and type 6 (n = 80; 13.2%). The most common limb alignment types were valgus (CPAK types 3,6,9; 41.8%). CONCLUSION This study, which investigated arthritic patients from a single institution in South Africa, shows a divergence of CPAK phenotypic knee patterns relative to other international studies, with much higher proportions of valgus phenotypes (3 and 6). This regional difference should be further investigated in other South African and African population samples and used to adapt the surgical strategies employed by local surgeons.
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Affiliation(s)
| | | | - Marilize Burger
- Division of Orthopaedic Surgery, Department of Surgical Sciences, Faculty of Medical and Health Sciences, Stellenbosch University, Cape Town, South Africa
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Kayaalp ME, Apseloff NA, Lott A, Kaarre J, Hughes JD, Ollivier M, Musahl V. Around-the-knee osteotomies part 1: definitions, rationale and planning-state of the art. J ISAKOS 2024; 9:645-657. [PMID: 38460600 DOI: 10.1016/j.jisako.2024.02.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Revised: 02/21/2024] [Accepted: 02/26/2024] [Indexed: 03/11/2024]
Abstract
Knee osteotomies are essential orthopedic procedures with the ability to preserve the joint and correct ligament instabilities. Literature supports the correlation between lower limb malalignment and outcomes after knee ligament reconstruction and cartilage procedures. Concepts such as joint line obliquity, posterior tibial slope angle, and intra-articular deformity correction are integral components of both preoperative planning and postoperative evaluations. The concept of preserving and/or restoring joint line congruence during simultaneous correction of varus or valgus deformity can be achieved through several different approaches. With advancements in osteotomy research and surgical planning technology, the surgical decision-making has increased in complexity. Based upon a patient's specific deformity, decisions need to be made whether to perform a single-level (proximal tibia or distal femur) versus double-level (both proximal tibia and distal femur) osteotomy, and whether to correct deformity in a single plane (coronal or sagittal) or perform a biplanar osteotomy, correcting two of the malalignments in either coronal, sagittal, or axial planes. Osteotomy procedures prioritize safety, reproducibility, precision, and meticulous planning. Equally important is the proactive management of possible complications and the implementation of preventive strategies for complications such as hinge fractures and unintentional changes to alignment in other planes. This review navigates the intricate landscape of lower limb alignment, commencing with foundational definitions and rationale for performing osteotomies, progressing through the planning phase, and addressing the critical aspect of complication prevention, all while looking ahead to anticipate future advancements in this field. However, rotational osteotomies and tibial tubercle osteotomies in isolation or as an adjunct procedure are beyond the scope of this review.
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Affiliation(s)
- M Enes Kayaalp
- Department of Orthopaedic Surgery, UPMC Freddie Fu Sports Medicine Center, University of Pittsburgh, Pittsburgh, PA, 15203, USA; Department Orthopaedics and Traumatology, Istanbul Kartal Training and Research Hospital, Istanbul, 34865, Turkiye
| | - Nicholas A Apseloff
- Department of Orthopaedic Surgery, UPMC Freddie Fu Sports Medicine Center, University of Pittsburgh, Pittsburgh, PA, 15203, USA
| | - Ariana Lott
- Department of Orthopaedic Surgery, UPMC Freddie Fu Sports Medicine Center, University of Pittsburgh, Pittsburgh, PA, 15203, USA
| | - Janina Kaarre
- Department of Orthopaedic Surgery, UPMC Freddie Fu Sports Medicine Center, University of Pittsburgh, Pittsburgh, PA, 15203, USA; Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, 41345, Sweden; Sahlgrenska Sports Medicine Center, Gothenburg, 41345, Sweden
| | - Jonathan D Hughes
- Department of Orthopaedic Surgery, UPMC Freddie Fu Sports Medicine Center, University of Pittsburgh, Pittsburgh, PA, 15203, USA
| | - Matthieu Ollivier
- Aix Marseille Univ, CNRS, ISM, Inst Movement Sci, Marseille, 13009, France
| | - Volker Musahl
- Department of Orthopaedic Surgery, UPMC Freddie Fu Sports Medicine Center, University of Pittsburgh, Pittsburgh, PA, 15203, USA.
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Hiranaka T, Fukai Y, Tanaka S, Okajima T, Ishida Y, Koide M, Fujishiro T, Okamoto K. Bone loss on the femoral side in knees with medial osteoarthritis: Implications for kinematically-aligned total knee arthroplasty - A comparative study of lateral distal femoral angle in knees with and without osteoarthritis in the same patients. Knee 2024; 49:62-69. [PMID: 38870616 DOI: 10.1016/j.knee.2024.05.002] [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: 01/30/2024] [Revised: 04/06/2024] [Accepted: 05/09/2024] [Indexed: 06/15/2024]
Abstract
BACKGROUND This study aimed to investigate the difference in lateral distal femoral angle (LDFA) between knees with medial osteoarthritis (mOA) and knees without osteoarthritis, and to explore the validity of the assumption that there is no bone wear on the femoral articular surface in kinematic alignment total knee arthroplasty (KA-TKA). METHODS The study included 69 patients with mOA on one side of the knee and but no OA on the other side. LDFA, medial proximal tibial angle (MPTA), mechanical hip-knee-ankle angle (mHKA), and arithmetic hip-knee-ankle angle (aHKA) were measured and compared between the knees. Pearson's correlation coefficient and paired t-tests were used for statistical analysis. RESULTS The LDFA and MPTA were significantly more varus in mOA knees than in knees non-OA knees, with differences of 1.0° ± 2.3° and 0.9° ± 2.0°, respectively. The difference between mHKA of the non-OA side and aHKA of the mOA side was not significant, indicating that it is appropriate to use aHKA as an estimation of postoperative alignment after kinematically-aligned total knee arthroplasty without anatomical correction. However, there was a significant difference in MPTA and aHKA between male and female patients in both mOA and non-OA knees. CONCLUSIONS The assumption that there is no bone wear on the femoral articular surface is rejectable, and the constant compensation thickness of 2 mm for cartilage wear may not be sufficient. Further research is needed to estimate the amount of bone wear in both femur and tibia side to develop more individualized surgical planning strategies in KA-TKA.
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Affiliation(s)
- Takafumi Hiranaka
- Department of Orthopaedic Surgery and Joint Surgery Centre, Takatsuki General Hospital, Osaka, Japan.
| | - Yasuhiro Fukai
- Department of Orthopaedic Surgery and Joint Surgery Centre, Takatsuki General Hospital, Osaka, Japan
| | - Sho Tanaka
- Department of Orthopaedic Surgery and Joint Surgery Centre, Takatsuki General Hospital, Osaka, Japan
| | - Takahiro Okajima
- Department of Orthopaedic Surgery and Joint Surgery Centre, Takatsuki General Hospital, Osaka, Japan
| | - Yuya Ishida
- Department of Orthopaedic Surgery and Joint Surgery Centre, Takatsuki General Hospital, Osaka, Japan
| | - Motoki Koide
- Department of Orthopaedic Surgery and Joint Surgery Centre, Takatsuki General Hospital, Osaka, Japan
| | - Takaaki Fujishiro
- Department of Orthopaedic Surgery and Joint Surgery Centre, Takatsuki General Hospital, Osaka, Japan
| | - Koji Okamoto
- Department of Orthopaedic Surgery and Joint Surgery Centre, Takatsuki General Hospital, Osaka, Japan
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Lee DW, Kang SJ, Kim RJ, Cho SI, Moon SG, Yang SJ, Kim JG. Clinical and Radiological Outcomes of Medial Meniscal Allograft Transplantation Combined With Realignment Surgery. Am J Sports Med 2024; 52:2260-2269. [PMID: 38910353 DOI: 10.1177/03635465241255346] [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] [Indexed: 06/25/2024]
Abstract
BACKGROUND The outcomes of medial meniscal allograft transplantation (MMAT) combined with high tibial osteotomy (HTO) compared with isolated MMAT remain unclear. PURPOSE To compare the clinical and radiological results of MMAT combined with HTO and isolated MMAT. STUDY DESIGN Cohort study; Level of evidence, 3. METHODS This retrospective study included 42 consecutive patients, who were divided into group M (isolated MMAT; n = 22) and group H (MMAT combined with HTO with a varus angle >3°; n = 20). Group differences in subjective knee scores, isokinetic muscle strength test, and radiological outcomes (Kellgren-Lawrence grade, mechanical axis, graft extrusion, graft status, and articular cartilage loss) were compared. RESULTS The mean follow-up period was 29.2 ± 4.9 months and 27.4 ± 5.3 months for groups M and H, respectively. The Lysholm score improved from 55.4 ± 9.5 to 81.3 ± 9.7 and from 52.6 ± 8.9 to 84.2 ± 10.2 in groups M and H, respectively (both P < .001). The International Knee Documentation Committee subjective score improved from 51.4 ± 10.3 to 79.6 ± 9.4 and from 49.3 ± 11.4 to 81.4 ± 8.3 in groups M and H, respectively (both P < .001). Both groups showed no significant differences in subjective knee scores and isokinetic extensor strength at the final follow-up. The rate of preoperative and postoperative high International Cartilage Regeneration & Joint Preservation Society grade (≥3) did not differ between the 2 groups. Group M showed greater coronal graft extrusion than did group H (3.3 ± 0.7 mm vs 2.7 ± 0.8 mm; P = .014); the rate of pathologic graft extrusion (≥3 mm) was not higher in group M (40.9%) than in group H (20%) with the number of patients available (P = .143). Both groups showed no significant difference in the graft status. Graft tears were observed in 2 patients (9%) in group M and 1 patient (5%) in group H (P = .607). CONCLUSION Clinical scores significantly improved after isolated MMAT and MMAT combined with HTO compared with preoperative values, and their short-term outcomes were similar. Postoperative graft extrusion was greater in patients who underwent isolated MMAT, implying that active correction of varus alignment during MMAT may help in intra-articular biomechanics.
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Affiliation(s)
- Dhong Won Lee
- Department of Orthopaedic Surgery, KonKuk University Medical Center, Konkuk University School of Medicine, Seoul, Republic of Korea
| | - Sung Jin Kang
- Department of Orthopaedic Surgery, KonKuk University Medical Center, Konkuk University School of Medicine, Seoul, Republic of Korea
| | - Rak Jun Kim
- Department of Orthopaedic Surgery, KonKuk University Medical Center, Konkuk University School of Medicine, Seoul, Republic of Korea
| | - Seung Ik Cho
- Sports Medical Center, KonKuk University Medical Center, Konkuk University School of Medicine, Seoul, Republic of Korea
| | - Sung Gyu Moon
- Department of Radiology, KonKuk University Medical Center, Konkuk University School of Medicine, Seoul, Republic of Korea
| | - Sang Jin Yang
- Department of Health and Exercise Management, Tongwon University, Gwangju-si, Gyeonggi-do, Republic of Korea
| | - Jin Goo Kim
- Department of Orthopaedic Surgery, Myongji Hospital, Goyang-si, Gyeonggi-do, Republic of Korea
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Hara J, Maeyama A, Ishimatsu T, Matsunaga T, Nakayama S, Yamamoto T. A Morphological Study of Distal Femoral Varus Deformity. Cureus 2024; 16:e64822. [PMID: 39156422 PMCID: PMC11330162 DOI: 10.7759/cureus.64822] [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] [Accepted: 07/16/2024] [Indexed: 08/20/2024] Open
Abstract
Background In the management of medial compartment knee osteoarthritis via around-knee osteotomy (AKO) and total knee arthroplasty (TKA), evaluating the lateral distal femoral angle (LDFA) is crucial. This angle reflects the presence of distal femoral varus deformity. This study aims to explore the relationship between LDFA and lower extremity bone morphology and identify factors contributing to a high LDFA. Methods A retrospective analysis was conducted on 59 patients who underwent AKO or TKA at our hospital. Alignment of the lower extremity was assessed using X-rays, and bone morphology was investigated through computed tomography (CT) employing the ZedKnee® system (LEXI, Tokyo, Japan). Each measured parameter was analyzed. Results Our findings indicate a significant correlation between LDFA and several parameters, including age, femoral tibial angle (FTA), hip knee ankle angle (HKA), percentage of mechanical axis (% MA), femoral bowing angle, femoral tibial joint torsion, and the height of lateral and medial femoral condyles. A multiple-regression analysis determined that the most significant influences on LDFA were the heights of the femoral condyle, age, and HKA. Conclusion LDFA is significantly affected by the heights of the medial and lateral femoral condyles and tends to increase with age, possibly as a result of attrition of the medial femoral condyle. Given its significance, LDFA should be carefully considered as a preoperative indicator in AKO and TKA to guide surgical caution when LDFA is elevated.
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Affiliation(s)
- Junya Hara
- Department of Orthopaedic Surgery, Fukuoka University Faculty of Medicine, Fukuoka, JPN
| | - Akira Maeyama
- Department of Orthopaedic Surgery, Fukuoka University Faculty of Medicine, Fukuoka, JPN
| | - Tetsuro Ishimatsu
- Department of Orthopaedic Surgery, Fukuoka University Faculty of Medicine, Fukuoka, JPN
| | - Taiki Matsunaga
- Department of Orthopaedic Surgery, Fukuoka University Faculty of Medicine, Fukuoka, JPN
| | - Shizuhide Nakayama
- Department of Orthopaedic Surgery, Fukuoka University Faculty of Medicine, Fukuoka, JPN
| | - Takuaki Yamamoto
- Department of Orthopaedic Surgery, Fukuoka University Faculty of Medicine, Fukuoka, JPN
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Bae K, Lee BS, Kim JM, Bin SI, Lee J, Kim D, Jeon T. Effect of joint-line obliquity on long-term survivorship of total knee arthroplasty: A postoperative phenotype analysis. Knee Surg Sports Traumatol Arthrosc 2024. [PMID: 38895851 DOI: 10.1002/ksa.12311] [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: 02/28/2024] [Revised: 05/22/2024] [Accepted: 05/25/2024] [Indexed: 06/21/2024]
Abstract
PURPOSE Whether the longevity of total knee arthroplasty (TKA) differs between postoperative phenotypes has not been investigated. This study aims to examine which phenotype has a worse long-term survival rate than the reference phenotype (neutral alignment-parallel joint line), and whether joint-line obliquity (JLO) affects the survivorship of TKA. METHODS A total of 945 knees that underwent primary TKAs for primary osteoarthritis from January 2000 to January 2009 were included. These were classified into nine postoperative phenotypes based on the combined assessment of the hip-knee-ankle (HKA) angle and JLO, measured on standing radiographs. The 5-, 10- and 15-year survival rates were analysed using Kaplan-Meier methods and log-rank tests. The long-term survival rates of each phenotype were compared with the reference phenotype. RESULTS There were 55 aseptic mechanical failures within a period of 10.4 ± 5.0 years. The most frequently observed phenotypes were the reference phenotype (n = 527), neutral alignment-lateral joint-line inclination (n = 162), varus alignment-lateral joint-line inclination (n = 104) and varus alignment-parallel joint line (n = 101). The overall failure rate for each phenotype was 3.6%, 3.7%, 18.3% and 7.9%, respectively. Only the 10- and 15-year survival rates of the varus alignment-lateral joint-line inclination phenotype were significantly different from those of the reference phenotype (97%-93% vs. 90%-69%; p = 0.017, <0.001). CONCLUSION The lateral joint-line inclination phenotype had an inferior long-term survival rate after varus-aligned TKA. This suggested that alignment and JLO affected the long-term survival rate of patients who underwent TKA. LEVEL OF EVIDENCE Level III, Retrospective cohort study.
