1
|
Hanada M, Hotta K, Matsuyama Y. Impact of the sagittal spinopelvic and coronal lower extremity alignments on clinical outcomes after medial unicompartmental knee arthroplasty. J Orthop 2024; 54:131-135. [PMID: 38567191 PMCID: PMC10982543 DOI: 10.1016/j.jor.2024.03.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2024] [Accepted: 03/17/2024] [Indexed: 04/04/2024] Open
Abstract
Introduction We evaluated whether the clinical outcomes, including postoperative knee range of motion (ROM), after unicompartmental knee arthroplasty (UKA) were associated with the sagittal spinopelvic parameters and coronal alignment of the full lower extremity. Methods Forty-two patients (50 knees: six men, seven knees; 36 women, 43 knees) who underwent medial UKA between April 2015 and December 2022 were included. Preoperative radiographic examinations of the index for sagittal spinopelvic alignment included the sagittal vertical axis (SVA), lumbar lordosis, sacral slope (SS), pelvic tilt (PT), and pelvic incidence. The anteroposterior hip-knee-ankle angle (HKAA) was calculated. The relationship of clinical outcomes and the risk of knee flexion angle ≤125° and knee flexion contracture ≥10° 1-year post-UKA with radiographic parameters were evaluated. Results Preoperative HKA angle affected postoperative knee flexion angle ≤125° (p = 0.017, 95% confidence interval [CI]: 0.473-0.930) in logistic regression analysis. Patients with a knee flexion angle ≤125° had a higher preoperative HKAA (9.8 ± 3.0°), higher SVA (83.8 ± 37.0 mm), and lower SS (23.7 ± 9.0°) than those with a flexion angle >125° (preoperative HKAA: 6.6 ± 4.0°, SVA: 40.3 ± 46.5 mm, SS: 32.0 ± 6.3°) (p = 0.029, 0.012, and 0.004, respectively). PT related to postoperative knee flexion contracture ≥10° (p = 0.010, 95% CI: 0.770-0.965) in the logistic regression analysis. Patients with flexion contracture ≥10° had higher PT (35.0 ± 6.6°) and SVA (82.2 ± 40.5 mm) than those with flexion contracture <10° (PT, 19.3 ± 9.0°; SVA, 42.4 ± 46.5 mm) (p = 0.001 and 0.028, respectively). The postoperative clinical outcome was correlated with the postoperative knee flexion angle and SVA (p = 0.036 and 0.020, respectively). Conclusions The preoperative HKAA affected postoperative knee flexion angle, and the knee flexion contracture and clinical outcomes post-UKA were associated with PT and SVA, respectively. To predict outcomes for knee ROM and clinical scores after UKA, radiographic examination, including the sagittal spinopelvic parameters and the coronal view of the full lower extremity, is essential.
Collapse
Affiliation(s)
- Mitsuru Hanada
- Department of Orthopaedic Surgery, Hamamatsu University School of Medicine, Hamamatsu, 431-3192, Japan
| | - Kensuke Hotta
- Department of Orthopaedic Surgery, Hamamatsu University School of Medicine, Hamamatsu, 431-3192, Japan
| | - Yukihiro Matsuyama
- Department of Orthopaedic Surgery, Hamamatsu University School of Medicine, Hamamatsu, 431-3192, Japan
| |
Collapse
|
2
|
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] [What about the content of this article? (0)] [Affiliation(s)] [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.
Collapse
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
| |
Collapse
|
3
|
Zhang H, Chen Y, Jiang H, Yan W, Ouyang Y, Wang W, Liu Y, Zhou Y, Gu S, Wan H, He A, Mao Y, Liu W. Comparison of accuracy for hip-knee-ankle (HKA) angle by X-ray and knee motion analysis system and the relationships between HKA and gait posture. BMC Musculoskelet Disord 2023; 24:452. [PMID: 37270561 DOI: 10.1186/s12891-023-06437-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Accepted: 04/18/2023] [Indexed: 06/05/2023] Open
Abstract
BACKGROUND The lower limb mechanical axis was used to assess the severity of knee osteoarthritis (KOA) with varus/valgus deformity and the accuracy of targeted lower limb alignment correction after operation by conventional X-rays. There are lots of parameters to assess the gait in elder patients such as velocity, stride length, step width and swing/stance ratio by knee joint movement analysis system. However, the correlation between the lower limb mechanical axis and gait parameters is not clear. This study is aimed at obtaining the accuracy of the lower limb mechanical axis by the knee joint movement analysis system and the correlation between the lower limb mechanical axis and gait parameters. METHODS We analysed 3D knee kinematics during ground gait of 99 patients with KOA and 80 patients 6 months after the operations with the vivo infrared navigation 3D portable knee joint movement analysis system (Opti-Knee®, Innomotion Inc, Shanghai, China). The HKA (Hip-Knee-Ankle) value was calculated and compared to X-ray findings. RESULTS HKA absolute variation after the operation was 0.83 ± 3.76°, which is lower than that before the operation (5.41 ± 6.20°, p = 0.001) and also lower than the entire cohort (3.36 ± 5.72). Throughout the cohort, a significant correlation with low coefficients (r = -0.19, p = 0.01) between HKA value and anterior-posterior displacement was found. In comparing the HKA values measured on the full-length alignment radiographs and 3D knee joint movement analysis system (Opti-Knee), there was a significant correlation with moderate to high coefficients (r = 0.784 to 0.976). The linear correlation analysis showed that there was a significant correlation between the values of HKA measured by X-ray and movement analysis system (R2 = 0.90, p < 0.01). CONCLUSIONS Data with equivalent results as HKA, the 6DOF of the knee and ground gait data could be provided by infrared navigation based 3D portable knee joint movement analysis system comparing with the conventional X-rays. There is no significant effect of HKA on the kinematics of the partial knee joint.
Collapse
Affiliation(s)
- Hui Zhang
- Department of Joint Surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, 222 West Huanhu Third Road, Pudong New Area, Shanghai, 201306, China
- College of Food Science and Nutritional Engineering, China Agricultural University, Beijing, 10083, China
| | - Yanan Chen
- Department of Joint Surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, 222 West Huanhu Third Road, Pudong New Area, Shanghai, 201306, China
- College of Food Science and Technology, Shanghai Ocean University, No. 999, Hucheng Ring Road, Pudong New Area, Shanghai, 201306, China
| | - Huiquan Jiang
- Department of Joint Surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, 222 West Huanhu Third Road, Pudong New Area, Shanghai, 201306, China
- College of Fisheries and Life Science, Shanghai Ocean University, No. 999, Hucheng Ring Road, Pudong New Area, Shanghai, 201306, China
| | - Wenqing Yan
- College of Food Science and Technology, Shanghai Ocean University, No. 999, Hucheng Ring Road, Pudong New Area, Shanghai, 201306, China
| | - Yuanming Ouyang
- Department of Joint Surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, 222 West Huanhu Third Road, Pudong New Area, Shanghai, 201306, China
| | - Wei Wang
- Department of Joint Surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, 222 West Huanhu Third Road, Pudong New Area, Shanghai, 201306, China
| | - Yaru Liu
- Department of Joint Surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, 222 West Huanhu Third Road, Pudong New Area, Shanghai, 201306, China
- College of Food Science and Technology, Shanghai Ocean University, No. 999, Hucheng Ring Road, Pudong New Area, Shanghai, 201306, China
| | - Ying Zhou
- Department of Joint Surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, 222 West Huanhu Third Road, Pudong New Area, Shanghai, 201306, China
| | - Shiyi Gu
- Department of Joint Surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, 222 West Huanhu Third Road, Pudong New Area, Shanghai, 201306, China
| | - Hong Wan
- Department of Joint Surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, 222 West Huanhu Third Road, Pudong New Area, Shanghai, 201306, China
| | - Axiang He
- Department of Joint Surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, 222 West Huanhu Third Road, Pudong New Area, Shanghai, 201306, China.
| | - Yanjie Mao
- Department of Joint Surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, 222 West Huanhu Third Road, Pudong New Area, Shanghai, 201306, China.
| | - Wanjun Liu
- Department of Joint Surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, 222 West Huanhu Third Road, Pudong New Area, Shanghai, 201306, China.
| |
Collapse
|
4
|
Shin C, Crovetti C, Huo E, Lionberger D. Unsatisfactory accuracy of recent robotic assisting system ROSA for total knee arthroplasty. J Exp Orthop 2022; 9:82. [PMID: 35984537 PMCID: PMC9391541 DOI: 10.1186/s40634-022-00522-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Accepted: 08/11/2022] [Indexed: 11/30/2022] Open
Abstract
Purpose The purpose of this study was to quantify accuracy of a recently FDA-approved robotic-assisted device. Methods Thirty-seven patients underwent TKA with the Robotic Surgical Assistant (ROSA) by the same operating surgeon and team over the course of 3 months. Intra-operative mechanical axis measurements, composed of alpha (α), beta (β), gamma (γ), and delta (δ) angles, and the hip-knee-ankle angle (HKA) were calculated by the ROSA. Post-operative mechanical implant angles were taken from 36″ stitched post-op films and measured in the PACS imaging system. Accuracy was assessed by comparing the percentage of postoperative long length films within 2° and 3° of the ROSA intra-operative plan. Results The ROSA system accurately calculated the HKA, α, and β angles (95% CI), but was inaccurate in calculating both γ and δ angles. Using a window of ± 3° accuracy, the HKA, α and β angles were accurate at levels of 89, 100 and 92% respectively. In contrast, the sagittal relationships were considerably less accurate at 77 and 74% for the γ and δ angles respectively. Subsequently, the proportion of cases within 2 and 3 degrees of the intra-operative plan for resection angles was considered accurate for HKA (73% within 2°, 89% within 3°), α (92% within 2°, 100% within 3°), and β (76% within 2°, 92% within 3°) angles, but considered inaccurate for γ (51% within 2°, 77% within 3°) and δ angles (57% within 2°, 74% within 3°). Conclusions This study demonstrated that while the ROSA system seems to accurately predict coronal plane resections in TKA, it falls short in the sagittal plane. Further research in these deficiencies can provide insight into the overall efficacy of robotic assisted surgery in TKA. Level of Evidence Level III Therapeutic Study.
Collapse
Affiliation(s)
- Caleb Shin
- Department of Orthopaedic Surgery, Houston Methodist Hospital, 6445 Main St, Houston, TX, USA. .,Texas A&M College of Medicine, Bryan, TX, USA.