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Affiliation(s)
- Kinam Bae
- Department of Orthopedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Bum-Sik Lee
- Department of Orthopedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Jong-Min Kim
- Department of Orthopedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | | | - Jongjin Lee
- Department of Orthopedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Donghyok Kim
- Department of Orthopedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Taehyeon Jeon
- Department of Orthopedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
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Ten Noever de Brauw GV, Bayoumi T, Ruderman LV, Kerkhoffs GMMJ, Zuiderbaan HA, Pearle AD. Knees with isolated lateral compartment osteoarthritis show a substantial variability in functional knee phenotypes with demographic-specific variations: Phenotypic analysis of 305 knees. Knee 2024; 48:265-278. [PMID: 38820655 DOI: 10.1016/j.knee.2024.05.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Revised: 04/03/2024] [Accepted: 05/01/2024] [Indexed: 06/02/2024]
Abstract
BACKGROUND The primary aim of this study was to assess and describe the phenotypic variation in the coronal plane of knees affected by isolated lateral compartment osteoarthritis (OA). The secondary aim was to investigate the potential gender-specific and age-related differences in functional knee phenotypes among knees with isolated lateral compartment OA. METHODS A comprehensive classification system was used to categorize 305 knees with isolated lateral compartment OA based on their mechanical hip-knee-ankle angle (HKA), femoral mechanical angle (FMA), and tibial mechanical angle (TMA). The phenotypic variation of functional knee phenotypes was assessed for the entire cohort and stratified by gender and age category. RESULTS Among knees with isolated lateral compartment OA, a total of 60 distinct functional knee phenotypes were identified, with phenotype VALHKA6°NEUFMA0°VALTMA3° being the most prevalent (10.8 %). Gender-specific differences were evident, with females exhibiting significantly greater valgus alignment in both mean HKA and TMA values compared with males (HKA: -6.4° vs. -5.4°, respectively; P = 0.02 and TMA 94.4° vs. 89.0°, respectively; P = 0.005). Age-related variations included younger patients predominantly displaying femoral deformities, while older patients primarily exhibited isolated tibial- or combined femoral and tibial deformities. CONCLUSIONS There is a broad variation of functional knee phenotypes among knees affected by isolated lateral compartment OA, with gender-specific and age-related differences. Recognizing this inherent phenotypic diversity during preoperative planning may facilitate the implementation of tailored approaches that account for the unique characteristics and bony deformities of the individual knee.
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Affiliation(s)
- G V Ten Noever de Brauw
- Hospital for Special Surgery, Department of Orthopaedic Surgery, Computer Assisted Surgery Center & Sports Medicine, Weill Medical College of Cornell University, New York, NY, USA; Amsterdam UMC location University of Amsterdam, Department of Orthopaedic Surgery, Amsterdam, the Netherlands.
| | - T Bayoumi
- Hospital for Special Surgery, Department of Orthopaedic Surgery, Computer Assisted Surgery Center & Sports Medicine, Weill Medical College of Cornell University, New York, NY, USA; Amsterdam UMC location University of Amsterdam, Department of Orthopaedic Surgery, Amsterdam, the Netherlands
| | - L V Ruderman
- Hospital for Special Surgery, Department of Orthopaedic Surgery, Computer Assisted Surgery Center & Sports Medicine, Weill Medical College of Cornell University, New York, NY, USA
| | - G M M J Kerkhoffs
- Amsterdam UMC location University of Amsterdam, Department of Orthopaedic Surgery, Amsterdam, the Netherlands; Amsterdam Movement Sciences, Sports, Amsterdam, the Netherlands
| | - H A Zuiderbaan
- Medische Kliniek Velsen, Department of Orthopaedic Surgery, Velsen-Noord, the Netherlands
| | - A D Pearle
- Hospital for Special Surgery, Department of Orthopaedic Surgery, Computer Assisted Surgery Center & Sports Medicine, Weill Medical College of Cornell University, New York, NY, USA
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Yang HY, Yoon TW, Kim JY, Seon JK. Radiologic Assessment of Knee Phenotypes Based on the Coronal Plane Alignment of the Knee Classification in a Korean Population. Clin Orthop Surg 2024; 16:422-429. [PMID: 38827768 PMCID: PMC11130633 DOI: 10.4055/cios23250] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Revised: 10/21/2023] [Accepted: 10/21/2023] [Indexed: 06/05/2024] Open
Abstract
Background The Coronal Plane Alignment of the Knee (CPAK) classification system has been developed as a comprehensive system that describes 9 coronal plane phenotypes based on constitutional limb alignment and joint line obliquity (JLO). Due to the characteristics of Asian populations, which show more varus and wider distribution in lower limb alignment than other populations, modification of the boundaries of the arithmetic hip-knee-ankle angle (aHKA) and JLO should be considered. The purpose of this study was to determine the knee phenotype in a Korean population based on the original CPAK and modified CPAK classification systems. Methods We reviewed prospectively collected data of 500 healthy and 500 osteoarthritic knees between 2021 and 2023 using radiographic analysis and divided them based on the modified CPAK classification system by widening the neutral boundaries of the aHKA to 0° ± 3° and using the actual JLO as a new variable. Using long-leg standing weight-bearing radiographs, 6 radiographic parameters were measured to evaluate the CPAK type: the mechanical HKA angle, medial proximal tibial angle (MPTA), lateral distal femoral angle (LDFA), aHKA, JLO, and actual JLO. Results From 2 cohorts of 1,000 knees, the frequency distribution representing all CPAK types was different between the healthy and arthritic groups. The most common categories were type II (38.2%) in the healthy group and type I (53.8%) in the arthritic group based on the original CPAK classification. The left and upward shift in the distribution of knee phenotypes in the original classification was corrected evenly after re-establishing the boundaries of a neutral aHKA and the actual JLO. According to the modified CPAK classification system, the most common categories were type II (35.2%) in the healthy group and type I (38.0%) in the arthritic group. Conclusions Although the modified CPAK classification corrected the uneven distribution seen when applying the original classification system in a Korean population, the most common category was type I in Korean patients with osteoarthritic knees in both classification systems. Furthermore, there were different frequencies of knee phenotypes among healthy and arthritic knees.
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Affiliation(s)
- Hong Yeol Yang
- Department of Orthopaedic Surgery, Chonnam National University Hwasun Hospital, Chonnam National University Medical School, Hwasun, Korea
| | - Tae Woong Yoon
- Department of Orthopaedic Surgery, Chonnam National University Hwasun Hospital, Chonnam National University Medical School, Hwasun, Korea
| | - Joon Yeong Kim
- Department of Orthopaedic Surgery, Chonnam National University Hwasun Hospital, Chonnam National University Medical School, Hwasun, Korea
| | - Jong Keun Seon
- Department of Orthopaedic Surgery, Chonnam National University Hwasun Hospital, Chonnam National University Medical School, Hwasun, Korea
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Bae K, Lee BS, Kim JM, Bin SI, Lee J, Kim D, Jeon T. Preoperative phenotype has no significant impact on the clinical outcomes and long-term survival of mechanically aligned total knee arthroplasty in Asian patients with osteoarthritis. Bone Joint J 2024; 106-B:460-467. [PMID: 38688498 DOI: 10.1302/0301-620x.106b5.bjj-2023-1110.r1] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/02/2024]
Abstract
Aims The aim of this study was to investigate the distribution of phenotypes in Asian patients with end-stage osteoarthritis (OA) and assess whether the phenotype affected the clinical outcome and survival of mechanically aligned total knee arthroplasty (TKA). We also compared the survival of the group in which the phenotype unintentionally remained unchanged with those in which it was corrected to neutral. Methods The study involved 945 TKAs, which were performed in 641 patients with primary OA, between January 2000 and January 2009. These were classified into 12 phenotypes based on the combined assessment of four categories of the arithmetic hip-knee-ankle angle and three categories of actual joint line obliquity. The rates of survival were analyzed using Kaplan-Meier methods and the log-rank test. The Hospital for Special Surgery score and survival of each phenotype were compared with those of the reference phenotype with neutral alignment and a parallel joint line. We also compared long-term survival between the unchanged phenotype group and the corrected to neutral alignment-parallel joint line group in patients with Type IV-b (mild to moderate varus alignment-parallel joint line) phenotype. Results The most common phenotype was Type I-b (mild to moderate varus alignment-medial joint line; 27.1% (n = 256)), followed by Type IV-b (23.2%; n = 219). There was no significant difference in the clinical outcomes and long-term survival between the groups. In Type IV-b phenotypes, the neutrally corrected group showed higher 15-year survival compared with the unchanged-phenotype group (94.9% (95% confidence interval (CI) 92.0 to 97.8) vs 74.2% (95% CI 98.0 to 100); p = 0.020). Conclusion Constitutional varus was confirmed in more than half of these patients. Mechanically aligned TKA can achieve consistent clinical outcomes and long-term survival, regardless of the patient's phenotype. The neutrally corrected group had better long-term survival compared with the unchanged phenotype group.
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Affiliation(s)
- Kinam Bae
- Department of Orthopedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Bum-Sik Lee
- Department of Orthopedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Jong-Min Kim
- Department of Orthopedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Seong-Il Bin
- Orthopaedic Surgery, Inbone Hospital, Paju-si, South Korea
| | - Jongjin Lee
- Department of Orthopedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Donghyok Kim
- Department of Orthopedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Taehyeon Jeon
- Department of Orthopedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
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Archer H, Reine S, Xia S, Vazquez LC, Ashikyan O, Pezeshk P, Kohli A, Xi Y, Wells JE, Hummer A, Difranco M, Chhabra A. Deep learning generated lower extremity radiographic measurements are adequate for quick assessment of knee angular alignment and leg length determination. Skeletal Radiol 2024; 53:923-933. [PMID: 37964028 DOI: 10.1007/s00256-023-04502-5] [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: 06/27/2023] [Revised: 10/21/2023] [Accepted: 10/28/2023] [Indexed: 11/16/2023]
Abstract
PURPOSE Angular and longitudinal deformities of leg alignment create excessive stresses across joints, leading to pain and impaired function. Multiple measurements are used to assess these deformities on anteroposterior (AP) full-length radiographs. An artificial intelligence (AI) software automatically locates anatomical landmarks on AP full-length radiographs and performs 13 measurements to assess knee angular alignment and leg length. The primary aim of this study was to evaluate the agreements in LLD and knee alignment measurements between an AI software and two board-certified radiologists in patients without metal implants. The secondary aim was to assess time savings achieved by AI. METHODS The measurements assessed in the study were hip-knee-angle (HKA), anatomical-tibiofemoral angle (aTFA), anatomical-mechanical-axis angle (AMA), joint-line-convergence angle (JLCA), mechanical-lateral-proximal-femur-angle (mLPFA), mechanical-lateral-distal-femur-angle (mLDFA), mechanical-medial-proximal-tibia-angle (mMPTA), mechanical-lateral-distal-tibia- angle (mLDTA), femur length, tibia length, full leg length, leg length discrepancy (LLD), and mechanical axis deviation (MAD). These measurements were performed by two radiologists and the AI software on 164 legs. Intraclass-correlation-coefficients (ICC) and Bland-Altman analyses were used to assess the AI's performance. RESULTS The AI software set incorrect landmarks for 11/164 legs. Excluding these cases, ICCs between the software and radiologists were excellent for 12/13 variables (11/13 with outliers included), and the AI software met performance targets for 11/13 variables (9/13 with outliers included). The mean reading time for the AI algorithm and two readers, respectively, was 38.3, 435.0, and 625.0 s. CONCLUSION This study demonstrated that, with few exceptions, this AI-based software reliably generated measurements for most variables in the study and provided substantial time savings.
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Affiliation(s)
- Holden Archer
- University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX, 75390, USA
| | - Seth Reine
- University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX, 75390, USA
| | - Shuda Xia
- University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX, 75390, USA
| | - Louis Camilo Vazquez
- University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX, 75390, USA
| | - Oganes Ashikyan
- University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX, 75390, USA
| | - Parham Pezeshk
- University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX, 75390, USA
| | - Ajay Kohli
- University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX, 75390, USA
| | - Yin Xi
- University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX, 75390, USA
| | | | - Allan Hummer
- IB Lab GmbH, Zehetnergasse 6/2/2, 1140, Vienna, Austria
| | | | - Avneesh Chhabra
- University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX, 75390, USA.
- Adjunct Faculty, Johns Hopkins University, Baltimore, MD, USA.
- University of Dallas, Richardson, TX, USA.
- Walton Centre for Neurosciences, Liverpool, UK.
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Ziegenhorn J, Kirschberg J, Heinecke M, von Eisenhart-Rothe R, Matziolis G. Significant difference in femoral torsion between coronal plane alignment of the knee type 1 and 4. Knee Surg Sports Traumatol Arthrosc 2024; 32:1199-1206. [PMID: 38511851 DOI: 10.1002/ksa.12149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Revised: 02/27/2024] [Accepted: 03/01/2024] [Indexed: 03/22/2024]
Abstract
PURPOSE The purpose of this study was to find out whether the torsions of the femur and tibia are dependent on the coronal plane alignment of the knee (CPAK) type. METHODS Five hundred patients (1000 legs) were included, who received a whole leg standing three-dimensional (3D) radiograph using EOS imaging (EOS Imaging, Paris, France). SterEOS software was used for digital reconstruction. Femoral and tibial torsions were determined by analysing 3D reconstructions of each leg. Femoral torsion was defined as the angle between the femoral neck axis (FNA) and the posterior condylar axis (PCA). Tibial torsion was defined as the angle between the axis tangent to the posterior part of the tibia plateau and the transmalleolar axis. Arithmetic hip-knee-ankle angle (aHKA) and joint-line obliquity (JLO) were also determined, allowing each leg to be assigned one of nine possible phenotypes according to CPAK. RESULTS The mean femoral torsion in CPAK type 1 was significantly higher (+ 2.6° ± 0.8°) than in CPAK type 4 (p = 0.02). All other CPAK types did not differ in the degree of femoral torsions. No differences could be demonstrated for the tibial torsion. CONCLUSION There is a correlation between the coronal alignment of the lower limb and femoral torsion. This may provide the basis for extending the CPAK classification beyond the coronal plane. LEVEL OF EVIDENCE Level III.
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Affiliation(s)
- Jonas Ziegenhorn
- Orthopaedic Department, University Hospital Jena, Campus Eisenberg, Germany
| | - Julia Kirschberg
- Orthopaedic Department, University Hospital Jena, Campus Eisenberg, Germany
- German Knee Society (DKG), Munich, Germany
| | - Markus Heinecke
- Orthopaedic Department, University Hospital Jena, Campus Eisenberg, Germany
- German Knee Society (DKG), Munich, Germany
| | - Rüdiger von Eisenhart-Rothe
- German Knee Society (DKG), Munich, Germany
- Department of Orthopedics and Sports Orthopedics, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | - Georg Matziolis
- Orthopaedic Department, University Hospital Jena, Campus Eisenberg, Germany
- German Knee Society (DKG), Munich, Germany
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Gao YH, Qi YM, Huang PH, Zhao XY, Qi X. Distribution of coronal plane alignment of the knee classification in Chinese osteoarthritic and healthy population: a retrospective cross-sectional observational study. Int J Surg 2024; 110:2583-2592. [PMID: 38349219 PMCID: PMC11093439 DOI: 10.1097/js9.0000000000001178] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Accepted: 01/29/2024] [Indexed: 05/16/2024]
Abstract
BACKGROUND Few studies have reported the coronal constitutional alignment of the lower limbs in mainland China. This study aimed to analyse the distribution of the coronal plane alignment of the knee (CPAK) classification in the osteoarthritic (OA) and healthy Chinese populations. MATERIALS AND METHODS The CPAK distributions of 246 patients (477 knees) with OA and 107 healthy individuals (214 knees) were retrospectively examined using long-leg radiographs. Radiological measurements and CPAK classification of different Kellgren-Lawrence grades in patients with unilateral total knee arthroplasty (TKA) were compared. The clinical outcomes of patients with CPAK type I who underwent mechanical alignment or restricted kinematic alignment during TKA were examined. RESULTS The most common distributions in the OA and healthy groups were type I and type II, respectively. In patients who underwent unilateral TKA, the most common distribution of knees graded as Kellgren-Lawrence 3-4 was type I. However, the most common distributions of contralateral knees graded as Grade 0-2 were type I and II. For patients with CPAK type I, the mechanical alignment and restricted kinematic alignment groups did not differ significantly concerning postoperative clinical outcomes at 3 months. CONCLUSION The most common distributions in Chinese osteoarthritic and healthy populations were types I and II, respectively. In addition, OA progression may lead to changes in the CPAK classification.