| | - Chelsea Crovetti
- Department of Orthopaedic Surgery, Houston Methodist Hospital, 6445 Main St, Houston, TX, USA.,Texas A&M College of Medicine, Bryan, TX, USA
| | - Enshuo Huo
- Department of Orthopaedic Surgery, Houston Methodist Hospital, 6445 Main St, Houston, TX, USA
| | - David Lionberger
- Department of Orthopaedic Surgery, Houston Methodist Hospital, 6445 Main St, Houston, TX, USA
| |
Collapse
|
5
|
Wang Z, Deng W, Shao H, Zhou Y, Yang D, Li H. Predictors of a forgotten joint after medial fixed-bearing unicompartmental knee arthroplasty. Knee 2022; 37:103-111. [PMID: 35753203 DOI: 10.1016/j.knee.2022.06.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2022] [Accepted: 06/09/2022] [Indexed: 02/02/2023]
Abstract
BACKGROUND A forgotten joint is considered the ultimate goal of joint replacement. We aim to explore the predictive factors of a forgotten joint after fixed-bearing unicompartmental knee arthroplasty (UKA). METHODS This retrospective cohort study used prospectively collected data from 302 cases of medial-compartment UKA with a minimum of 2-year follow-up. The primary outcome was the achievement of a forgotten joint after UKA, according to the Forgotten Joint Score (FJS-12) at the last follow-up. Patients with FJS-12 > 84 were considered to have forgotten UKA. Univariate and multivariate logistic regression analyses were conducted with preoperative patient characteristics and surgery-related factors as potential predictors. RESULTS Of patients, 94 (31.1%) achieved a forgotten joint post-surgery. Multivariate logistic regression analysis revealed that preoperative hip-knee-ankle angle (HKAA), anatomic lateral distal femoral angle (aLDFA), and postoperative HKAA and HKAA changes were independent predictors of a forgotten joint. The probability of achieving a forgotten joint increased by 29% (OR = 1.29, 95% CI: 1.12-1.51) with a 1° increase in aLDFA. Preoperative HKAA, postoperative HKAA, HKAA changes (ΔHKAA), and outcomes exhibited a non-linear relationship. The probability of achieving a forgotten joint was the highest with preoperative HKAA > 172.0°, postoperative HKAA of 176.0-178.5°, and ΔHKAA < 5.5°. CONCLUSION To achieve the forgotten joint state, the ideal HKAA range after medial fixed-bearing UKA is 176.0-178.5° and ΔHKAA should be <5.5°. Patients with smaller preoperative aLDFA and HKAA have a lower probability of achieving a forgotten joint after UKA.
Collapse
Affiliation(s)
- Zhaolun Wang
- Department of Orthopaedic Surgery, Beijing Jishuitan Hospital, Fourth Clinical College of Peking University, No. 31 Xinjiekou East Street, Xicheng District, Beijing 100035, China
| | - Wang Deng
- Department of Orthopaedic Surgery, Beijing Jishuitan Hospital, Fourth Clinical College of Peking University, No. 31 Xinjiekou East Street, Xicheng District, Beijing 100035, China
| | - Hongyi Shao
- Department of Orthopaedic Surgery, Beijing Jishuitan Hospital, Fourth Clinical College of Peking University, No. 31 Xinjiekou East Street, Xicheng District, Beijing 100035, China
| | - Yixin Zhou
- Department of Orthopaedic Surgery, Beijing Jishuitan Hospital, Fourth Clinical College of Peking University, No. 31 Xinjiekou East Street, Xicheng District, Beijing 100035, China.
| | - Dejin Yang
- Department of Orthopaedic Surgery, Beijing Jishuitan Hospital, Fourth Clinical College of Peking University, No. 31 Xinjiekou East Street, Xicheng District, Beijing 100035, China
| | - Hua Li
- Department of Orthopedics, General Hospital of Chinese PLA, No. 28 Fuxing Road, Beijing 100853, China; National Clinical Research Center for Orthopedics, Sports Medicine & Rehabilitation, No. 28 Fuxing Road, Beijing 100853, China
| |
Collapse
|
6
|
Han X, Cui J, Chu L, Zhang W, Xie K, Jiang X, He Z, Du J, Ai S, Sun Q, Wang L, Wu H, Yan M, Yu Z. Abnormal subchondral trabecular bone remodeling in knee osteoarthritis under the influence of knee alignment. Osteoarthritis Cartilage 2022; 30:100-109. [PMID: 34699993 DOI: 10.1016/j.joca.2021.10.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Revised: 08/06/2021] [Accepted: 10/13/2021] [Indexed: 02/02/2023]
Abstract
OBJECTIVE This study aimed to investigate the abnormal subchondral trabecular bone (STB) remodeling in knee osteoarthritis (OA) under the influence of knee alignment [hip-knee-ankle (HKA) angle]. DESIGN Forty-one patients with knee OA underwent radiographic examination before total knee arthroplasty (TKA) for the measurement of HKA angle. Tibial plateau specimens obtained during TKA were used for histomorphometric analyses to assess STB remodeling and cartilage degradation. Tartrate-resistant acidic phosphatase (TRAP) staining was used to test osteoclast activity. Osterix, osteocalcin, and sclerostin expression in the STB were determined using immunohistochemistry. RESULTS The interaction between HKA angle and side (medial vs lateral of tibial plateau) was the main significant influence factor for STB remodeling and microstructure. The STB with the deviation of the knee alignment was accompanied by obvious abnormal bone remodeling and microstructural sclerosis. Bone volume fraction (BV/TV) was the only significant influence factor for OARSI score, the larger the BV/TV of STB, the higher the OARSI score of cartilage. Moreover, the tibial plateau affected by alignment had more TRAP + osteoclasts, Osterix + osteoprogenitors, and osteocalcin + osteoblasts and fewer sclerostin + osteocytes. CONCLUSIONS The variation of tibial plateau STB remodeling activity and microstructure was associated with HKA angle and cartilage degradation. Knee malalignment may cause abnormal STB remodeling and microstructural sclerosis, which may potentially affect load stress transmission from the cartilage to the STB, thus resulting in accelerated knee OA progression.
Collapse
Affiliation(s)
- Xuequan Han
- Shanghai Key Laboratory of Orthopaedic Implants, Department of Orthopaedic Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
| | - Junqi Cui
- Department of Pathology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
| | - Linyang Chu
- Department of Orthopedic Surgery, Shanghai Sixth People's Hospital, Shanghai Jiao Tong University, Shanghai 200233, China.
| | - Weituo Zhang
- Clinical Research Center, School of Medicine, Shanghai Jiao Tong University, Shanghai, China.
| | - Kai Xie
- Shanghai Key Laboratory of Orthopaedic Implants, Department of Orthopaedic Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
| | - Xu Jiang
- Shanghai Key Laboratory of Orthopaedic Implants, Department of Orthopaedic Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
| | - Zihao He
- Shanghai Key Laboratory of Orthopaedic Implants, Department of Orthopaedic Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
| | - Jingke Du
- Shanghai Key Laboratory of Orthopaedic Implants, Department of Orthopaedic Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
| | - Songtao Ai
- Department of Radiology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
| | - Qi Sun
- Department of Radiology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
| | - Liao Wang
- Shanghai Key Laboratory of Orthopaedic Implants, Department of Orthopaedic Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
| | - Haishan Wu
- Shanghai Key Laboratory of Orthopaedic Implants, Department of Orthopaedic Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
| | - Mengning Yan
- Shanghai Key Laboratory of Orthopaedic Implants, Department of Orthopaedic Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
| | - Zhifeng Yu
- Shanghai Key Laboratory of Orthopaedic Implants, Department of Orthopaedic Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
| |
Collapse
|
7
|
Hess S, Moser LB, Robertson EL, Behrend H, Amsler F, Iordache E, Leclercq V, Hirschmann MT. Osteoarthritic and non-osteoarthritic patients show comparable coronal knee joint line orientations in a cross-sectional study based on 3D reconstructed CT images. Knee Surg Sports Traumatol Arthrosc 2022; 30:407-18. [PMID: 34564737 DOI: 10.1007/s00167-021-06740-3] [Citation(s) in RCA: 40] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2021] [Accepted: 09/02/2021] [Indexed: 11/17/2022]
Abstract
PURPOSE Recently introduced total knee arthroplasty (TKA) alignment strategies aim to restore the pre-arthritic alignment of an individual patient. The native alignment of a patient can only be restored with detailed knowledge about the native and osteoarthritic alignment as well as differences between them. The first aim of this study was to assess the alignment of a large series of osteoarthritic (OA) knees and investigate whether femoral and tibial joint lines vary within patients with the same overall lower limb alignment. The secondary aim was to compare the alignment of OA patients to the previously published data of non-OA patients. This information could be useful for surgeons considering implementing one of the new alignment concepts. MATERIAL Coronal alignment parameters of 2692 knee OA patients were measured based on 3D reconstructed CT data using a validated planning software (Knee-PLAN®, Symbios, Yverdon les Bains, Switzerland). Based on these measurements, patients' coronal alignment was phenotyped according to the functional knee phenotype concept. These phenotypes represent an alignment variation of either the overall alignment, the femoral joint line orientation or the tibial joint line orientation. Each phenotype is defined by a specific mean and covers a range of ± 1.5° from this mean. Mean values and distribution among the phenotypes are presented and compared between two populations (OA patients of this study and non-OA patients of a previously published study) as well as between HKA subgroups (varus, valgus and neutral) using t tests and Chi-square tests (p < 0.05). RESULTS Femoral and tibial joint lines varied within patients with the same overall lower limb alignment. A total of 162 functional knee phenotypes were found (119 males, 136 females and 94 mutual phenotypes). Mean values differed between the OA and non-OA population, but differences were small (< 2°) except for the overall alignment (e.g. HKA). The distribution of OA and non-OA patients among the phenotypes differed significantly, especially among the limb phenotypes. CONCLUSION Differences between OA and non-OA knees are small regarding coronal femoral and tibial joint line orientation. Femoral and tibial joint line orientation of osteoarthritic patients can, therefore, be used to estimate their native coronal alignment and plan an individualized knee alignment. LEVEL OF CLINICAL EVIDENCE III.
Collapse
|
8
|
Diao N, Yu F, Yang B, Ma L, Yin H, Guo A. Association between changes in hip-knee-ankle angle and hindfoot alignment after total knee arthroplasty for varus knee osteoarthritis. BMC Musculoskelet Disord 2021; 22:610. [PMID: 34229696 PMCID: PMC8261933 DOI: 10.1186/s12891-021-04488-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Accepted: 06/18/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The change in hip-knee-ankle (HKA) angle after total knee arthroplasty (TKA) may cause an adjustment in hindfoot alignment (HFA). However, the relationship between the changes in HKA angle and HFA is still not well studied. This study aimed to investigate the association between HKA angle and hindfoot alignment changes after TKA for varus knee osteoarthritis. METHODS A prospective study was carried out in which 108 patients with varus knee deformities were radiographically and clinically evaluated before and 3 months after TKA. The relationship of change in HFA with correction in HKA angle was investigated. RESULTS The results showed that the HFA was adjusted significantly by 3 months after TKA (p < 0.001), along with improved American Orthopaedic Foot and Ankle Society (AOFAS) ankle hindfoot score (p < 0.001). Next, a univariate correlation and linear regression analysis showed that the change in HFA was weakly correlated with the change in HKA angle (r=-0.262, β=-0.14, 95 % CI: -0.23 to -0.04, P = 0.006). Further stratified analysis and interaction tests revealed that age has a distinct effect on the correlation between the changes in HFA and HKA angle. The correlation was dramatically greater in the group under 65 years (r=-0.474, β=-0.26, 95 % CI: -0.41 to -0.12, P = 0.001), whilst, no correlation was observed in those above 65 years old (r=-0.036, β=-0.02, 95 % CI: -0.14 to 0.11, P = 0.779). CONCLUSIONS Our findings indicated that correction of HKA after TKA tend to promote adjustment in the hindfoot alignment toward re-balance of the whole lower limb weight-bearing axis. However, this mechanism obviously weakens in elderly patients. Therefore, if apparent hindfoot deformity exists in these patients before TKA, more perioperative intervention is required for hindfoot adjustment, and even HKA undercorrection may be considered.