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Affiliation(s)
- Yu-Hang Gao
- Department of Orthopaedic Surgery, Orthopaedic Center, The First Hospital of Jilin University, Changchun, Jilin, China
| | - Yu-Meng Qi
- Departments of Biostatistics, Columbia University, New York, NY, USA
| | - Pei-Hong Huang
- Department of Orthopaedic Surgery, Orthopaedic Center, The First Hospital of Jilin University, Changchun, Jilin, China
| | - Xing-Yu Zhao
- Department of Orthopaedic Surgery, Orthopaedic Center, The First Hospital of Jilin University, Changchun, Jilin, China
| | - Xin Qi
- Department of Orthopaedic Surgery, Orthopaedic Center, The First Hospital of Jilin University, Changchun, Jilin, China
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15
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Hsu CE, Tsai MH, Wu HT, Huang JT, Huang KC. Phenotype-considered kinematically aligned total knee arthroplasty for windswept-deformity-associated osteoarthritis: surgical strategy and clinical outcomes. Knee Surg Relat Res 2024; 36:16. [PMID: 38566175 PMCID: PMC10985952 DOI: 10.1186/s43019-024-00220-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: 10/07/2023] [Accepted: 03/18/2024] [Indexed: 04/04/2024] Open
Abstract
BACKGROUND Windswept deformity (WSD) in relation to advanced osteoarthritis (OA) presents a significant surgical challenge in total knee arthroplasty (TKA). The primary goal of this study is to investigate the Prevalance of WSD associated osteoarthritis who have undergone total knee arthroplasty. The secondary goal is to explore the causes of WSD and its association with spinal deformity or leg length discrepancy in these patients. Finally, we evaluate the surgical outcomes of phenotype-considered kinematically aligned TKA (KA-TKA) in treating patients with WSD. METHODS A review was conducted on data from 40 knees of 33 WSD patients who underwent phenotype-considered KA-TKA from August 2016 to December 2020. Patient demographics, associated diseases, preoperative and postoperative knee alignment angles, range of motion (ROM), Oxford Knee Score (OKS), and Knee Society Score (KSS) were collected and analyzed. Subgroup analysis for comparing the results between valgus and varus knees were also performed. RESULTS Within the studied cohort of WSD patients, a substantial 64% displayed concomitant coronal spinal imbalance and 21% evidenced leg length discrepancy. Postoperative improvements were notable in knee alignments, ROM, OKS, and KSS following the application of the phenotype-considered KA-TKA approach. There were significant differences in the knee alignment angles, including mHKA, LDFA, and MPTA, between the valgus and varus side of knees (P = 0.018). However, no statistically significant difference were observed in the functional scores, comprising ROM, OKS, and KSS, between valgus and varus knees. CONCLUSIONS A high percentage of patients with WSD exhibited coronal spinal imbalance and leg length discrepancy. Phenotype-considered KA-TKA effectively provided alignment targets for the treatment of both varus and valgus knees in patients with WSD, achieving excellent short-term outcomes and acceptable knee alignment.
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Affiliation(s)
- Cheng-En Hsu
- Sports Recreation and Health Management Continuing Studies-Bachelor's Degree Completion Program, Tunghai University, Taichung, 407, Taiwan
- Department of Orthopedics Surgery, Taichung Veterans General Hospital, 1650 Taiwan Boulevard Sect. 4, Taichung, 40705, Taiwan
| | - Meng-Hsueh Tsai
- Department of Orthopedics Surgery, Asia University Hospital, 222 Fuxin Rd., Wufeng District, Taichung, 41354, Taiwan
| | - Hsin-Ting Wu
- Department of Orthopedics Surgery, Asia University Hospital, 222 Fuxin Rd., Wufeng District, Taichung, 41354, Taiwan
| | - Jen-Ting Huang
- Department of Orthopedics Surgery, Asia University Hospital, 222 Fuxin Rd., Wufeng District, Taichung, 41354, Taiwan
| | - Kui-Chou Huang
- Department of Orthopedics Surgery, Asia University Hospital, 222 Fuxin Rd., Wufeng District, Taichung, 41354, Taiwan.
- Department of Occupational Therapy, Asia University, 500 Lioufeng Rd., Wufeng, Taichung, 41354, Taiwan.
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Van Genechten W, Vanneste Y, van Beek N, Michielsen J, Claes S, Verdonk P. No clinical outcome difference between varus phenotypes after medial opening-wedge high tibial osteotomy at 2 years follow-up. Knee Surg Sports Traumatol Arthrosc 2024; 32:1016-1025. [PMID: 38409956 DOI: 10.1002/ksa.12099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Revised: 02/06/2024] [Accepted: 02/08/2024] [Indexed: 02/28/2024]
Abstract
PURPOSE Clinical studies regarding medial open-wedge high tibial osteotomy (MOWHTO) often analyse a large group of mechanical varus knees rather than differentiating for its primary varus-inducing component. This study aims to compare the radiological and clinical outcomes of the most prevalent varus malalignment phenotypes using the coronal plane alignment of the knee (CPAK) classification. METHODS MOWHTO cases with minimal 2-year clinical follow-up were retrospectively selected from a knee osteotomy database (2016-2020). Based on the medial proximal tibial angle (MPTA) and lateral distal femoral angle (LDFA), subjects were allocated to the correct CPAK phenotype pre- and postoperatively. Clinical outcomes were the numeric rating scale (NRS), the knee injury and osteoarthritis outcome score (KOOS) and the therapeutic response rate (TRR) at 2-year follow-up. Inter-observer correlation coefficient (ICC) and unpaired student t test were performed for cross-phenotype comparison. RESULTS One hundred thirty-five (135) subjects were found eligible (53.0 years old ±9.6 [19-77], 72% male, 53% left-sided). The most prevalent preoperative phenotype was CPAK 1 (n = 70 (52%)) and the postoperative phenotype was CPAK 6 (n = 66 (49%)). All CPAK phenotypes improved significantly relative to baseline but cross-phenotype comparison yielded no significant differences in clinical outcome. The TRR at 2 years was 67% for CPAK 1, 69% for CPAK 2 and 87% for CPAK 4. The TRR for CPAK 6 was 64% compared with 80% for CPAK 9, which was not significantly different. CONCLUSION At 2-year follow-up, no clinically significant differences are observed between different CPAK phenotypes. Accurate MOWHTO corrections provide significant clinical improvement even in the femoral-driven varus knee and the constitutional varus knee dominated by intra-articular wear. The clinical indication for MOWHTO performance should not be reduced to the medial arthritic varus knee with underlying tibial varus alone. LEVEL OF EVIDENCE Level IV, retrospective comparative study.
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Affiliation(s)
- Wouter Van Genechten
- Orthopedic Department, University Hospital Antwerp, Edegem, Antwerpen, Belgium
- More Institute, Antwerp, Belgium
- Orthopedic Department, Herentals, Antwerpen, Belgium
| | - Yannick Vanneste
- Orthopedic Department, University Hospital Antwerp, Edegem, Antwerpen, Belgium
| | | | - Jozef Michielsen
- Orthopedic Department, University Hospital Antwerp, Edegem, Antwerpen, Belgium
| | - Steven Claes
- Orthopedic Department, Herentals, Antwerpen, Belgium
| | - Peter Verdonk
- Orthopedic Department, University Hospital Antwerp, Edegem, Antwerpen, Belgium
- More Institute, Antwerp, Belgium
- ORTHOCA, Antwerp, Belgium
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Rupp MC, Hochberger F, Berthold DP, Muench LN, Imhoff AB, Siebenlist S, Willinger L. Tibiofemoral Subluxation on Radiograph as a Predictor of Location and Size of Osteochondritis Dissecans Lesions of the Knee. Orthop J Sports Med 2024; 12:23259671241232397. [PMID: 38455152 PMCID: PMC10919139 DOI: 10.1177/23259671241232397] [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: 07/20/2023] [Accepted: 08/18/2023] [Indexed: 03/09/2024] Open
Abstract
Background Lower limb malalignment has been associated with osteochondritis dissecans (OCD). However, the location of the OCD lesion often is not concordant with the mechanical leg axis. Other potentially modifiable alignment parameters may influence the propensity for impingement of the femoral condyles. Purpose To assess differences in lower limb alignment (LLA) and relative tibiofemoral position between patients with medial (MFC-OCD) or lateral OCD (LFC-OCD) of the femoral condyle. Study Design Cohort study; Level of evidence, 3. Methods Patients ≤30 years old who were diagnosed with unicondylar OCD between January 2010 and January 2020 were eligible for this study. Included were 55 patients (age, 20.8 ± 4.5 years)-46 with MFC-OCD and 9 with LFC-OCD. Preoperative standing long-leg radiographs were studied to obtain primary outcomes-including LLA and mechanical alignment analyses-and secondary outcomes-including knee joint obliquity angle; rotation angle; medial, central (c-subluxation), and lateral subluxation (L-subluxation) of the tibia relative to the femur in the coronal plane; and tibiofemoral joint line center distance (TFJCD). Results With regard to primary outcomes, LLA was significantly different between MFC-OCD (1.7°± 3.1° varus) and LFC-OCD (2.7 ± 3.1° valgus) (P < .001), and 78% (36/46) of patients with MFC-OCD had varus alignment, whereas 78% (7/9) of patients with LFC-OCD had valgus alignment (P < 0.002). With regard to secondary outcomes, patients with MFC-OCD had a more medial tibial position in relation to the femur, with a significantly smaller rotation angle (5.6°± 2.4° vs 9.6°± 3.6°; P < .001), a smaller C-subluxation (7.2 ± 6.6 vs 14.9 ± 8.8 mm; P < .01), a smaller L-subluxation (2.3 ± 2.6 vs 4.4 ± 2.7 mm; P < .05), and reduced TFJCD (3.5 ± 1.7 vs 6.6 ± 1.8 mm; P < .001) compared with the LFC-OCD group. For patients with MFC-OCD, the size of the OCD was significantly correlated with C-subluxation (r = 0.412; P = .006). Conclusion LLA was significantly different according to OCD location. In patients with MFC-OCD, the tibia was subluxated medially, resulting in a change of joint geometry by approximation of the medial tibial eminence toward the medial femoral condyle, potentially causing excessive pressure overload and microtrauma of the cartilage. Interestingly, the extent of subluxation was correlated with OCD size.
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Affiliation(s)
| | - Felix Hochberger
- Department of Sports Orthopaedics, Technical University Munich, Munich, Germany
| | - Daniel P. Berthold
- Department of Sports Orthopaedics, Technical University Munich, Munich, Germany
- Department of Orthopaedics and Trauma Surgery, Musculoskeletal University Center Munich (MUM), University Hospital, Ludwig Maximilian University of Munich (LMU Munich), Munich, Germany
| | - Lukas N. Muench
- Department of Sports Orthopaedics, Technical University Munich, Munich, Germany
| | - Andreas B. Imhoff
- Department of Sports Orthopaedics, Technical University Munich, Munich, Germany
| | | | - Lukas Willinger
- Department of Sports Orthopaedics, Technical University Munich, Munich, Germany
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Chelli S, Rudyy T, Avram GM, Huegli RW, Amsler F, Hirschmann MT. Gender-based differences exist in the functional knee phenotypes classification of the osteoarthritic knee. Knee Surg Sports Traumatol Arthrosc 2024. [PMID: 38415864 DOI: 10.1002/ksa.12082] [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: 10/06/2023] [Revised: 12/11/2023] [Accepted: 02/05/2024] [Indexed: 02/29/2024]
Abstract
PURPOSE To identify gender differences in (1) the coronal alignment of functional knee phenotypes and (2) the JLCA (joint line convergence angle) in relation to the phenotype classification. METHODS This study is a retrospective data analysis, including 12,099 osteoarthritic knee computed tomography (5025 male, 7074 female) analysed by Medacta software for hip-knee-ankle angle (HKA), femoral mechanical angle (FMA), tibial mechanical angle (TMA) and JLCA. The data were grouped into genders and combined according to the Functional Knee Phenotypes Classification. RESULTS Out of 127 phenotypes for males and 131 for females, 17 common phenotypes were reported. The commonest four were similar for both genders with VARHKA177° NEUFMA93° NEUTMA87° (9.8% males, 9.50% females), followed by VARHKA174° NEUFMA93°VARTMA84° (7.1%) and VARHKA174°VARFMA90° NEUTMA87° (7.0%) for males and VARHKA174° NEUFMA93° NEUTMA87° (6.1%), VARHKA174° NEUFMA93°VARTMA84° (5.1%) for females. The commonest FMA and TMA (91.5° to 94.5° and 85.5° to 88.5°, respectively) were the same for both genders, however, the rest of the male population observed greater femoral varus than the female population (p < 0.001). JLCA values ranged from -28.4° to 8.2° in the overall study population. Males and females had a mean JLCA of -2.96° (±2.6° SD) and -2.66° (±2.8°7 SD), respectively, p < 0.001. CONCLUSIONS Gender differences exist within the osteoarthritic knee phenotype. The male varus phenotype is influenced by FMA, while TMA values are similar across genders. JLCA variations show similarities to both TMA and FMA, suggesting JLCA is influenced by bone morphology more than by gender. These differences inform surgical decision-making for the personalised approach to the primary TKA. LEVEL OF EVIDENCE Level III.
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Affiliation(s)
- Sabrina Chelli
- Department of Orthopedic Surgery and Traumatology, Kantonsspital Baselland, Bruderholz, Switzerland
| | - Taras Rudyy
- Department of Orthopedic Surgery and Traumatology, Kantonsspital Baselland, Bruderholz, Switzerland
| | - George Mihai Avram
- Department of Orthopedic Surgery and Traumatology, Kantonsspital Baselland, Bruderholz, Switzerland
| | - Rolf W Huegli
- Institute of Radiology and Nuclear Medicine, Kantonsspital Baselland, Bruderholz, Switzerland
| | | | - Michael T Hirschmann
- Department of Orthopedic Surgery and Traumatology, Kantonsspital Baselland, Bruderholz, Switzerland
- Department of Clinical Research, Research Group Michael T. Hirschmann, Regenerative Medicine & Biomechanics, University of Basel, Basel, Switzerland
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Corbett J, Sinha P, Esposito CI, Wood JA, Chen DB, MacDessi SJ. Multi-Planar Expansion of the Coronal Plane Alignment of the Knee Classification? A Computed Tomographic Study Indicates No Significant Correlation With Alignment Parameters in Other Planes. J Arthroplasty 2024; 39:336-342. [PMID: 37586596 DOI: 10.1016/j.arth.2023.08.033] [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: 05/11/2023] [Revised: 08/08/2023] [Accepted: 08/09/2023] [Indexed: 08/18/2023] Open
Abstract
BACKGROUND The Coronal Plane Alignment of the Knee (CPAK) classification categorizes knee phenotypes based on constitutional limb alignment (arithmetic hip-knee-ankle angle or aHKA) and joint line obliquity (JLO). This study aimed to determine if sagittal and rotational knee alignments vary among CPAK types in order to establish whether this classification should be expanded beyond coronal plane assessment. METHODS Coronal, sagittal, and rotational alignment measurements were made and CPAK types were calculated from computed tomographic data of 437 patients (509 knees) who underwent robotic-assisted total knee arthroplasty (TKA). Differences in femoral, tibial, and tibio-femoral angular measurements were compared across CPAK types, and correlations were made to aHKA and JLO. Nonparametric and linear regression tests were used to analyze between-type differences. RESULTS There were no differences in tibial slope or femoral rotational measures across CPAK phenotypes. However, CPAK Type III knees had a greater tibio-femoral rotation mean difference than CPAK Type I, II, IV, and V knees (P < .05). We also found increased femoral flexion in Type I knees when compared to Type VI knees (P = .01). The aHKA had a weak correlation with femoral flexion angle, and JLO had a weak correlation with femoral posterior condylar axis to tibial antero-posterior axis angle. CONCLUSION Few clinically important differences in sagittal and rotational alignments were found between CPAK types, indicating that CPAK phenotype has little correlation to 3-dimensional alignment characteristics. Need for an expansion of the CPAK classification beyond coronal plane alignment is not supported from these results.
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Affiliation(s)
- James Corbett
- Sydney Knee Specialists, Kogarah, New South Wales, Australia
| | - Pranab Sinha
- Sydney Knee Specialists, Kogarah, New South Wales, Australia
| | | | - Jil A Wood
- Sydney Knee Specialists, Kogarah, New South Wales, Australia
| | - Darren B Chen
- Sydney Knee Specialists, Kogarah, New South Wales, Australia; CPAK Research Group, Sydney, Australia
| | - Samuel J MacDessi
- Sydney Knee Specialists, Kogarah, New South Wales, Australia; CPAK Research Group, Sydney, Australia; School of Clinical Medicine, University of New South Wales, Sydney, Australia
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20
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Patil VV, Sancheti PK, Patil K, Gugale S, Shyam A. Functional Outcome of Mechanical Alignment in Total Knee Arthroplasty Surgery: A Short-Term Cohort Study at an Indian Tertiary Care Hospital. Indian J Orthop 2024; 58:11-17. [PMID: 38161396 PMCID: PMC10754769 DOI: 10.1007/s43465-023-01016-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Accepted: 10/03/2023] [Indexed: 01/03/2024]
Abstract
Background In severe arthritis cases, goal of total knee arthroplasty (TKA) management is to attain pain-free joint and restore the overall limb alignment. There are limited short-term studies published from Indian hospitals that investigated the importance of neutral mechanical component alignment in TKA patients. Methods Retrospective and prospective study was conducted at the Department of orthopaedics, Sancheti Institute for Orthopaedics and Rehabilitation, Pune from June 2020 to September 2022. Enrolled patients were assessed preoperatively and postoperatively using clinical examination, radiological assessment and functional outcomes through the Oxford knee score, Knee society score and VAS score. Results 204 patients enrolled, and 267 knees were evaluated for the study. Osteoarthritis was the commonest diagnosis (254 knees, 95.13%). Pre-operatively, 92.13% knees were varus, 4.87% valgus and 3% neutral while post-operatively, 51.69% were varus, 16.1% were valgus, and 32.32% were with neutral axis. Majority of patients with a pre-operative neutral axis converted to varus axis (62.5%), while most valgus axis cases preoperatively converted to a neutral axis (53.84%). For pre-operative varus subgroup, the majority patients with < 10° pre-operative axis converted to neutral (41.28%). Majority patients with 10°-20° pre-operative axis remained varus (60.53%) and with > 20° pre-operative axis remained varus (78.26%). Functional outcome parameters were significantly improved at follow-up (P < 0.05). Conclusion Short-term postoperative functional scores were significantly improved in postoperative cases, with the postoperative alignment of 0° ± 3° relative to the mechanical axis was achieved. Thus, postoperative neutral mechanical alignment of 0° ± 3° can be the standard of care for patients undergoing TKA. Graphical abstract
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Affiliation(s)
- Vishwajit V. Patil
- Department of Orthopaedics, Sancheti Institute for Orthopedics and Rehabilitation, Sancheti Boys Hostel, Thube Park, Shivajinagar, Pune, Maharashtra 411005 India
| | - Parag K. Sancheti
- Department of Orthopaedics, Sancheti Institute for Orthopedics and Rehabilitation, Sancheti Boys Hostel, Thube Park, Shivajinagar, Pune, Maharashtra 411005 India
| | - Kailash Patil
- Department of Orthopaedics, Sancheti Institute for Orthopedics and Rehabilitation, Sancheti Boys Hostel, Thube Park, Shivajinagar, Pune, Maharashtra 411005 India
| | - Sunny Gugale
- Department of Orthopaedics, Sancheti Institute for Orthopedics and Rehabilitation, Sancheti Boys Hostel, Thube Park, Shivajinagar, Pune, Maharashtra 411005 India
| | - Ashok Shyam
- Sancheti Institute for Orthopedics and Rehabilitation, Pune, Maharashtra India
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Ten Noever de Brauw GV, Bayoumi T, Ruderman LV, Kerkhoffs GMMJ, Pearle AD, Zuiderbaan HA. Knees with anteromedial osteoarthritis show a substantial phenotypic variation prior and following medial unicompartmental knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 2023; 31:5579-5590. [PMID: 37848566 DOI: 10.1007/s00167-023-07603-9] [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: 07/18/2023] [Accepted: 09/21/2023] [Indexed: 10/19/2023]
Abstract
PURPOSE The primary aim of this study was to evaluate the phenotypic variation using the Coronal Plane Alignment of the Knee (CPAK) classification among 1000 knees with anteromedial osteoarthritis (OA) both prior to and following medial unicompartmental knee arthroplasty (UKA). The secondary aim of this study was to investigate whether knees maintained their preoperative CPAK phenotype and to evaluate the phenotypic alterations following medial UKA. METHODS The CPAK classification was used to analyze 1000 knees that underwent medial UKA as treatment for anteromedial OA. Knees were categorized into nine distinct CPAK phenotypes based on their arithmetic hip-knee-ankle angle (aHKA), which estimates the pre-arthritic alignment, and joint line obliquity (JLO), both pre- and postoperatively. Phenotypic variation was analyzed by sex and age, and the phenotypic alterations following medial UKA were evaluated by phenotype. RESULTS Preoperatively, CPAK phenotype I had the highest prevalence (45.0%). Among males, the preoperative prevalence of CPAK phenotype I was significantly higher compared to females (53.2% vs. 35.0%, respectively; p ≤ .001), whereas females exhibited a significantly higher occurrence of CPAK phenotype V compared to males (9.8% vs. 4.4%, respectively; p ≤ .015). Following medial UKA, CPAK phenotype II had the highest prevalence (53.3%). Overall, 45.1% of knees maintained their preoperative CPAK phenotype following medial UKA, which was most frequently observed among CPAK phenotype II (67.7%) and III (65.8%). CONCLUSION There is a substantial variation in CPAK phenotypes among knees with anteromedial OA, as well as following treatment with medial UKA. This variability challenges the assumption of uniform characteristics among knees with an identical wear pattern associated with anteromedial OA and emphasizes the complexity and variability of this specific form of OA. LEVEL OF EVIDENCE III, Retrospective cohort study.
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Affiliation(s)
- G V Ten Noever de Brauw
- Hospital for Special Surgery, Department of Orthopaedic Surgery, Computer Assisted Surgery Center and Sports Medicine, Weill Medical College of Cornell University, 535 East 70th Street, New York, NY, 10021, USA.
- Department of Orthopaedic Surgery, Amsterdam UMC Location University of Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands.
| | - T Bayoumi
- Hospital for Special Surgery, Department of Orthopaedic Surgery, Computer Assisted Surgery Center and Sports Medicine, Weill Medical College of Cornell University, 535 East 70th Street, New York, NY, 10021, USA
- Department of Orthopaedic Surgery, Amsterdam UMC Location University of Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands
| | - L V Ruderman
- Hospital for Special Surgery, Department of Orthopaedic Surgery, Computer Assisted Surgery Center and Sports Medicine, Weill Medical College of Cornell University, 535 East 70th Street, New York, NY, 10021, USA
| | - G M M J Kerkhoffs
- Department of Orthopaedic Surgery, Amsterdam UMC Location University of Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands
- Amsterdam Movement Sciences, Sports, Amsterdam, The Netherlands
| | - A D Pearle
- Hospital for Special Surgery, Department of Orthopaedic Surgery, Computer Assisted Surgery Center and Sports Medicine, Weill Medical College of Cornell University, 535 East 70th Street, New York, NY, 10021, USA
| | - H A Zuiderbaan
- Department of Orthopaedic Surgery, Medische Kliniek Velsen, Velsen-Noord, The Netherlands
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22
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Qin S, Li M, Jia Y, Gao W, Xu J, Zhang B, Guo H, Feng A, Sun R. How Do the Morphological Abnormalities of Femoral Head and Neck, Femoral Shaft and Femoral Condyle Affect the Occurrence and Development of Medial Knee Osteoarthritis. Orthop Surg 2023; 15:3174-3181. [PMID: 37873579 PMCID: PMC10694027 DOI: 10.1111/os.13910] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Revised: 08/30/2023] [Accepted: 09/03/2023] [Indexed: 10/25/2023] Open
Abstract
OBJECTIVE At present, the main viewpoint is that tibial varus is the main reason of medial knee osteoarthritis (OA), and high tibial osteotomy (HTO) is also the main alignment correction method to correct medial knee OA. In contrast, the impact of the anatomical alignment of the femur on medial knee OA is often overlooked. We evaluated the increased risk for medial knee OA because a varus alignment could be attributed to the anatomical reasons that include hip anatomy, femoral shaft bowing (FSB) and femoral condylar dysplasia. METHODS The present research adopted a cross-sectional study method. We selected 62 patients with HTO in the Third Hospital of Hebei Medical University from June 2021 to March 2022 as the HTO group and 55 healthy volunteers as the control group. Femoral neck-shaft angle (NSA), lateral FSB, mechanical lateral distal femoral angle (mLDFA) and hip-knee-ankle (HKA) was radiographically examined within the two groups. The femoral neck length and offset were also measured, and the ratio is represented by the ratio of the femoral neck length to off-set (N/O). The 2-tailed Student t-test was used to compare the differences between groups when the data were in accordance with a normal distribution. Otherwise, the Mann-Whitney U tests was used to compare the differences between groups. RESULT Compared to the control group, the HTO group had a higher offset (p < 0.05), greater femoral neck length (p < 0.05), and decreased (more varus) NSA (p < 0.05). The HKA in the HTO group was 172.20 ° (3.50°), which was significantly lower than that of the control group 177.00° (3.05°), (p < 0.001), while the medial OA was associated with more varus HKA. The mean mLDFA was 89.10 ° (2.35°) and 87.50° (2.85°) in the HTO and control groups (p < 0.005), respectively. The mean lateral FSB values of the full-length radiographs were larger (p < 0.001) in the HTO group (4.24° ± 3.25°) than that in control group (1.16° ± 2.32°). CONCLUSION The reduction of NSA (coxa vara) and the increase of the mLDFA can lead to medial knee OA, while the lateral FSB also affects medial OA. We believe that femoral deformity is also one of the cause of the medial knee OA. Therefore, it is necessary to evaluate the joint deformity of the femur and tibia before surgery in order to determine whether to use HTO alone to correct the lower limb alignment.
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Affiliation(s)
- Shiqi Qin
- Hebei Medical University Third Affiliated HospitalShijiazhuangChina
| | - Ming Li
- Hebei Medical University Third Affiliated HospitalShijiazhuangChina
| | - Yanfeng Jia
- Hebei Medical University Third Affiliated HospitalShijiazhuangChina
| | - Wei Gao
- Hebei Medical University Third Affiliated HospitalShijiazhuangChina
| | - Juncai Xu
- Third Military Medical University Southwest HospitalChongqingChina
| | | | - Hailong Guo
- Hebei Medical University Third Affiliated HospitalShijiazhuangChina
| | - Ao Feng
- Hebei Medical University Third Affiliated HospitalShijiazhuangChina
| | - Ran Sun
- Hebei Medical University Third Affiliated HospitalShijiazhuangChina
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Karasavvidis T, Pagan Moldenhauer CA, Lustig S, Vigdorchik JM, Hirschmann MT. Definitions and consequences of current alignment techniques and phenotypes in total knee arthroplasty (TKA) - there is no winner yet. J Exp Orthop 2023; 10:120. [PMID: 37991599 PMCID: PMC10665290 DOI: 10.1186/s40634-023-00697-7] [Citation(s) in RCA: 16] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Accepted: 11/16/2023] [Indexed: 11/23/2023] Open
Abstract
Dissatisfaction following total knee arthroplasty (TKA) has been extensively documented and it was attributed to numerous factors. In recent years, significant focus has been directed towards implant alignment and stability as potential causes and solutions to this issue. Surgeons are now exploring a more personalized approach to TKA, recognizing the importance of thoroughly understanding each individual patient's anatomy and functional morphology. A more comprehensive preoperative analysis of alignment and knee morphology is essential to address the unresolved questions in knee arthroplasty effectively. The crucial task of determining the most appropriate alignment strategy for each patient arises, given the substantial variability in bone resection resulting from the interplay of phenotype and the alignment strategy chosen. This review aims to comprehensively present the definitions of different alignment techniques in all planes and discuss the consequences dependent on knee phenotypes.Level of evidence V.
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Affiliation(s)
- Theofilos Karasavvidis
- Adult Reconstruction and Joint Replacement Service, Department of Orthopaedic Surgery, Hospital for Special Surgery, 535 East 70th Street, New York, NY, 10021, USA.
| | - Cale A Pagan Moldenhauer
- Adult Reconstruction and Joint Replacement Service, Department of Orthopaedic Surgery, Hospital for Special Surgery, 535 East 70th Street, New York, NY, 10021, USA
| | - Sébastien Lustig
- Department of Orthopaedic Surgery and Sports Medicine, Croix-Rousse Hospital, Lyon, 69004, France
| | - Jonathan M Vigdorchik
- Adult Reconstruction and Joint Replacement Service, Department of Orthopaedic Surgery, Hospital for Special Surgery, 535 East 70th Street, New York, NY, 10021, USA
| | - Michael T Hirschmann
- Department of Orthopaedic Surgery and Traumatology, Kantonsspital Baselland, Bruderholz, CH-4101, Switzerland
- Department of Clinical Research, Research Group Michael T. Hirschmann, Regenerative Medicine & Biomechanics, University of Basel, Basel, CH-4001, Switzerland
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24
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Saad A, Nischal N, Sharma A, Agrawal Y, Iyengar KP, Botchu R. The Linear Coronal Knee Offset (LCKO)-Preliminary Study of New Method of Measuring Knee Varus/Valgus Malalignment. Indian J Radiol Imaging 2023; 33:484-488. [PMID: 37811190 PMCID: PMC10556331 DOI: 10.1055/s-0043-1770085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/10/2023] Open
Abstract
Introduction Considerable attention is focused on preoperative templating of radiological images in patients undergoing total knee arthroplasty to obtain optimal alignment and outcome. Several radiological measurements have been described. Purpose In this study, we illustrate a new linear measurement: The linear coronal knee offset (LCKO) that can be used to analyze the coronal configuration on long leg alignment radiographs commonly undertaken during preoperative templating. Methods A retrospective search was performed of our Picture Archiving and Communication System and Radiology Information System to identify 100 lower limbs anteroposterior, weight bearing, long leg alignment view radiographs of patients referred to knee clinics over 1 year with knee pain. Demographic details, clinical indication, standard radiological measurement of the anatomical tibiofemoral angle, and the LCKO were measured and data were analyzed using Student's t -test. In addition, intraclass correlation coefficient was used to analyze for intraclass reliability. Results The average age of patients was 36.3 years (range: 12-80 years) with a male predominance. The LCKO was statistically significant between the three cohorts of patients. The mean LCKO in normal cohorts was 0.24 cm, varus was -0.6 cm, and valgus was 1.72cm. There was good inter and interobserver reliability (Kappa of 0.8 and 0.8, respectively). Conclusion The novel LCKO measurement provides a simpler method in assessing coronal lower limb malalignment and can easily identify a normal, varus, or valgus knee deformity.
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Affiliation(s)
- Ahmed Saad
- Department of Orthopaedics, Royal Orthopaedic Hospital, Birmingham, United Kingdom
| | - Neha Nischal
- Department of Radiology, Royal Orthopaedic Hospital, Birmingham, United Kingdom
| | - Akash Sharma
- Department of Arthroplasty, Royal Orthopaedic Hospital, Birmingham, United Kingdom
| | - Yuvraj Agrawal
- Department of Arthroplasty, Royal Orthopaedic Hospital, Birmingham, United Kingdom
| | | | - Rajesh Botchu
- Department of Musculoskeletal Radiology, Royal Orthopedic Hospital, Birmingham, United Kingdom
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25
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Pagan CA, Karasavvidis T, Lebrun DG, Jang SJ, MacDessi SJ, Vigdorchik JM. Geographic Variation in Knee Phenotypes Based on the Coronal Plane Alignment of the Knee Classification: A Systematic Review. J Arthroplasty 2023; 38:1892-1899.e1. [PMID: 36963533 DOI: 10.1016/j.arth.2023.03.047] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Revised: 03/13/2023] [Accepted: 03/16/2023] [Indexed: 03/26/2023] Open
Abstract
BACKGROUND The extent of geographic variation in knee phenotypes remains unclear. The Coronal Plane Alignment of the Knee (CPAK) Classification proposes 9 coronal plane phenotypes based on constitutional limb alignment and joint line obliquity. This systematic review aims to examine differences in the distributions of CPAK types across geographic regions. METHODS A systematic review of the literature was performed according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Studies reporting distributions of knee phenotypes according to the CPAK classification for healthy and/or arthritic knees were included. RESULTS There were 7 studies included, accounting for 5,964 knees in 3,917 subjects. Among healthy knees (n = 1,214), CPAK type II was the most common type in Belgium (39.2%), Taiwan (39.3%), and India (25.6%). Among arthritic knees (n = 2,804), CPAK type I was the most common in France (33.4%), India (58.8%), and Japan (53.8%), whereas CPAK type II was the most common in Australia (32.8%). The proportion of CPAK type I and II knees varied significantly across geographic regions among healthy (P < .01) and arthritic knees (P < .01). CONCLUSION Significant variation in CPAK distributions exists between countries. Further work is needed to delineate racial and sexual differences in CPAK types, which were not explored in this article. A better understanding of population-level variability in knee phenotypes may enable orthopaedic surgeons to offer a more personalized approach to knee arthroplasty.