Collapse
Affiliation(s)
- Naicheng Diao
- Department of Orthopaedics, Beijing Friendship Hospital, Capital Medical University, No. 95, Yongan Road, Xicheng District, 100050, Beijing, China
| | - Fei Yu
- Department of Orthopaedics, Beijing Friendship Hospital, Capital Medical University, No. 95, Yongan Road, Xicheng District, 100050, Beijing, China
| | - Bo Yang
- Department of Orthopaedics, Beijing Friendship Hospital, Capital Medical University, No. 95, Yongan Road, Xicheng District, 100050, Beijing, China
| | - Lifeng Ma
- Department of Orthopaedics, Beijing Friendship Hospital, Capital Medical University, No. 95, Yongan Road, Xicheng District, 100050, Beijing, China
| | - Heyong Yin
- Department of Orthopaedics, Beijing Friendship Hospital, Capital Medical University, No. 95, Yongan Road, Xicheng District, 100050, Beijing, China
| | - Ai Guo
- Department of Orthopaedics, Beijing Friendship Hospital, Capital Medical University, No. 95, Yongan Road, Xicheng District, 100050, Beijing, China.
| |
Collapse
|
9
|
Tack A, Preim B, Zachow S. Fully automated Assessment of Knee Alignment from Full-Leg X-Rays employing a "YOLOv4 And Resnet Landmark regression Algorithm" (YARLA): Data from the Osteoarthritis Initiative. Comput Methods Programs Biomed 2021; 205:106080. [PMID: 33892211 DOI: 10.1016/j.cmpb.2021.106080] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Accepted: 03/29/2021] [Indexed: 06/12/2023]
Abstract
BACKGROUND AND OBJECTIVE We present a fully automated method for the quantification of knee alignment from full-leg radiographs. METHODS A state-of-the-art object detector, YOLOv4, was trained to locate regions of interests in full-leg radiographs for the hip joint, knee, and ankle. Residual neural networks were trained to regress landmark coordinates for each region of interest. Based on the detected landmarks the knee alignment, i.e., the hip-knee-ankle (HKA) angle was computed. The accuracy of landmark detection was evaluated by a comparison to manually placed ones for 180 radiographs. The accuracy of HKA angle computations was assessed on the basis of 2,943 radiographs by a comparison to results of two independent image reading studies (Cooke; Duryea) both publicly accessible via the Osteoarthritis Initiative. The agreement was evaluated using Spearman's Rho, weighted kappa, and regarding the correspondence of the class assignment. RESULTS The average deviation of landmarks manually placed by experts and automatically detected ones by our proposed "YOLOv4 And Resnet Landmark regression Algorithm" (YARLA) was less than 2.0 ± 1.5 mm for all structures. The average mismatch between HKA angle determinations of Cooke and Duryea was 0.09 ± 0.63°; YARLA resulted in a mismatch of 0.09 ± 0.73° compared to Cooke and of 0.18 ± 0.67° compared to Duryea. Cooke and Duryea agreed almost perfectly with respect to a weighted kappa value of 0.86, and showed an excellent reliability as measured by a Spearman's Rho value of 0.98. Similar values were achieved by YARLA, i.e., a weighted kappa value of 0.83 and 0.87 and a Spearman's Rho value of 0.98 and 0.98 compared to Cooke and Duryea, respectively. Cooke and Duryea agreed in 91% of all class assignments and YARLA did so in 90% against Cooke and 92% against Duryea. CONCLUSIONS YARLA yields HKA angles similar to those of human experts and provides a basis for an automated assessment of knee alignment in full-leg radiographs.
Collapse
Affiliation(s)
- Alexander Tack
- Zuse Institute Berlin, Research Group for Computational Diagnosis and Therapy Planning, Department of Visual and Data-centric Computing, Takustraße 7, Berlin, 14195, Germany.
| | - Bernhard Preim
- Otto von Guericke University Magdeburg, Department of Simulation and Graphics, Universitätsplatz 2, Magdeburg, 39106, Germany
| | - Stefan Zachow
- Zuse Institute Berlin, Research Group for Computational Diagnosis and Therapy Planning, Department of Visual and Data-centric Computing, Takustraße 7, Berlin, 14195, Germany
| |
Collapse
|
10
|
Han X, Cui J, Xie K, Jiang X, He Z, Du J, Chu L, Qu X, Ai S, Sun Q, Wang L, Wu H, Zhang W, Yu Z, Yan M. Association between knee alignment, osteoarthritis disease severity, and subchondral trabecular bone microarchitecture in patients with knee osteoarthritis: a cross-sectional study. Arthritis Res Ther 2020; 22:203. [PMID: 32887657 DOI: 10.1186/s13075-020-02274-0] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2019] [Accepted: 07/20/2020] [Indexed: 01/19/2023] Open
Abstract
Background Knee osteoarthritis (OA) is a common disabling disease involving the entire joint tissue, and its onset and progression are affected by many factors. However, the current number of studies investigating the relationship between subchondral trabecular bone (STB), knee alignment, and OA severity is limited. We aimed to investigate the variation in tibial plateau STB microarchitecture in end-stage knee OA patients and their association with knee alignment (hip-knee-ankle, HKA, angle) and OA severity. Methods Seventy-one knee OA patients scheduled for total knee arthroplasty (TKA) underwent preoperative radiography to measure the HKA angle and Kellgren-Lawrence grade. Tibial plateaus collected from TKA were scanned using micro-computed tomography to analyze the STB microarchitecture. Histological sections were used to assess cartilage degeneration (OARSI score). Correlations between the HKA angle, OA severity (OARSI score, Kellgren-Lawrence grade), and STB microarchitecture were evaluated. Differences in STB microstructural parameters between varus and valgus alignment groups based on the HKA angle were examined. Results The HKA angle was significantly correlated with all STB microarchitecture parameters (p < 0.01). The HKA angle was more correlated with the medial-to-lateral ratios of the microarchitecture parameters than with the medial or lateral tibia plateaus. The HKA angle and all STB microarchitecture parameters are significantly correlated with both the OARSI score and Kellgren-Lawrence grade (p < 0.01). Conclusions The STB microarchitecture is associated with the HKA angle and OA severity. With the increase of the knee alignment deviation and OA severity, the STB of the affected side tibial plateau increased in bone volume, trabecular number, and trabecular thickness and decreased in trabecular separation.
Collapse
|
11
|
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] [What about the content of this article? (0)] [Affiliation(s)] [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.