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Affiliation(s)
- Cale A Pagan
- Adult Reconstruction and Joint Replacement Service, Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, New York
| | - Theofilos Karasavvidis
- Adult Reconstruction and Joint Replacement Service, Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, New York
| | - Drake G Lebrun
- Adult Reconstruction and Joint Replacement Service, Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, New York
| | - Seong J Jang
- Adult Reconstruction and Joint Replacement Service, Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, New York; Weill Cornell College of Medicine, New York, New York
| | - Samuel J MacDessi
- Sydney Knee Specialists, Kogarah, New South Wales, Australia; St. George and Sutherland Clinical School, University of New South Wales, St George Hospital, Kogarah, New South Wales, Australia; Department of Orthopaedic Surgery, St George Private Hospital, Kogarah, New South Wales, Australia
| | - Jonathan M Vigdorchik
- Adult Reconstruction and Joint Replacement Service, Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, New York
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26
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Itou J, Kuwashima U, Itoh M, Okazaki K. Open-wedge high tibial osteotomy with a slight valgus correction from neutral limb alignment achieves clinical improvements comparable with those for knees with varus deformity. J Exp Orthop 2023; 10:75. [PMID: 37515658 PMCID: PMC10386984 DOI: 10.1186/s40634-023-00640-w] [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: 05/19/2023] [Accepted: 07/14/2023] [Indexed: 07/31/2023] Open
Abstract
PURPOSE The effect of open-wedge high tibial osteotomy (OWHTO) on the preoperative neutral alignment of the knee is unknown. The purpose of this study was to clarify the clinical outcome of OWHTO with neutral alignment, defined as within 4 degrees of varus. METHODS This retrospective study included 72 knees with varus that underwent medial OWHTO. The knees were divided according to the preoperative hip-knee-ankle angle into a neutral alignment group (≤ 4° of varus alignment) and a varus alignment group (> 4° of varus alignment). The Knee Injury and Osteoarthritis Outcome Score (KOOS) and the Forgotten Joint Score-12 (FJS-12) were evaluated preoperatively and during at least 2 years of follow-up postoperatively. RESULTS There were no significant differences between the preoperative FJS-12 (17.9 versus 23.7; p = 0.16) and postoperative FJS-12 (57.3 versus 60.6; p = 0.52) or KOOS subscale scores (p > 0.05) in the neutral alignment group or the varus alignment group. Each group had a mean change in the KOOS subscale scores that exceeded the minimum clinically important difference. CONCLUSION The short-term clinical results of OWHTO for neutral alignment were as favourable as those for varus malalignment. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Junya Itou
- Department of Orthopaedic Surgery, Tokyo Women's Medical University, 8-1 Kawada-Cho, Shinjuku-Ku, Tokyo, 162-8666, Japan
| | - Umito Kuwashima
- Department of Orthopaedic Surgery, Tokyo Women's Medical University, 8-1 Kawada-Cho, Shinjuku-Ku, Tokyo, 162-8666, Japan
| | - Masafumi Itoh
- Department of Orthopaedic Surgery, Tokyo Women's Medical University, 8-1 Kawada-Cho, Shinjuku-Ku, Tokyo, 162-8666, Japan
| | - Ken Okazaki
- Department of Orthopaedic Surgery, Tokyo Women's Medical University, 8-1 Kawada-Cho, Shinjuku-Ku, Tokyo, 162-8666, Japan.
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Carman L, Besier T, Stott NS, Choisne J. Sex differences in linear bone measurements occur following puberty but do not influence femoral or tibial torsion. Sci Rep 2023; 13:11733. [PMID: 37474546 PMCID: PMC10359265 DOI: 10.1038/s41598-023-38783-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Accepted: 07/14/2023] [Indexed: 07/22/2023] Open
Abstract
Torsional, angular, and linear measurements in a paediatric population are clinically important but not well defined and understood. Different methods of measurement and discrepancies between assessors leads to a lack of understanding of what should be defined as typical or atypical for the growing skeleton. From a large dataset of 333 paediatric CT scans, we extracted three-dimensional torsional, angular, and linear measurements from the pelvis, femur, and tibia/fibula. Sex differences in linear measurements were observed in bones of children aged 13+ (around puberty), but femoral and tibial torsion were similar between males and females. The rotational profile (femoral anteversion minus tibial torsion) tended to increase with growth. Epicondylar, condylar, and malleolar widths were smaller in females than males for the same bone length after the age of 13 years, which could explain why females may be more at risk for sport injuries during adolescence. This rich dataset can be used as an atlas for researchers and clinicians to understand typical development of critical rotational profiles and linear bone measurements in children.
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Affiliation(s)
- Laura Carman
- Auckland Bioengineering Institute, The University of Auckland, Auckland, New Zealand
| | - Thor Besier
- Auckland Bioengineering Institute, The University of Auckland, Auckland, New Zealand
- Department of Engineering Science, The University of Auckland, Auckland, New Zealand
| | - N Susan Stott
- Department of Surgery, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand
| | - Julie Choisne
- Auckland Bioengineering Institute, The University of Auckland, Auckland, New Zealand.
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28
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Almaawi A, AlAbdullatif FS, AlOmar AH, Aljammaz B, Almohaimeed M, Alkheraiji A. Neutral Mechanical Alignment and Prevalence of Constitutional Varus Knees Among the Saudi Population at King Saud University Medical City. Cureus 2023; 15:e41753. [PMID: 37575843 PMCID: PMC10415852 DOI: 10.7759/cureus.41753] [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] [Accepted: 07/12/2023] [Indexed: 08/15/2023] Open
Abstract
Background Various studies have described the restoration of the neutral mechanical alignment of the lower limb in total knee replacement (TKR) as a key factor of knee implant durability. Mechanical alignment of the knee requires that the tibial and femoral cuts are perpendicular to the mechanical axis of each bone in the coronal plane. Objectives The aim of this study is to investigate mechanical knee alignment and the prevalence of constitutional varus knee among the Saudi population at a single tertiary center with no history of musculoskeletal abnormalities. Methodology This is a retrospective cross-sectional study involving patients with no musculoskeletal abnormality who had their lower limb X-ray Centigram using the universal viewer zero footprint system made between 2015 and 2021. The study took place at King Saud University Medical City. The X-rays were obtained from patients' electronic medical records retrospectively. A total of 728 knees of 370 males and 358 females were included in this study. Results The results showed that 165 male knees (44.4%) and 218 female knees (60%) had constitutional varus alignment with the hip-knee-ankle (HKA) angle of ≤3° or less. The average HKA angle was smaller in males than in females: -3.69° versus -1.98°, respectively. Conclusion We have identified variables and factors that can help surgeons detect the constitutional varus on a full leg radiograph preoperatively at the time of TKA, regardless of the osteoarthritic changes of the knee. We encourage the scientific community to look for causes and risk factors for developing constitutional varus.
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Affiliation(s)
| | | | - Abdullah H AlOmar
- Department of Orthopedics, King Khalid University Hospital, Riyadh, SAU
| | - Bandar Aljammaz
- College of Medicine, King Saud University Medical City, Riyadh, SAU
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29
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Hsieh SL, Lin TL, Hung CH, Fong YC, Chen HT, Tsai CH. Clinical and Radiographic Outcomes of Inversed Restricted Kinematic Alignment Total Knee Arthroplasty by Asia Specific (Huang’s) Phenotypes, a Prospective Pilot Study. J Clin Med 2023; 12:jcm12062110. [PMID: 36983113 PMCID: PMC10057926 DOI: 10.3390/jcm12062110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Revised: 02/23/2023] [Accepted: 03/03/2023] [Indexed: 03/10/2023] Open
Abstract
Inverse restricted kinematic alignment (irKA) was modified from restricted kinematic alignment for total knee arthroplasty (TKA). This prospective single-center study aimed to evaluate the outcomes of irKA-TKA on all knee subtypes classified by Asia specific (Huang’s) phenotypes. A total of 96 knees that underwent irKA-TKA at one hospital between January 2018 and June 2020 were included, with 15 knees classified in Type 1, nine in Type 2, 15 in Type 3, 47 in Type 4, and 10 in Type 5 by Huang’s phenotypes. Outcomes were knee alignment measures and patient-reported satisfaction evaluated by the Western Ontario and McMaster Universities Arthritis Index (WOMAC) and traditional Chinese version of the Forgotten Joint Score-12 (FJS-12). Follow-up was one year. Type 4 knee was most significantly corrected in all angles by irKA-TKA, followed by Type 2 and 3 knees. Type 5 and 1 knee were only significantly corrected in some angles. The correlation between FJS-12 and WOMAC was good at 6 months (Pearson correlation coefficient (r) = 0.74) and moderate at 6 weeks, 3 months, and 12 months during follow-up (r = 0.37~0.47). FJS-12 and WOMAC displayed comparable hip–knee–ankle angle cut-off value (4.71° vs. 6.20°), sensitivity (70.49% vs. 67.19%), specificity (84.00% vs. 85.71%), and Youden index (54.49% vs. 52.90%) in prediction of good prognosis. In conclusion, irKA-TKA corrects knee alignment in all knee types with increasing satisfaction for one-year follow-up. Knees with presurgical varus deformity are most recommended for irKA-TKA. Both presurgical scores of the traditional Chinese version of FJS-12 and WOMAC predict the prognosis of irKA-TKA.
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Affiliation(s)
- Shang-Lin Hsieh
- Department of Orthopedics, China Medical University Hospital, Taichung 404, Taiwan
- Graduate Institute of Biomedical Sciences, China Medical University, Taichung 404, Taiwan
| | - Tsung-Li Lin
- Department of Orthopedics, China Medical University Hospital, Taichung 404, Taiwan
- Graduate Institute of Biomedical Sciences, China Medical University, Taichung 404, Taiwan
- Department of Sports Medicine, College of Health Care, China Medical University, Taichung 404, Taiwan
| | - Chih-Hung Hung
- Department of Orthopedics, China Medical University Hospital, Taichung 404, Taiwan
| | - Yi-Chin Fong
- Department of Orthopedics, China Medical University Hospital, Taichung 404, Taiwan
- Department of Sports Medicine, College of Health Care, China Medical University, Taichung 404, Taiwan
- Department of Orthopedics, China Medical University Beigang Hospital, Yunlin 651, Taiwan
| | - Hsien-Te Chen
- Department of Orthopedics, China Medical University Hospital, Taichung 404, Taiwan
- Department of Sports Medicine, College of Health Care, China Medical University, Taichung 404, Taiwan
| | - Chun-Hao Tsai
- Department of Orthopedics, China Medical University Hospital, Taichung 404, Taiwan
- Department of Sports Medicine, College of Health Care, China Medical University, Taichung 404, Taiwan
- Correspondence:
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da Rosa BN, Camargo EN, Candotti CT. Radiographic Measures for the Assessment of Frontal and Sagittal Knee Alignments and the Associated Normality Values: A Meta-Analysis. J Chiropr Med 2023; 22:72-84. [PMID: 36844994 PMCID: PMC9947998 DOI: 10.1016/j.jcm.2022.03.005] [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: 05/22/2021] [Revised: 03/28/2022] [Accepted: 03/28/2022] [Indexed: 10/17/2022] Open
Abstract
Objective The purpose of this literature review was to identify knee alignment assessment methods using radiography in the sagittal and frontal planes and to identify normality values for classifying knee alignment using these methods. Methods A systematic review with a meta-analysis was conducted. The eligibility criterion was studies that performed radiographic examinations to assess the knee alignment of adults without a history of hip or knee prosthesis surgery. The methodological qualities of the included studies were assessed using the QUADAS-2 tool. A meta-analysis was performed to measure the normality values of knee alignment in the frontal plane. Results The hip-knee-ankle (HKA) angle was the measure most frequently used to assess knee alignment. Only a meta-analysis of HKA normality values was possible. Thereby, we found normality values of the HKA angle for the overall population, men, and women. The normality values of knee alignment for healthy adults that were found in this study were as follows: overall sample (male and female patients) HKA angle = -0.2° (-2.8° to 2.41°), male patient HKA angle = 0.77° (-2.91° to 7.94°), and female patient HKA angle = -0.67° (-5.32° to 3.98°). Conclusion This review identified the most common methods and expected values for knee alignment assessment methods using radiography in the sagittal and frontal planes. We suggest HKA angles ranging from -3° to 3° as the cutoff for classifying knee alignment in the frontal plane, in accordance with the normality limits found in the meta-analysis.
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Affiliation(s)
- Bruna Nichele da Rosa
- School of Physical Education, Physiotherapy and Dance, Federal University of the Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil
| | - Eduardo Nunes Camargo
- School of Physical Education, Physiotherapy and Dance, Federal University of the Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil
| | - Cláudia Tarragô Candotti
- School of Physical Education, Physiotherapy and Dance, Federal University of the Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil
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Key-Point Detection Algorithm of Deep Learning Can Predict Lower Limb Alignment with Simple Knee Radiographs. J Clin Med 2023; 12:jcm12041455. [PMID: 36835990 PMCID: PMC9959348 DOI: 10.3390/jcm12041455] [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: 12/16/2022] [Revised: 02/07/2023] [Accepted: 02/10/2023] [Indexed: 02/15/2023] Open
Abstract
(1) Background: There have been many attempts to predict the weight-bearing line (WBL) ratio using simple knee radiographs. Using a convolutional neural network (CNN), we focused on predicting the WBL ratio quantitatively. (2) Methods: From March 2003 to December 2021, 2410 patients with 4790 knee AP radiographs were randomly selected using stratified random sampling. Our dataset was cropped by four points annotated by a specialist with a 10-pixel margin. The model predicted our interest points, which were both plateau points, i.e., starting WBL point and exit WBL point. The resulting value of the model was analyzed in two ways: pixel units and WBL error values. (3) Results: The mean accuracy (MA) was increased from around 0.5 using a 2-pixel unit to around 0.8 using 6 pixels in both the validation and the test sets. When the tibial plateau length was taken as 100%, the MA was increased from approximately 0.1, using 1%, to approximately 0.5, using 5% in both the validation and the test sets. (4) Conclusions: The DL-based key-point detection algorithm for predicting lower limb alignment through labeling using simple knee AP radiographs demonstrated comparable accuracy to that of the direct measurement using whole leg radiographs. Using this algorithm, the WBL ratio prediction with simple knee AP radiographs could be useful to diagnose lower limb alignment in osteoarthritis patients in primary care.
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Cieremans DA, Arraut J, Marwin S, Slover J, Schwarzkopf R, Rozell JC. Patellar Component Design Does Not Impact Clinical Outcomes in Primary Total Knee Arthroplasty. J Arthroplasty 2023:S0883-5403(23)00081-5. [PMID: 36764403 DOI: 10.1016/j.arth.2023.01.061] [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: 07/30/2022] [Revised: 01/26/2023] [Accepted: 01/31/2023] [Indexed: 02/12/2023] Open
Abstract
BACKGROUND Round or oval implants are used in patellar resurfacing during total knee arthroplasty (TKA). However, whether component geometry affects clinical outcomes is unclear. This study aimed to determine if one implant shape conferred superior outcomes to the other. METHODS A retrospective review of primary TKA cases performed from 2016 to 2020 was conducted at an urban, tertiary academic center. Four hundred consecutive, primary TKAs were included in these analyses. Cases were included if a surgeon used the round design then oval design for fifty consecutive cases. Baseline demographic data and radiographic measurements were assessed. Surgical data, reasons for revision, and patient-reported outcome measures were analyzed. Independent samples t-test and chi-square tests were used to compare means and proportions. There were no demographic differences between the cohorts. RESULTS Postoperative patellar tilt was statistically different between the cohorts. Sixteen patients required revision surgery; however, revision rates did not differ between the cohorts. Of the 9 rounds, 1 button was revised for infection. Of the 7 ovals, 1 button was revised for infection and 1 for loosening. Veterans RAND 12 Physical Component Score at 3 months postoperatively was higher for the round cohort, but no differences were observed at 1 year. CONCLUSION While radiographic patellar tilt was significantly different between the cohorts, there was no clinical correlation in outcomes at 3 months or 1 year postoperatively. Longer-term follow-up studies are needed to evaluate the implications of patellar component design on outcomes and function. Nevertheless, the current study affirms that both designs are clinically equivalent which should be used to guide clinical decision-making. LEVEL III EVIDENCE Retrospective Cohort.
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Affiliation(s)
| | - Jerry Arraut
- New York University Langone Orthopedic Hospital, New York, New York
| | - Scott Marwin
- New York University Langone Orthopedic Hospital, New York, New York
| | - James Slover
- New York University Langone Orthopedic Hospital, New York, New York
| | - Ran Schwarzkopf
- New York University Langone Orthopedic Hospital, New York, New York
| | - Joshua C Rozell
- New York University Langone Orthopedic Hospital, New York, New York
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Femoral-varus tibial-valgus osteotomy (FVTVO) for neutrally-aligned knee osteoarthritis with severe joint line obliquity enables return to sports activities: A case series study. Asia Pac J Sports Med Arthrosc Rehabil Technol 2023; 31:11-17. [PMID: 36825133 PMCID: PMC9941361 DOI: 10.1016/j.asmart.2023.01.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Revised: 12/22/2022] [Accepted: 01/11/2023] [Indexed: 02/11/2023] Open
Abstract
Background Re-alignment surgeries for uni-compartmental knee osteoarthritis, such as high tibial osteotomy (HTO) for varus knees or distal femoral osteotomy (DFO) for valgus knees, are recognized as standard strategies. However, the treatment strategy has not been established for patients with a neutrally-aligned osteoarthritic knee with severe joint line obliquity (JLO) owing to the combination of a valgus femur and a varus tibia; i.e., type II coronal plane alignment of the knee (CPAK). total knee arthroplasty (TKA) can be an option for CPAK type II-aligned osteoarthritis in older inactive patients. Here, we hypothesized that joint line horizontalization by femoral-varus tibial-valgus osteotomy (FVTVO), which may reduce the shear stress induced by JLO, could be a treatment option for CPAK type II-aligned osteoarthritis in young active patients who wish to return to sports (RTS) activity. Our aim in this study was to evaluate the postoperative results of FVTVO with RTS. Methods Our indications for FVTVO are as follows: JLO >5°; mechanical medial proximal tibial angle (mMPTA) < 87°; mechanical lateral distal femoral angle (mLDFA) < 87°; typical osteoarthritis patterns for CPAK type II on magnetic resonance images, namely osteoarthritic change of the lateral tibial spine, medial slip of the femur, and/or lateral meniscal extrusion from the lateral femoral condyle; and flexion contracture <10°. We enrolled patients who wished to RTS and who had a pre-symptom Tegner score ≥5 and had completed at least a 1-year follow-up. For FVTVO, closed-wedge DFO was performed in all femurs; both closed-wedge HTO and open-wedge HTO were used in the tibia, depending on the situation. Range of motion exercises began on the first postoperative day, and full weight-bearing was permitted 6 weeks postoperatively. Jogging was permitted 3 months postoperatively after confirming bone union, and patients could gradually return to their sports activity 6-12 months' postoperatively. The Japanese Orthopaedic Association (JOA) score and knee flexion range were assessed preoperatively and at the last follow-up. Tegner activity scale scores were assessed presymptom, preoperatively, and at the last follow-up. The hip-knee-ankle (HKA) angle, JLO, mMPTA, and mLDFA were evaluated radiologically, and meniscal extrusions, osteoarthritic change, and/or bone marrow edema were assessed on magnetic resonance images. Results One man and two women were included in this case series. Two were competitive athletes and one was a mountain climber. The patients' ages were 69, 46, and 57 years (Case 1, 2, and 3, respectively). All patients' CPAK type was converted from type II to type V; i.e., neutral-aligned knee with a neutral joint line, postoperatively. All patients returned to their presymptom sports activity level by the final follow-up. The presymptom/preoperative/final follow-up Tegner scale in Case 1, 2, and 3 were 6/1/6, 5/2/5, and 7/3/7, respectively. Conclusion Joint line horizontalization by FVTVO for patients with a neutral-aligned knee with severe JLO provided highly satisfactory clinical results and successfully led to RTS.
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Ma R, Chen X, Li H, Wang Y, Li S, Li S, Qian W. Computer Navigation Assisted Restricted Kinematic Alignment Improves Short-Term Outcomes in Total Knee Arthroplasty: An Ambispective Cohort Study. Orthop Surg 2023; 15:460-470. [PMID: 36453440 PMCID: PMC9891913 DOI: 10.1111/os.13603] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Revised: 10/17/2022] [Accepted: 10/28/2022] [Indexed: 12/03/2022] Open
Abstract
OBJECTIVES Mechanical alignment (MA)-total knee arthroplasty (TKA) has been challenged due to the excessive soft tissue release and the evidence of the clinical outcomes of computer assisted navigation is still limited. The aim of this ambispective cohort study was to: (i) investigate whether computer assisted navigation is capable to achieve restricted kinematic alignment (rKA)-TKA; and (ii) compare the short-term outcomes between rKA-TKA and MA-TKA. METHODS We retrospectively included 41 patients diagnosed with osteoarthritis who received MA-TKA between April 2019 and January 2021 and 43 patients diagnosed with osteoarthritis who received rKA-TKA were included in the prospective cohort from January 2021 to September 2021. Demographical, peri-operative, and radiological data were collected and compared. Unpaired two-sample t-test for continuous variables and χ2 test for categorical variables were used to compare various measurements in two groups. The patient-reported outcome measures at baseline, 10 days (T1), and 6 months (T6) after surgery were statistically analyzed by generalized estimating equation (GEE) models. RESULTS Fourty-one patients (45 knees) and 43 patients (48 knees) were included in the MA and the rKA group respectively. Three constitutional knee phenotypes (II, I, IV) were the commonest in our population. Navigation improved the surgical accuracy (1.5° vs 3.5°, p < 0.001) and precision (interquartile range 4.0 vs 2.0, p < 0.001) in the rKA group than the MA group. The changes in Knee Injury and Osteoarthritis Outcome Score 12 (KOOS12), EuroQol five-dimension questionnaire (EQ5D) from baseline to T1 and T6 for patients with on-target rKA were larger than on-target MA counterparts (26.053 vs 18.607, P < 0.001(KOOS12, T1) , 0.457 vs 0.367 p < 0.001(EQ5D, T1) ; 51.017 vs 46.896, P = 0.023(KOOS12, T6) , 0.606 vs 0.565, P = 0.01(EQ5D, T6) ). Patients with on-target rKA had better Forgotten Joint Score (FJS) at T1 (54.126 vs 40.965, P = 0.002) compared with on-target MA counterparts. CONCLUSIONS Computer assisted navigation achieved the level of accuracy required by rKA-TKA. rKA-TKA offered significantly better short-term outcomes than MA-TKA.
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Affiliation(s)
- Ruichen Ma
- School of MedicineTsinghua UniversityBeijingChina
| | - Xi Chen
- Department of Orthopedic Surgery, Peking Union Medical College HospitalPeking Union Medical College, Chinese Academy of Medical SciencesBeijingChina
- Department of Orthopedics, West China Hospital, West China School of MedicineSichuan UniversityChengduChina
| | - Haolin Li
- Department of biostatisticsUniversity of North CarolinaChapel HillNorth CarolinaUSA
| | - Yiou Wang
- Department of Orthopedic Surgery, Peking Union Medical College HospitalPeking Union Medical College, Chinese Academy of Medical SciencesBeijingChina
| | - Songlin Li
- Department of Orthopedic Surgery, Peking Union Medical College HospitalPeking Union Medical College, Chinese Academy of Medical SciencesBeijingChina
| | - Shanni Li
- Department of Orthopedic Surgery, Peking Union Medical College HospitalPeking Union Medical College, Chinese Academy of Medical SciencesBeijingChina
| | - Wenwei Qian
- Department of Orthopedic Surgery, Peking Union Medical College HospitalPeking Union Medical College, Chinese Academy of Medical SciencesBeijingChina
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Wanezaki Y, Suzuki A, Takakubo Y, Nakajima T, Toyono S, Toyoshima S, Fukushima S, Yamamoto T, Ito T, Takagi M. Lower limb alignment in healthy Japanese adults. J Orthop Sci 2023; 28:200-203. [PMID: 34815138 DOI: 10.1016/j.jos.2021.10.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2021] [Revised: 10/16/2021] [Accepted: 10/27/2021] [Indexed: 01/10/2023]
Abstract
BACKGROUND Knowledge regarding the normal alignment of the lower limb is important when considering alignment for total knee arthroplasty. However, few studies have explored the lower limb alignment of healthy Japanese subjects. METHODS Between July and October 2020, we performed whole leg standing radiography of 120 legs of 60 healthy adult Japanese volunteers aged <50 years in the closed-leg stance. The measurement parameters were hip knee ankle angle (positive for varus), percentage of constitutional varus (hip knee ankle angle ≥ 3°), mechanical axis deviation ratio, mechanical lateral distal femoral angle, medial proximal tibial angle, joint line convergence angle (positive for lateral opening), and tibial joint line angle (positive for medial inclination). RESULTS The mean measured values for all volunteers, men and women, were as follows: hip knee ankle angle (°), 2.3, 2.6, and 2.0; mechanical axis deviation ratio, 35.8, 35.6, and 36.9; mechanical lateral distal femoral angle (°), 86.7, 87.0, and 86.7; medial proximal tibial angle (°), 85.6, 85.0, and 86.2; joint line convergence angle (°), 0.6, 0.3, and 0.8; and tibial joint line angle (°), -1.0, -0.7, -1.4, respectively. The percentage of constitutional varus was 35.8% overall, 35.8% in men and 35.3% in women. Only the medial proximal tibial angle was smaller in men than that in women (p = 0.003). CONCLUSIONS The mechanical lateral distal femoral and medial proximal tibial angles were smaller, hip knee ankle angle was larger, and percentage of constitutional varus was higher in Japanese subjects than those reported for subjects in other countries. Our findings improve the understanding of Japanese-specific alignments when considering alignment for lower limb surgery, especially, total knee arthroplasty.
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Affiliation(s)
- Yoshihiro Wanezaki
- Department of Orthopedic Surgery, Yamagata University Faculty of Medicine, Yamagata, Yamagata, 990-9585, Japan.
| | - Akemi Suzuki
- Department of Orthopedic Surgery, Yamagata University Faculty of Medicine, Yamagata, Yamagata, 990-9585, Japan
| | - Yuya Takakubo
- Department of Orthopedic Surgery, Yamagata University Faculty of Medicine, Yamagata, Yamagata, 990-9585, Japan
| | - Taku Nakajima
- Department of Orthopedic Surgery, Yamagata University Faculty of Medicine, Yamagata, Yamagata, 990-9585, Japan
| | - Shuji Toyono
- Department of Orthopedic Surgery, Yamagata University Faculty of Medicine, Yamagata, Yamagata, 990-9585, Japan
| | - Sadami Toyoshima
- Department of Orthopedic Surgery, Miyukikai Hospital, Kaminoyama, Yamagata, 999-3161, Japan
| | - Shigenobu Fukushima
- Department of Orthopedic Surgery, Saiseikai Yamagata Saisei Hospital, Yamagata, Yamagata, 990-8545, Japan
| | - Takao Yamamoto
- Department of Orthopedic Surgery, Saiseikai Yamagata Saisei Hospital, Yamagata, Yamagata, 990-8545, Japan
| | - Takashi Ito
- Department of Orthopedic Surgery, Saiseikai Yamagata Saisei Hospital, Yamagata, Yamagata, 990-8545, Japan
| | - Michiaki Takagi
- Department of Orthopedic Surgery, Yamagata University Faculty of Medicine, Yamagata, Yamagata, 990-9585, Japan
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Giustino V, Messina G, Patti A, Padua E, Zangla D, Drid P, Battaglia G, Palma A, Bianco A. Effects of a Postural Exercise Program on Vertical Jump Height in Young Female Volleyball Players with Knee Valgus. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19073953. [PMID: 35409635 PMCID: PMC8997520 DOI: 10.3390/ijerph19073953] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Revised: 03/22/2022] [Accepted: 03/24/2022] [Indexed: 02/06/2023]
Abstract
Background: Although a knee valgus position is related to the increase in injury risk in volleyball players, there is a lack of studies on the relationship between knee valgus and vertical jump (VJ) performance. Hence, the aim of this study was to investigate the effects of a postural exercise program on VJ height in young female volleyball players with knee valgus. Methods: This pilot study included 19 young female volleyball players divided into the following groups: the Valgus Experimental Group (VEG); the Valgus Control Group (VCG); and the Neutral Control Group (NCG). All three groups carried out the same volleyball training program. In addition, only the VEG underwent a 3-month postural exercise program of 30–45 min/session, twice/week. VJ performance was measured through the Sargent test before (T0), at 6 weeks (T1), and at 12 weeks (T2). Results: A significant effect from T0 to T1 (p = 0.0017) and from T0 to T2 (p = 0.0001) was found in the VEG. No significant differences were found over time in the VCG and in the NCG. Conclusion: An integrated postural exercise program might lead to a more balanced muscle efficiency inducing athletes to obtain a higher VJ performance.
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Affiliation(s)
- Valerio Giustino
- Sport and Exercise Sciences Research Unit, Department of Psychology, Educational Science and Human Movement, University of Palermo, 90144 Palermo, Italy; (V.G.); (G.M.); (D.Z.); (G.B.); (A.P.); (A.B.)
| | - Giuseppe Messina
- Sport and Exercise Sciences Research Unit, Department of Psychology, Educational Science and Human Movement, University of Palermo, 90144 Palermo, Italy; (V.G.); (G.M.); (D.Z.); (G.B.); (A.P.); (A.B.)
| | - Antonino Patti
- Sport and Exercise Sciences Research Unit, Department of Psychology, Educational Science and Human Movement, University of Palermo, 90144 Palermo, Italy; (V.G.); (G.M.); (D.Z.); (G.B.); (A.P.); (A.B.)
- Correspondence:
| | - Elvira Padua
- Department of Human Sciences and Promotion of Quality of Life, San Raffaele Roma Open University, 00166 Rome, Italy;
| | - Daniele Zangla
- Sport and Exercise Sciences Research Unit, Department of Psychology, Educational Science and Human Movement, University of Palermo, 90144 Palermo, Italy; (V.G.); (G.M.); (D.Z.); (G.B.); (A.P.); (A.B.)
| | - Patrik Drid
- Faculty of Sport and Physical Education, University of Novi Sad, 21000 Novi Sad, Serbia;
| | - Giuseppe Battaglia
- Sport and Exercise Sciences Research Unit, Department of Psychology, Educational Science and Human Movement, University of Palermo, 90144 Palermo, Italy; (V.G.); (G.M.); (D.Z.); (G.B.); (A.P.); (A.B.)
| | - Antonio Palma
- Sport and Exercise Sciences Research Unit, Department of Psychology, Educational Science and Human Movement, University of Palermo, 90144 Palermo, Italy; (V.G.); (G.M.); (D.Z.); (G.B.); (A.P.); (A.B.)
| | - Antonino Bianco
- Sport and Exercise Sciences Research Unit, Department of Psychology, Educational Science and Human Movement, University of Palermo, 90144 Palermo, Italy; (V.G.); (G.M.); (D.Z.); (G.B.); (A.P.); (A.B.)
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Hsu CE, Chen CP, Wang SP, Huang JT, Tong KM, Huang KC. Validation and modification of the Coronal Plane Alignment of the Knee classification in the Asian population. Bone Jt Open 2022; 3:211-217. [PMID: 35274982 PMCID: PMC8965787 DOI: 10.1302/2633-1462.33.bjo-2022-0001.r1] [Citation(s) in RCA: 34] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
AIMS The Coronal Plane Alignment of the Knee (CPAK) classification is a simple and comprehensive system for predicting pre-arthritic knee alignment. However, when the CPAK classification is applied in the Asian population, which is characterized by more varus and wider distribution in lower limb alignment, modifications in the boundaries of arithmetic hip-knee-ankle angle (aHKA) and joint line obliquity (JLO) should be considered. The purposes of this study were as follows: first, to propose a modified CPAK classification based on the actual joint line obliquity (aJLO) and wider range of aHKA in the Asian population; second, to test this classification in a cohort of Asians with healthy knees; third, to propose individualized alignment targets for different CPAK types in kinematically aligned (KA) total knee arthroplasty (TKA). METHODS The CPAK classification was modified by changing the neutral boundaries of aHKA to 0° ± 3° and using aJLO as a new variable. Radiological analysis of 214 healthy knees in 214 Asian individuals was used to assess the distribution and mean value of alignment angles of each phenotype among different classifications based on the coronal plane. Individualized alignment targets were set according to the mean lateral distal femoral angle (LDFA) and medial proximal tibial angle (MPTA) of different knee types. RESULTS A very high concentration, 191 from 214 individuals (89.3%), were found in knee types with apex distal JLO when the CPAK classification was applied in the Asian population. By using aJLO as a new variable, the high distribution percentage in knee types with apex distal JLO decreased to 125 from 214 individuals (58.4%). The most common types in order were Type II (n = 70; 32.7%), Type V (n = 55; 25.7%), and Type I (n = 46; 21.5%) in the modified CPAK classification. CONCLUSION The modified CPAK classification corrected the uneven distribution when applying the CPAK classification in the Asian population. Setting individualized TKA alignment targets according to CPAK type may be a practical method to recreate optimal LDFA and MPTA in KA-TKA. Cite this article: Bone Jt Open 2022;3(3):211-217.