Collapse
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.
| |
Collapse
|
12
|
Nejima S, Akamatsu Y, Kobayashi H, Tsuji M, Mitsuhashi S, Sasaki T, Kumagai K, Inaba Y. Relationship between lower limb torsion and coronal morphologies of the femur and tibia in patients with medial knee osteoarthritis. BMC Musculoskelet Disord 2020; 21:254. [PMID: 32303239 PMCID: PMC7165393 DOI: 10.1186/s12891-020-03286-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2019] [Accepted: 04/13/2020] [Indexed: 11/15/2022] Open
Abstract
Background To investigate the relationship between femoral or tibial torsion and hip-knee-ankle angle (HKA), mechanical lateral distal femoral angle (mLDFA), or mechanical medial proximal tibial angle (mMPTA) in patients with medial knee osteoarthritis (OA). Methods A total of 75 knees were enrolled. Femoral and tibial torsions were measured by superimposing the axial planes of computed tomography images. The relationship between femoral or tibial torsion and HKA, mLDFA, or mMPTA on radiographs was examined. Results The mean femoral torsion was 12.2 ± 8.5° internally; femoral internal and external torsions were observed in 70 and 5 knees, respectively. The mean tibial external torsion was 18.0 ± 7.4° externally; tibial external torsion was observed in all 75 knees. Femoral internal and tibial external torsions increased with lower mMPTA (r = 0.33, P = 0.003; r = − 0.32, P = 0.005, respectively) but were not related to HKA or mLDFA. Conclusion Femoral and tibial torsions were correlated with varus inclination of the proximal tibia in patients with medial knee OA.
Collapse
Affiliation(s)
- Shuntaro Nejima
- Department of Orthopaedic Surgery, Yokohama City University School of Medicine, 3-9 Fukuura, Kanazawa-ku, Yokohama, 236-0004, Japan.
| | - Yasushi Akamatsu
- Department of Orthopaedic Surgery, Yokohama City University School of Medicine, 3-9 Fukuura, Kanazawa-ku, Yokohama, 236-0004, Japan
| | - Hideo Kobayashi
- Department of Orthopaedic Surgery, Yokohama City University School of Medicine, 3-9 Fukuura, Kanazawa-ku, Yokohama, 236-0004, Japan
| | - Masaki Tsuji
- Department of Orthopaedic Surgery, Yokohama City University School of Medicine, 3-9 Fukuura, Kanazawa-ku, Yokohama, 236-0004, Japan
| | - Shota Mitsuhashi
- Department of Orthopaedic Surgery, Yokohama City University School of Medicine, 3-9 Fukuura, Kanazawa-ku, Yokohama, 236-0004, Japan
| | - Takahiro Sasaki
- Department of Orthopaedic Surgery, Yokohama City University School of Medicine, 3-9 Fukuura, Kanazawa-ku, Yokohama, 236-0004, Japan
| | - Ken Kumagai
- Department of Orthopaedic Surgery, Yokohama City University School of Medicine, 3-9 Fukuura, Kanazawa-ku, Yokohama, 236-0004, Japan
| | - Yutaka Inaba
- Department of Orthopaedic Surgery, Yokohama City University School of Medicine, 3-9 Fukuura, Kanazawa-ku, Yokohama, 236-0004, Japan
| |
Collapse
|
13
|
Zhou F, Xue F, Zhang S. The application of 3D printing patient specific instrumentation model in total knee arthroplasty. Saudi J Biol Sci 2020; 27:1217-1221. [PMID: 32346327 PMCID: PMC7182983 DOI: 10.1016/j.sjbs.2020.02.017] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2019] [Revised: 02/26/2020] [Accepted: 02/26/2020] [Indexed: 02/05/2023] Open
Abstract
The application of 3D printing patient specific instrumentation model in total knee arthroplasty was explored to improve the operative accuracy and safety of artificial total knee arthroplasty. In this study, a total of 52 patients who need knee replacement were selected as the study objects, and 52 patients were divided into experimental group and control group. First, the femoral mechanical-anatomical angle (FMAA), lateral femoral angle (LFA), hip-knee-ankle angle (HKA), femorotibial angle (FTA) of research objects in both groups were measured. Then, the blood loss during the operations, drainage volume after operations, total blood loss, hidden blood loss, and hemoglobin decrease of the experiment group and the control group were measured and calculated. Finally, the postoperative outcomes of patients who underwent total knee arthroplasty were evaluated. The results showed that before the operations, in the PSI group, the femoral mechanical-anatomical angle (FMAA) was (6.9 ± 2.4)°, the lateral femoral angle (LFA) was (82.4 ± 1.6)°, the hip-knee-ankle angle (HKA) was (166.4 ± 1.4)°, and the femorotibial angle (FTA) was (179.5 ± 7.3)°. In the CON group, the FMAA was (5.8 ± 2.4)°, the LFA was (81.3 ± 2.1)°, the HKA was (169.5 ± 1.9)°, and the FTA was (185.4 ± 5.4)°. The differences in these data between the two groups were not statistically significant (P > 0.05). After the operations, in the PSI group, the total blood loss, the hidden blood loss, and the hemoglobin (Hb) decrease were respectively (420.2 ± 210.5), (240.5 ± 234.5), and (1.7 ± 0.9); in the CON group, the total blood loss, the hidden blood loss, and the Hb decrease were respectively (782.1 ± 340.4), (450.9 ± 352.6), and (2.9 ± 1.0). These data of both groups were statistically significant (P < 0.05). Therefore, it can be seen that the 3D printing patient specific instrumentation model can effectively simulate the lower limb coronal force line and was highly consistent of the preoperative software simulation plan. In addition, the random interviews of patients who underwent total knee arthroplasty showed that the knees of patients had recovered well. The application of 3D printing patient specific instrumentation model in artificial total knee arthroplasty can effectively improve the operative accuracy and safety, and the clinical therapeutic effects were significant.