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Affiliation(s)
- Cheng-En Hsu
- Sports Recreation and Health Management Continuing Studies-Bachelor's Degree Completion Program, Tunghai University, Taichung, Taiwan.,Department of Orthopedics, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Chao-Ping Chen
- Department of Orthopedics, Taichung Veterans General Hospital, Taichung, Taiwan.,Course Database of General Education TW, Chaoyang University of Technology, Taichung, Taiwan
| | - Shun-Ping Wang
- Sports Recreation and Health Management Continuing Studies-Bachelor's Degree Completion Program, Tunghai University, Taichung, Taiwan.,Department of Orthopedics, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Jen-Ting Huang
- Department of Orthopedics, Asia University Hospital, Taichung, Taiwan.,Department of Occupational Therapy, Asia University, Taichung, Taiwan
| | - Kwok-Man Tong
- Department of Orthopedics, Asia University Hospital, Taichung, Taiwan.,Department of Occupational Therapy, Asia University, Taichung, Taiwan
| | - Kui-Chou Huang
- Department of Orthopedics, Asia University Hospital, Taichung, Taiwan.,Department of Occupational Therapy, Asia University, Taichung, Taiwan
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Ishibashi K, Sasaki E, Ota S, Oyama T, Chiba D, Yamamoto Y, Tsuda E, Uemura N, Sawada K, Ishibashi Y. Bone marrow lesion severity was associated with proximal tibial inclination in early knee osteoarthritis. Knee Surg Sports Traumatol Arthrosc 2022; 30:668-679. [PMID: 33394079 DOI: 10.1007/s00167-020-06378-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Accepted: 11/17/2020] [Indexed: 10/22/2022]
Abstract
PURPOSE This study aimed to investigate the effect of tibial plateau (TP) inclination and serum bone metabolic markers on bone marrow lesion (BML) in the general Japanese population with early knee osteoarthritis (EKOA). METHODS A total of 441 female volunteers who participated in the Iwaki Health Promotion Project in 2017 were enrolled. Participants without radiographic abnormalities were divided into normal and EKOA groups according to the Luyten's classification criteria for EKOA. The medial proximal tibial angle (MPTA), growth plate-TP angle, and growth plate-medial tibial plateau (MTP) angle were measured on standing anteroposterior radiographs of the knees. BML severity on T2-weighted fat-suppressed magnetic resonance imaging (MRI) was scored using the Whole-Organ MRI Score method. Serum levels of N-telopeptide of type I collagen, tartrate-resistant acid phosphatase-5b (TRACP-5b), bone-specific alkaline phosphatase, procollagen type I N-terminal propeptide, pentosidine, and homocysteine were assessed. Linear regression analysis was conducted to investigate the relationship between proximal tibial inclination, BML, and serum bone metabolic markers. RESULTS The growth plate was observed in 309 (70%) participants, and 48 (16%) participants had EKOA. The mean MPTA, growth plate-TP angle, and growth plate-MTP angle were 86.1 ± 5.9°, 3.6 ± 1.1°, and 9.9 ± 2.6°, respectively. The MPTA was negatively correlated with the growth plate-TP and growth plate-MTP angles (p = 0.006, p < 0.001). Participants with EKOA who had BML exhibited greater growth plate-MTP angle than those who did not (p = 0.018). Regression analysis revealed that BML severity was positively associated with MPTA (p = 0.036) and a bone formation marker (p = 0.045). CONCLUSION BML severity was positively associated with proximal tibial inclination and serum TRACP-5b level in participants with EKOA and normal knees, respectively. Assessment of proximal tibial inclination may provide insight into potential BML risk. Residual medial tibial inclination may potentially result in knee pain and symptoms in EKOA. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Kyota Ishibashi
- Department of Orthopaedic Surgery, Hirosaki University Graduate School of Medicine, 5 Zaifu-cho, Hirosaki, Aomori, 036-8562, Japan.
| | - Eiji Sasaki
- Department of Orthopaedic Surgery, Hirosaki University Graduate School of Medicine, 5 Zaifu-cho, Hirosaki, Aomori, 036-8562, Japan
| | - Seiya Ota
- Department of Orthopaedic Surgery, Hirosaki University Graduate School of Medicine, 5 Zaifu-cho, Hirosaki, Aomori, 036-8562, Japan
| | - Tetsushi Oyama
- Department of Orthopaedic Surgery, Hirosaki University Graduate School of Medicine, 5 Zaifu-cho, Hirosaki, Aomori, 036-8562, Japan
| | - Daisuke Chiba
- Department of Orthopaedic Surgery, Hirosaki University Graduate School of Medicine, 5 Zaifu-cho, Hirosaki, Aomori, 036-8562, Japan
| | - Yuji Yamamoto
- Department of Orthopaedic Surgery, Hirosaki University Graduate School of Medicine, 5 Zaifu-cho, Hirosaki, Aomori, 036-8562, Japan
| | - Eiichi Tsuda
- Department of Rehabilitation Medicine, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Nozomi Uemura
- Department of QOL and Health Promotion, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Kaori Sawada
- Department of Social Medicine, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Yasuyuki Ishibashi
- Department of Orthopaedic Surgery, Hirosaki University Graduate School of Medicine, 5 Zaifu-cho, Hirosaki, Aomori, 036-8562, Japan
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Rivière C, Jackson W, Villet L, Sivaloganathan S, Barziv Y, Vendittoli PA. Specific case consideration for implanting TKA with the Kinematic Alignment technique. EFORT Open Rev 2021; 6:881-891. [PMID: 34760288 PMCID: PMC8559564 DOI: 10.1302/2058-5241.6.210042] [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] [Indexed: 11/05/2022] Open
Abstract
The Kinematic Alignment (KA) technique for total knee arthroplasty (TKA) is an alternative surgical technique aiming to resurface knee articular surfaces.The restricted KA (rKA) technique for TKA applies boundaries to the KA technique in order to avoid reproducing extreme constitutional limb/knee anatomies.The vast majority of TKA cases are straightforward and can be performed with KA in a standard (unrestricted) fashion.There are some specific situations where performing KA TKA may be more challenging (complex KA TKA cases) and surgical technique adaptations should be included.To secure good clinical outcomes, complex KA TKA cases must be preoperatively recognized, and planned accordingly.The proposed classification system describes six specific issues that must be considered when aiming for a KA TKA implantation.Specific recommendations for each situation type should improve the reliability of the prosthetic implantation to the benefit of the patient.The proposed classification system could contribute to the adoption of a common language within our orthopaedic community that would ease inter-surgeon communication and could benefit the teaching of the KA technique. This proposed classification system is not exhaustive and will certainly be improved over time. Cite this article: EFORT Open Rev 2021;6:881-891. DOI: 10.1302/2058-5241.6.210042.
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Affiliation(s)
- Charles Rivière
- Clinique du Sport, Bordeaux-Mérignac, France.,Personalized Arthroplasty Society, Atlanta, Georgia, USA
| | - William Jackson
- Personalized Arthroplasty Society, Atlanta, Georgia, USA.,Nuffield Orthopaedic Centre, Headington, Oxford, UK
| | - Loïc Villet
- Clinique du Sport, Bordeaux-Mérignac, France.,Personalized Arthroplasty Society, Atlanta, Georgia, USA
| | - Sivan Sivaloganathan
- Personalized Arthroplasty Society, Atlanta, Georgia, USA.,South-West London Elective Orthopaedic Centre, Epsom, UK
| | - Yaron Barziv
- Personalized Arthroplasty Society, Atlanta, Georgia, USA.,Shamir Medical Center, Zriffin, Israel
| | - Pascal-André Vendittoli
- Personalized Arthroplasty Society, Atlanta, Georgia, USA.,Département de Chirurgie, Université de Montréal, Hôpital Maisonneuve-Rosemont, Montréal, Québec, Canada
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Nishida R, Hiranaka T. Response to Letter to the Editor "Nishida et al.: Impact of joint line orientation on clinical outcomes in bilateral Oxford mobile-bearing unicompartmental knee arthroplasty". Knee 2021; 31:195-197. [PMID: 33867251 DOI: 10.1016/j.knee.2021.03.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Affiliation(s)
- Ryota Nishida
- Department of Orthopaedic Surgery and Joint Surgery Centre, Takatsuki General Hospital, Japan
| | - Takafumi Hiranaka
- Department of Orthopaedic Surgery and Joint Surgery Centre, Takatsuki General Hospital, Japan.
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Rivière C. Letter to the Editor "Nishida et al.: Impact of joint line orientation on clinical outcomes in bilateral Oxford mobile-bearing unicompartmental knee arthroplasty". Knee 2021; 31:192-194. [PMID: 33875346 DOI: 10.1016/j.knee.2021.03.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Accepted: 03/26/2021] [Indexed: 02/02/2023]
Affiliation(s)
- Charles Rivière
- Clinique du Sport, 04 Rue Nègrevergne, 33700 Mérignac, France; MSK Lab - Imperial College London, Sir Michael Uren Hub, London W12 0BZ, United Kingdom.
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Griffiths-Jones W, Chen DB, Harris IA, Bellemans J, MacDessi SJ. Arithmetic hip-knee-ankle angle (aHKA): An algorithm for estimating constitutional lower limb alignment in the arthritic patient population. Bone Jt Open 2021; 2:351-358. [PMID: 34042492 PMCID: PMC8168548 DOI: 10.1302/2633-1462.25.bjo-2021-0028.r1] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Aims Once knee arthritis and deformity have occurred, it is currently not known how to determine a patient’s constitutional (pre-arthritic) limb alignment. The purpose of this study was to describe and validate the arithmetic hip-knee-ankle (aHKA) algorithm as a straightforward method for preoperative planning and intraoperative restoration of the constitutional limb alignment in total knee arthroplasty (TKA). Methods A comparative cross-sectional, radiological study was undertaken of 500 normal knees and 500 arthritic knees undergoing TKA. By definition, the aHKA algorithm subtracts the lateral distal femoral angle (LDFA) from the medial proximal tibial angle (MPTA). The mechanical HKA (mHKA) of the normal group was compared to the mHKA of the arthritic group to examine the difference, specifically related to deformity in the latter. The mHKA and aHKA were then compared in the normal group to assess for differences related to joint line convergence. Lastly, the aHKA of both the normal and arthritic groups were compared to test the hypothesis that the aHKA can estimate the constitutional alignment of the limb by sharing a similar centrality and distribution with the normal population. Results There was a significant difference in means and distributions of the mHKA of the normal group compared to the arthritic group (mean -1.33° (SD 2.34°) vs mean -2.88° (SD 7.39°) respectively; p < 0.001). However, there was no significant difference between normal and arthritic groups using the aHKA (mean -0.87° (SD 2.54°) vs mean -0.77° (SD 2.84°) respectively; p = 0.550). There was no significant difference in the MPTA and LDFA between the normal and arthritic groups. Conclusion The arithmetic HKA effectively estimated the constitutional alignment of the lower limb after the onset of arthritis in this cross-sectional population-based analysis. This finding is of significant importance to surgeons aiming to restore the constitutional alignment of the lower limb during TKA. Cite this article: Bone Jt Open 2021;2(5):351–358.
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Affiliation(s)
- William Griffiths-Jones
- CPAK Research Group, Kogarah, New South Wales, Australia.,North Devon District Hospital, Barnstaple, UK
| | - Darren B Chen
- CPAK Research Group, Kogarah, New South Wales, Australia.,Sydney Knee Specialists, Kogarah, New South Wales, Australia.,St George Private Hospital, Kogarah, New South Wales, Australia
| | - Ian A Harris
- Ingham Institute for Applied Medical Research, South Western Sydney Clinical School, University of New South Wales, Sydney, NSW, Australia
| | - Johan Bellemans
- CPAK Research Group, Kogarah, New South Wales, Australia.,Hasselt University, Department of Orthopaedic Surgery, ZOL Hospitals, Genk, ArthroClinic Leuven, Belgium
| | - Samuel J MacDessi
- CPAK Research Group, Kogarah, New South Wales, Australia.,Sydney Knee Specialists, Kogarah, New South Wales, Australia.,St George Private Hospital, Kogarah, New South Wales, Australia.,St George & Sutherland Clinical School, University of New South Wales, Kogarah, New South Wales, Australia
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Abstract
Aims A comprehensive classification for coronal lower limb alignment with predictive capabilities for knee balance would be beneficial in total knee arthroplasty (TKA). This paper describes the Coronal Plane Alignment of the Knee (CPAK) classification and examines its utility in preoperative soft tissue balance prediction, comparing kinematic alignment (KA) to mechanical alignment (MA). Methods A radiological analysis of 500 healthy and 500 osteoarthritic (OA) knees was used to assess the applicability of the CPAK classification. CPAK comprises nine phenotypes based on the arithmetic HKA (aHKA) that estimates constitutional limb alignment and joint line obliquity (JLO). Intraoperative balance was compared within each phenotype in a cohort of 138 computer-assisted TKAs randomized to KA or MA. Primary outcomes included descriptive analyses of healthy and OA groups per CPAK type, and comparison of balance at 10° of flexion within each type. Secondary outcomes assessed balance at 45° and 90° and bone recuts required to achieve final knee balance within each CPAK type. Results There was similar frequency distribution between healthy and arthritic groups across all CPAK types. The most common categories were Type II (39.2% healthy vs 32.2% OA), Type I (26.4% healthy vs 19.4% OA) and Type V (15.4% healthy vs 14.6% OA). CPAK Types VII, VIII, and IX were rare in both populations. Across all CPAK types, a greater proportion of KA TKAs achieved optimal balance compared to MA. This effect was largest, and statistically significant, in CPAK Types I (100% KA vs 15% MA; p < 0.001), Type II (78% KA vs 46% MA; p = 0.018). and Type IV (89% KA vs 0% MA; p < 0.001). Conclusion CPAK is a pragmatic, comprehensive classification for coronal knee alignment, based on constitutional alignment and JLO, that can be used in healthy and arthritic knees. CPAK identifies which knee phenotypes may benefit most from KA when optimization of soft tissue balance is prioritized. Further, it will allow for consistency of reporting in future studies. Cite this article: Bone Joint J 2021;103-B(2):329–337.
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Affiliation(s)
- Samuel J MacDessi
- CPAK Research Group, Sydney, Australia.,Sydney Knee Specialists, St George Private Hospital, Kogarah, Australia.,St George Hospital Clinical School, University of New South Wales, Sydney, Australia
| | | | - Ian A Harris
- Orthopaedic Surgery, University of New South Wales, South Western Sydney Clinical School, Liverpool, NSW, Australia.,Whitlam Orthopaedic Research Group, Ingham Institute for Applied Medical Research, Liverpool, NSW, Australia
| | - Johan Bellemans
- CPAK Research Group, Sydney, Australia.,Department of Orthopaedic Surgery, Hasselt University, ZOL Hospitals, Genk, Belgium.,ArthroClinic, Leuven, Belgium
| | - Darren B Chen
- CPAK Research Group, Sydney, Australia.,Sydney Knee Specialists, St George Private Hospital, Kogarah, Australia
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Deering J, Dowling KI, DiCecco LA, McLean GD, Yu B, Grandfield K. Selective Voronoi tessellation as a method to design anisotropic and biomimetic implants. J Mech Behav Biomed Mater 2021; 116:104361. [PMID: 33550142 DOI: 10.1016/j.jmbbm.2021.104361] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Revised: 01/12/2021] [Accepted: 01/22/2021] [Indexed: 12/18/2022]
Abstract
The geometry of a metallic scaffold is important for the success of bone implants, where the introduction of porosity can reduce stress shielding effects and allow for bone tissue integration. In this work, porous scaffolds were designed to closely mimic the natural structure of trabecular bone using selective Voronoi tessellation with preferential seeding. A workflow to generate these structures is introduced, where voided regions of seeds in the starting volume create preferential texture during polyhedral expansion, resulting in modified strut orientation in the implant. Anisotropy was digitally characterized by mean-intercept length and star volume distribution measurements to determine similarity to trabecular orientation. This work demonstrates that selective Voronoi tessellation is an effective method to generate biomimetic porous scaffolds with increased anisotropy and tunable strut architecture in three dimensions as a suitable alternative to patient-derived bone geometries.
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Affiliation(s)
- Joseph Deering
- Department of Materials Science and Engineering, McMaster University, Hamilton, ON, Canada
| | - Kierdra I Dowling
- Department of Materials Science and Engineering, McMaster University, Hamilton, ON, Canada
| | - Liza-Anastasia DiCecco
- Department of Materials Science and Engineering, McMaster University, Hamilton, ON, Canada
| | - Griffin D McLean
- Department of Mechanical Engineering, McMaster University, Hamilton, ON, Canada
| | - Bosco Yu
- Department of Materials Science and Engineering, McMaster University, Hamilton, ON, Canada
| | - Kathryn Grandfield
- Department of Materials Science and Engineering, McMaster University, Hamilton, ON, Canada; School of Biomedical Engineering, McMaster University, Hamilton, ON, Canada.
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Hsu CE, Huang JT, Tong KM, Huang KC. Total knee arthroplasty according to the original knee phenotypes with kinematic alignment surgical technique-early clinical and functional outcomes. BMC Musculoskelet Disord 2020; 21:839. [PMID: 33308196 PMCID: PMC7731459 DOI: 10.1186/s12891-020-03862-6] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Accepted: 12/04/2020] [Indexed: 11/10/2022] Open
Abstract
Background The kinematic alignment (KA) technique in total knee arthroplasty (TKA) aims to restore the native alignment of pre-disease knee joint anatomy. Determining the individualized alignment targets is crucial for pre-operative planning, which can be set according to different original knee phenotypes. Five most common knee phenotypes have been categorized for KA-TKA alignment target setting in our previous study. The purpose of this study was to investigate the distribution of the five phenotypes in advanced OA knee patients and evaluate the clinical outcomes of this phenotype-oriented KA-TKA using the generic instrument, with particular emphasis on alignment strategy, surgical technique, survivorship, radiographic and functional outcomes. Methods The clinical data of 123 patients (88 women, 35 men) who had undergone 140 TKAs in our hospital were reviewed. All the TKAs were performed with alignment targets set according to the original phenotypes of the knee, with the KA method, using the generic total knee instrument. The patients’ demographics, preoperative and postoperative knee alignment angles, one-year postoperative range of motion (ROM), Oxford knee scores (OKS), Combined knee society score (CKSS) were collected and analyzed. Results The 3 years survivorship was 99.3% for all cause of revision, and 100% with revision other than infection as the endpoint. The preoperative phenotypes of the knee were as follows: neutral alignment 20.1% (type 1: 3.6%, type 2: 16.5%), varus alignment 71.2% (type 3: 46.0%, type 4: 25.2%), and valgus alignment (type 5: 8.6%). Using our protocol, patients with different knee phenotypes could get similar great functional improvement though the postoperative alignment parameters were significantly different between the knee phenotypes (P < 0.05). Conclusion The early outcomes of this phenotype-oriented KA-TKA using generic total knee instruments are promising. Setting individualized alignment target according to original knee phenotype is rational and practical. The residual varus alignment did not cause any aseptic loosening in the 3 years follow-up. Long-term survivorship and functional outcomes need to be evaluated in future studies.
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Affiliation(s)
- Cheng-En Hsu
- Sports Recreation and Health Management Continuing Studies-Bachelor's Degree Completion Program, Tunghai University, Taichung, 407, Taiwan.,Department of Orthopedics, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Jen-Ting Huang
- Department of Orthopedics Surgery, Asia University Hospital, 222 Fuxin Rd., Wufeng District, Taichung City, 41354, Taiwan.,Department of Occupational Therapy, Asia University, Taichung, Taiwan
| | - Kwok-Man Tong
- Department of Orthopedics Surgery, Asia University Hospital, 222 Fuxin Rd., Wufeng District, Taichung City, 41354, Taiwan.,Department of Occupational Therapy, Asia University, Taichung, Taiwan
| | - Kui-Chou Huang
- Department of Orthopedics Surgery, Asia University Hospital, 222 Fuxin Rd., Wufeng District, Taichung City, 41354, Taiwan. .,Department of Occupational Therapy, Asia University, Taichung, Taiwan.
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Tanaka T, Hiranaka T, Okimura K, Fujishiro T, Okamoto K. Bilateral unicompartmental knee arthroplasty for windswept knee osteoarthritis: A report of 13 cases. Knee 2020; 27:1715-1720. [PMID: 33197809 DOI: 10.1016/j.knee.2020.10.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Revised: 08/31/2020] [Accepted: 10/07/2020] [Indexed: 02/02/2023]
Abstract
BACKGROUND Windswept deformity is a condition of the lower limbs with a valgus knee on one side and a varus knee on the other. We present a case series of bilateral unicompartmental knee arthroplasty (UKA) for windswept knee osteoarthritis (WSKO). METHODS We analysed the outcomes of 26 knees of 13 consecutive patients with WSKO treated with bilateral UKA. The mean age was 73.0 years and the mean follow up period was 2.6 years. Pre- and postoperative Oxford Knee Score (OKS) and Japanese Orthopaedic Association (JOA) score, radiological measurements and postoperative complications were evaluated. No knees required revision for either infection or loosening. RESULTS The mean preoperative OKS was 25.3 ± 9.7, which increased to 34.9 ± 5.8 at the latest follow up. The mean preoperative JOA scores for the varus and the valgus sides were 64.6 ± 12.5 and 66.9 ± 14.1, which increased to 85.0 ± 11.3 and 84.6 ± 11.2, respectively, after operation. CONCLUSIONS Our results show that good short-term clinical results can be achieved by bilateral UKA in cases of WSKO. Bilateral UKA may be an effective treatment for WSKO if indications are met.
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Affiliation(s)
- Toshikazu Tanaka
- Department of Orthopaedic Surgery and Joint Surgery Center, Takatsuki General Hospital, Osaka, Japan.
| | - Takafumi Hiranaka
- Department of Orthopaedic Surgery and Joint Surgery Center, Takatsuki General Hospital, Osaka, Japan
| | - Kenjiro Okimura
- Department of Orthopaedic Surgery and Joint Surgery Center, Takatsuki General Hospital, Osaka, Japan
| | - Takaaki Fujishiro
- Department of Orthopaedic Surgery and Joint Surgery Center, Takatsuki General Hospital, Osaka, Japan
| | - Koji Okamoto
- Department of Orthopaedic Surgery and Joint Surgery Center, Takatsuki General Hospital, Osaka, Japan
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Nayak M, Kumar V, Yadav R, Srivastava DN, Pandit H, Malhotra R. Lateral Coronal Bowing of Femur and/or Tibia Amplifies the Varus Malalignment of Lower Limb as well as Increases Functional Disability in Patients with Knee Osteoarthritis. Indian J Orthop 2020; 55:88-96. [PMID: 34122760 PMCID: PMC8149558 DOI: 10.1007/s43465-020-00303-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Accepted: 10/24/2020] [Indexed: 02/04/2023]
Abstract
PURPOSE In the present study, we aimed at assessing the effect of femoral and tibial coronal bowing on varus malalignment and Oxford knee score (OKS) at different grades of knee osteoarthritis (OA). MATERIALS AND METHODS This prospective observational study was conducted at a tertiary referral centre in New Delhi, India. Consecutive patients presenting to the "knee OA" outpatient clinics were invited to take part in the study conducted over a 12-month period. All consented patients underwent long-leg standing alignment radiographs using standardised technique and patient reported knee pain and function were recorded using Oxford knee score. The following radiological parameters were measured from weight-bearing long-leg radiographs of 824 varus aligned limbs via a morphometric software (Matlab R2009a) (1) hip-knee-ankle angle (HKAA), (2) femoral bowing, (3) tibial bowing. The knees were graded according to Kellegren and Lawrence grade (K&L) and OKS was recorded. 3 groups of HKAA were made based on the angle, A (0° to - 3°), B (- 3° to - 10°) and C (< - 10°). Both the femoral and tibial bow were also categorized into three groups depending upon the angle; in-range (- 2° to + 2°), varus (< - 2°), valgus (> + 2°). RESULTS The mean (± SD) of HKAA, femoral bow and tibial bow of the whole cohort was - 6.97° ± 5.64°, - 1.54° ± 4.31° and - 1.96° ± 3.5°, respectively. An increase in the lateral bow of both femur and tibia was seen with an increase in the severity of OA. A consequent increase in the varus malalignment was observed with an increase in the lateral bow of both femur as well as the tibia at all grades of OA, with significant correlation observed between HKAA with Femoral bowing and HKAA with tibial bowing. The mean OKS for femoral bow, in-range, varus and valgus was 30.6 ± 11.5, 21.3 ± 11.5 and 35.3 ± 11.4, respectively, and for tibial bow, in-range, varus and valgus was 27.6 ± 11.5, 26. ± 11.5 and 28 ± 11.4, respectively. The difference in the mean OKS was observed to be significant when the varus bow group was compared to in range as well as valgus group (p < 0.01) for both femur and tibia for all the grades of OA. CONCLUSION The present study shows a significant correlation between varus malalignment and the bowing of extremities. Varus coronal bowing of both femur and tibia were seen to have significantly lower mean OKS as compared to valgus bowing or in-range bowing at all grades of knee OA.
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Affiliation(s)
- Mayur Nayak
- Department of Orthopaedics, All India Institute of Medical Sciences (AIIMS), New Delhi, 110029 India
| | - Vijay Kumar
- Department of Orthopaedics, All India Institute of Medical Sciences (AIIMS), New Delhi, 110029 India
| | - Rahul Yadav
- Department of Orthopaedics, All India Institute of Medical Sciences (AIIMS), New Delhi, 110029 India
| | - Deep Narayan Srivastava
- Department of Radiodiagnosis, All India Institute of Medical Sciences (AIIMS), New Delhi, 110029 India
| | - Hemant Pandit
- Chapel Allerton Hospital, University of Leeds, Leeds, UK
| | - Rajesh Malhotra
- Department of Orthopaedics, All India Institute of Medical Sciences (AIIMS), New Delhi, 110029 India
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Lim CS, Kim JM. Significant proportion of severe lateral osteoarthritis in korean patients have non-valgus knee alignment with milder clinical manifestation. Orthop Traumatol Surg Res 2020; 106:487-493. [PMID: 31859252 DOI: 10.1016/j.otsr.2019.09.025] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2019] [Revised: 09/18/2019] [Accepted: 09/23/2019] [Indexed: 02/03/2023]
Abstract
BACKGROUND Knee malalignment is strongly associated with risk of knee osteoarthritis (OA). Although several studies have described the relationship between valgus knee alignment and incidence of severe lateral OA, little research is available on the association with non-valgus (neutral or varus) knee alignment. Therefore, we performed a retrospective study to determine: 1) whether a substantial proportion of severe lateral OA patients have non-valgus knee alignment and 2) whether there are any difference in clinical manifestations between patients with valgus and non-valgus alignment. HYPOTHESIS A large proportion of severe lateral OA patients in Korea have non-valgus knee alignment. PATIENTS AND METHODS The medical records of 647 patients (825 knees) who visited our outpatient clinic from 2008 to 2018 and were diagnosed with lateral OA were retrospectively reviewed. Knee OA severity was evaluated according to the Kellgren-Lawrence (K-L) grading system and those with K-L grade 3 or 4 were enrolled in this study. Alignment was measured by the hip-knee-ankle angle on full-limb radiographs and classified as varus (<180°), neutral (180°), or valgus (>180°). Patients with K-L grade 4 lateral OA (bone-on-bone arthritis) were divided into two groups according to knee alignment (non-valgus or valgus) and compared for recommended treatment (surgery or conservative treatment) as an indicator of clinical manifestations. RESULTS Of the 825 knees, 67.1% (553/825) were K-L grade 3 or 4. Of these 553 K-L grade 3/4 knees, 20.4% (113/553) had neutral, 23.3% (129/553) varus, and 56.2% (331/553) valgus knee alignment. Notably, 43.8% (242/553) of the K-L grade 3 or 4 knees had non-valgus alignment (95% CI: 40%-48%, exact binomial test). Of the K-L grade 4 patients (263 knees), the proportion recommended conservative treatment was significantly higher in the non-valgus group (80.2% (69/86)) than the valgus group (62.1% (110/177)) (χ2 test, p=0.003)). CONCLUSION In contrast to the widespread belief that most lateral OA patients have valgus knee alignment, a substantial proportion of Korean patients with severe lateral OA in this study had non-valgus alignment. In addition, these non-valgus alignment patients presented with significantly milder clinical manifestations in bone-on-bone lateral OA than valgus patients. While orthopaedic surgeons tend to initially consider surgery for bone-on-bone lateral OA, full-limb radiographs should be acquired to assess knee alignment, because patients with non-valgus alignment may be treated conservatively. LEVEL OF EVIDENCE III, Case control study.
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Affiliation(s)
- Cheong-Su Lim
- Department of Orthopedic Surgery, University of Ulsan College of Medicines, Asan Medical Center, Olympic-ro 43-gil, Seoul, Songpa-gu, 05505, Korea
| | - Jong-Min Kim
- Department of Orthopedic Surgery, University of Ulsan College of Medicines, Asan Medical Center, Olympic-ro 43-gil, Seoul, Songpa-gu, 05505, Korea.
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Hirschmann MT, Moser LB, Amsler F, Behrend H, Leclerq V, Hess S. Functional knee phenotypes: a novel classification for phenotyping the coronal lower limb alignment based on the native alignment in young non-osteoarthritic patients. Knee Surg Sports Traumatol Arthrosc 2019; 27:1394-1402. [PMID: 30976825 DOI: 10.1007/s00167-019-05509-z] [Citation(s) in RCA: 216] [Impact Index Per Article: 43.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2019] [Accepted: 04/05/2019] [Indexed: 10/27/2022]
Abstract
PURPOSE The currently used system to classify the lower limb alignment (neutral, varus, valgus) does not consider the orientation of the joint line or its relationship to the overall lower limb alignment. Similarly, current total knee arthroplasty (TKA) alignment concepts do not sufficiently consider the variability of the native coronal alignment. Therefore, the purpose of this study was (1) to introduce a new classification system for the lower limb alignment, based on phenotypes, and (2) to compare the alignment targets of different TKA alignment concepts with the native alignment of non-osteoarthritic patients. METHODS Two recent articles phenotyped the lower limb, the femur and tibia of 308 non-osteoarthritic knees of 160 patients [male to female ratio = 102:58, mean age ± standard deviation 30 ± 7 years (16-44 years)]. The present study introduces functional knee phenotypes, which are a combination of all previously introduced phenotypes. The functional knee phenotypes therefore enable an evaluation of all parameters in relation to each other and thus a comprehensive analysis of the coronal alignment. The existing functional knee phenotypes in the female and male population were investigated. In addition, how many non-osteoarthritic knees had an alignment within the range of current TKA alignment targets (mechanical, anatomical and restricted kinematic alignment) was investigated. Therefore, it was defined which functional knee phenotypes represented a target of the TKA alignment concepts and which percentage of the population had such a phenotype. RESULTS Out of 125 possible functional knee phenotypes, 43 were found (35 male, 26 and 18 mutual). The most common functional knee phenotype in males was NEUHKA0° + NEUFMA0° + NEUTMA0° (19%), followed by VARHKA3° + NEUFMA0° + VARTMA0° (8.2%). The most common functional knee phenotype in females was NEUHKA0° + NEUFMA0° + NEUTMA0° (17.7%), closely followed by NEUHKA0° + NEUFMA0° + VALTMA0° (16.6%). The functional knee phenotype representing a mechanical alignment target was found in 5.6% of the males and 3.6% of the females. The phenotype representing an anatomical alignment target was found in 18% of the males and 17% in females. Five of the nine phenotypes representing a restricted kinematic alignment target were found in this population (male 5, female 4, mutual 4). They represented 31.3% of all males and 45.1% of all females. CONCLUSION A more individualized approach to TKA alignment is needed. The functional knee phenotypes enable a simple, but detailed assessment of a patient's individual anatomy and thereby could be a helpful tool to individualize the approach to TKA. LEVEL OF CLINICAL EVIDENCE III, retrospective cohort study.
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Affiliation(s)
- Michael T Hirschmann
- Department of Orthopaedic Surgery and Traumatology, Kantonsspital Baselland (Bruderholz, Liestal, Laufen), 4101, Bruderholz, Switzerland. .,University of Basel, Basel, Switzerland.
| | - Lukas B Moser
- Department of Orthopaedic Surgery and Traumatology, Kantonsspital Baselland (Bruderholz, Liestal, Laufen), 4101, Bruderholz, Switzerland.,University of Basel, Basel, Switzerland
| | | | - Henrik Behrend
- Department of Orthopaedic Surgery, Kantonsspital St. Gallen, 9007, St. Gallen, Switzerland
| | | | - Silvan Hess
- Department of Orthopaedic Surgery and Traumatology, Kantonsspital Baselland (Bruderholz, Liestal, Laufen), 4101, Bruderholz, Switzerland.,University of Basel, Basel, Switzerland
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