Collapse
|
14
|
Zhang Y, Wang X, Shao Y, Xia Q. The orientation of the surgical epicondylar axis varies in varus and non-varus knees in the coronal plane. Knee Surg Sports Traumatol Arthrosc 2018; 26:2580-2586. [PMID: 27896394 DOI: 10.1007/s00167-016-4386-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2016] [Accepted: 11/15/2016] [Indexed: 12/01/2022]
Abstract
PURPOSE To investigate the orientations of the surgical epicondylar axis (SEA) of varus and non-varus knees in the coronal plane. METHODS One-hundred and sixty-two knees from 81 Chinese patients undergoing total knee arthroplasty (TKA) were retrospectively investigated. The angle between the medial side of the femoral mechanical axis and the SEA (MA-SEA), as well as the physiological valgus angle, was measured in the coronal plane using three-dimensional reconstruction. The joint line angle (JLA) and hip-knee-ankle angle (HKAA) were measured in long-leg weight-bearing radiographs. The mean of each parameter was compared between the varus (HKAA < 177.0°) and the non-varus knees (HKAA ≥ 177.0°) using an independent t test. Linear regression was used to assess the correlation between MA-SEA with JLA and HKAA. RESULTS A total of 42 non-varus knees (6 valgus and 36 neutral knees) and 98 varus knees were measured, as 22 knees were abandoned due to unrecognizable bony landmarks. The mean MA-SEA and JLA were significantly larger in non-varus knees (both, p < 0.01). The mean physiological valgus angle was 5.9 ± 1.0° for Chinese TKA patients and was significantly larger in varus knees (p < 0.01). There was a strong positive correlation between the MA-SEA and JLA (R 2 = 0.35, p < 0.05). CONCLUSIONS There were significant differences in the orientation of the SEA between varus and non-varus knees, which was strongly correlated with the orientation of the femoral joint line. These findings will enhance the current knowledge of knee anatomy and should prove useful for coronal alignment in TKA. LEVEL OF EVIDENCE III.
Collapse
Affiliation(s)
- Yunjie Zhang
- Department of Orthopedic, Zhongshan Hospital, Fudan University, No. 180, Rd. Fenglin, Shanghai, China
| | - Xiaofeng Wang
- Department of Orthopedic, Zhongshan Hospital, Fudan University, No. 180, Rd. Fenglin, Shanghai, China
| | - Yunchao Shao
- Department of Orthopedic, Zhongshan Hospital, Fudan University, No. 180, Rd. Fenglin, Shanghai, China.
| | - Qing Xia
- Department of Orthopedic, Zhongshan Hospital, Fudan University, No. 180, Rd. Fenglin, Shanghai, China.
| |
Collapse
|
15
|
Predescu V, Prescura C, Olaru R, Savin L, Botez P, Deleanu B. Patient specific instrumentation versus conventional knee arthroplasty: comparative study. Int Orthop 2016; 41:1361-1367. [PMID: 27995304 DOI: 10.1007/s00264-016-3356-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/15/2016] [Accepted: 11/16/2016] [Indexed: 10/20/2022]
Abstract
BACKGROUND The key to a successful knee replacement is restoring normal kinematics with a neutral alignment, thus a hip-knee-ankle (HKA) angle of 180° (within 3° limits). Conventional TKR is proven to have excellent results but relies in extensive visual referencing of bony landmarks. Customised cutting blocks provide accurate bone cuts, also lowering the risk of fat embolism, blood loss and operating time. METHOD We share our experience comparing two different TKA techniques using patient specific instrumentation (PSI) with the Visionaire knee and conventional instrumentation (CVI) from the same system (Genesis II Smith&Nephew). A total number of 80 knees were divided into two equal groups, 40 PSI and 40 CVI respectively, operated between April 2013 and August 2014. One female patient had bilateral TKR during this period, at six months interval, both with the PSI. RESULTS All operated knees had varus deformity, with a mean HKA of 168° (PSI) vs 163° (CVI). We used tranexamic acid (double-dose scheme) and suction drains for 48 hours, with a mean blood drainage in the PSI group of 185 ml and Hb levels of 11.2 g/dl at three days post, compared to 260 ml and 10.7 g/dl in the CVI. Mean blood loss was 3.5 g/dl in PSI, and 4.2 g/dl in the CVI. On the long leg standing radiograph at six weeks, all knees were aligned in frontal plane, with simillar HKA values (178.9° PSI vs 178.6° CVI). Bone cuts measured intraoperatively proved to be accurate within a 1 mm limit. CONCLUSIONS We cannot recommend PSI-TKR for a better outcome. It is an alternative to conventional and computer-assisted TKR, but further studies are needed to evaluate weather surgical or economic benefits may be achieved by choosing customised instruments.
Collapse
Affiliation(s)
- Vlad Predescu
- University of Medicine and Pharmacy "Carol Davila", Bucharest, Romania
| | - Catalin Prescura
- Department of Orthopaedics and Trauma, St Pantelimon Clinical Hospital, Bucharest, Romania
| | - Razvan Olaru
- Department of Orthopaedics and Trauma, St Pantelimon Clinical Hospital, Bucharest, Romania
| | - Liliana Savin
- Orthopaedics and Trauma Clinic, Rehabilitation Clinical Hospital Iasi, UMF Gr T Popa Iasi, Iasi, Romania
| | - Paul Botez
- Orthopaedics and Trauma Clinic, Rehabilitation Clinical Hospital Iasi, UMF Gr T Popa Iasi, Iasi, Romania.
| | - Bogdan Deleanu
- Victor Babes University of Medicine and Pharmacy, Timisoara, Romania
| |
Collapse
|
16
|
Lazennec JY, Chometon Q, Folinais D, Robbins CB, Pour AE. Are advanced three-dimensional imaging studies always needed to measure the coronal knee alignment of the lower extremity? Int Orthop 2016; 41:917-924. [PMID: 27844117 DOI: 10.1007/s00264-016-3340-y] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/18/2016] [Accepted: 11/04/2016] [Indexed: 10/20/2022]
Abstract
BACKGROUND Coronal malalignment of the lower extremity is closely related to the onset and progression of osteoarthritis. Restoring satisfactory alignment after tibial osteotomy improves the long-term success of this conservative surgery. The purpose of our study was to determine (1) if there is a difference between two-dimensional (2D) and 3D measurements of the hip-knee-ankle (HKA) angle between the mechanical axes of the femur and the tibia, (2) which parameter most affects 2D-3D HKA measurement, and (3) the percentage of patients who are at risk of error in HKA measurement. METHODS We reviewed imaging studies of the consecutive patients referred to us for hip or knee pain between June and October 2013. Patients with previous pelvis or lower extremity surgery were excluded. RESULTS In 51 % (95/186) of lower extremities examined, the 3D method showed more valgus than the 2D method, and in 49 % (91/186), the 3D method showed more varus. In 12 % of extremities (23/186), the knee varus or valgus alignment was completely opposite in 3D images compared to 2D images. Having more than 7° of flexum/recurvatum alignment increased error in 2D HKA measurement by 5.7°. This was calculated to be 0.15° per 1° increase in femoral torsion and 0.05° per 1° increase in tibial torsion. Approximately 20 % of patients might be at risk of error in HKA angle measurement in 2D imaging studies. CONCLUSIONS Orthopaedic surgeons should assess lower extremity alignment in standing position, with enough exposure of the extremity to find severe alignment or rotational deformities, and consider advanced 3D images of those patients who have them. Otherwise, HKA angle can be measured with good accuracy with 2D techniques. LEVEL OF EVIDENCE Level-III diagnostic.
Collapse
|
17
|
Sheehy L, Cooke TDV. Radiographic assessment of leg alignment and grading of knee osteoarthritis: A critical review. World J Rheumatol 2015; 5:69-81. [DOI: 10.5499/wjr.v5.i2.69] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2014] [Revised: 02/25/2015] [Accepted: 05/06/2015] [Indexed: 02/06/2023] Open
Abstract
Knee osteoarthritis (OA) is a progressive joint disease hallmarked by cartilage and bone breakdown and associated with changes to all of the tissues in the joint, ultimately causing pain, stiffness, deformity and disability in many people. Radiographs are commonly used for the clinical assessment of knee OA incidence and progression, and to assess for risk factors. One risk factor for the incidence and progression of knee OA is malalignment of the lower extremities (LE). The hip-knee-ankle (HKA) angle, assessed from a full-length LE radiograph, is ideally used to assess LE alignment. Careful attention to LE positioning is necessary to obtain the most accurate measurement of the HKA angle. Since full-length LE radiographs are not always available, the femoral shaft - tibial shaft (FS-TS) angle may be calculated from a knee radiograph instead. However, the FS-TS angle is more variable than the HKA angle and it should be used with caution. Knee radiographs are used to assess the severity of knee OA and its progression. There are three types of ordinal grading scales for knee OA: global, composite and individual feature scales. Each grade on a global scale describes one or more features of knee OA. The entire description must be met for a specific grade to be assigned. The Kellgren-Lawrence scale is the most commonly-used global scale. Composite scales grade several features of knee OA individually and sum the grades to create a total score. One example is the compartmental grading scale for knee OA. Composite scales can respond to change in a variety of presentations of knee OA. Individual feature scales assess one or more OA features individually and do not calculate a total score. They are most often used to monitor change in one OA feature, commonly joint space narrowing. The most commonly-used individual feature scale is the OA Research Society International atlas. Each type of scale has its advantages; however, composite scales may offer greater content validity. Responsiveness to change is unknown for most scales and deserves further evaluation.
Collapse
|
18
|
Sheehy L, Cooke TDV, McLean L, Culham E. Standardized standing pelvis-to-floor photographs for the assessment of lower-extremity alignment. Osteoarthritis Cartilage 2015; 23:379-82. [PMID: 25528105 DOI: 10.1016/j.joca.2014.12.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2014] [Revised: 12/05/2014] [Accepted: 12/10/2014] [Indexed: 02/02/2023]
Abstract
OBJECTIVES The objective of this cross-sectional study was to assess the intra-rater, inter-rater and test-retest reliability and concurrent validity of lower-extremity alignment estimated from a photograph [photographic alignment (PA) angle]. METHODS A convenience sample of participants was recruited from the community. Radiopaque stickers were placed over participants' anterior superior iliac spines. One radiograph and one photograph were taken with the participant standing in a standardized position. The stickers were removed. After 30 min they were reapplied and a second photograph was taken. The hip-knee-ankle (HKA) angle was measured from each radiograph using customized imaging analysis software. The same software was used by three readers to measure the PA angle from each photograph from the first set twice, at least 2 weeks apart. One reader measured the PA angle from the second set of photographs. Reliability was tested using intraclass correlation coefficients (ICC(2,1)), Bland-Altman analyses and the minimal detectable change (MDC95). Concurrent validity was tested using a Pearson's correlation coefficient and Bland-Altman analysis. RESULTS Fifty adults participated (mean age 41.8 years; mean body mass index 24.7 kg/m(2)). The PA angle was 4.5° more varus than the HKA angle; these measures were highly correlated (r = 0.92). Intra-rater (ICC(2,1) > 0.985), inter-rater (ICC(2,1) = 0.988) and test-retest reliability (ICC(2,1) = 0.903) showed negligible bias (<0.20°). The MDC95 was 2.69°. CONCLUSIONS The PA angle may be used in place of the HKA angle if a bias of 4.5° is added. A difference of 3° between baseline and follow-up would be considered a true difference.
Collapse
Affiliation(s)
- L Sheehy
- Bruyère Research Institute, Ottawa, ON, Canada.
| | - T D V Cooke
- School of Rehabilitation Therapy, Queen's University, Kingston, ON, Canada.
| | - L McLean
- School of Rehabilitation Therapy, Queen's University, Kingston, ON, Canada; School of Rehabilitation Sciences, University of Ottawa, Ottawa, ON, Canada.
| | - E Culham
- School of Rehabilitation Therapy, Queen's University, Kingston, ON, Canada.
| |
Collapse
|