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Todoriki K, Kai Y, Mukai S, Murata S. Validating Knee Varus Alignment Measurements Using Markerless Motion Capture. Geriatrics (Basel) 2023; 8:109. [PMID: 37987469 PMCID: PMC10660526 DOI: 10.3390/geriatrics8060109] [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: 06/28/2023] [Revised: 08/09/2023] [Accepted: 10/30/2023] [Indexed: 11/22/2023] Open
Abstract
This study aimed to determine the validity of specific knee varus alignment measurement methods. We measured the femorotibial angle (FTA) using radiography and optical motion capture and validated the FTA measurement using markerless motion capture. The subjects included 34 legs of 19 patients with knee osteoarthritis (OA). One-way analysis of variance and multiple comparison tests were used to compare the FTA values between the Kellgren-Lawrence classification (KL) and Pearson's correlation coefficient for validity. The analysis showed that the FTA measured by markerless motion capture had a significant correlation to the FTA measured by radiography (r = 0.869, p < 0.01) and significantly increased with increasing KL (p < 0.05). These results indicate that markerless motion capture is a valid outcome measure for varus alignment in patients with knee OA.
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Affiliation(s)
- Kensuke Todoriki
- Graduate School of Health Sciences, Kyoto Tachibana University, Kyoto 607-8175, Japan
| | - Yoshihiro Kai
- Department of Physical Therapy, Faculty of Health Sciences, Kyoto Tachibana University, Kyoto 607-8175, Japan; (Y.K.); (S.M.)
| | - Shogo Mukai
- Department of Orthopedic Surgery, National Hospital Organization Kyoto Medical Center, Kyoto 612-0861, Japan;
| | - Shin Murata
- Department of Physical Therapy, Faculty of Health Sciences, Kyoto Tachibana University, Kyoto 607-8175, Japan; (Y.K.); (S.M.)
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Kempenaers K, VAN Beek N, Lauwers R, Tengrootenhuysen M. Total knee arthroplasty: do newer CR implants yield better results? A single center prospective study. Acta Orthop Belg 2023; 89:477-483. [PMID: 37935232 DOI: 10.52628/89.3.11325] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2023]
Abstract
The aim of this study was to compare whether the newest TKA prosthesis (Persona) gives improved clinical outcomes due its more anatomical design in comparison to older prostheses (balanSys). This study included a total of 89 patients planned for TKA from June 2018 to September 2019. Outcomes such as Knee Injury and Osteoarthritis Outcome Score (KOOS), range of motion (ROM), numeric pain rating scale (NRS), analgesics and alignment were recorded next to patient characteristics and complications. Our results showed a significant improvement in NRS, ROM and functional scores postoperatively compared to preoperatively for both the Persona and the balanSys implants. Although the flexion ROM for the Persona group was higher at 6 and 12 months postoperative compared to the balanSys, this was mainly a regaining of the preoperative ROM. Throughout all timepoints, there were no statistically significant differences observed in NSAID and opioid usage between the balanSys and Persona groups. Both implants are safe and efficient to use in the treatment of knee osteoarthritis. Although Persona had an improved postoperative flexion, this did not have an impact on any of the patient-reported outcomes.
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Murata S, Kijima H, Saito K, Saito H, Miura T, Akagawa M, Tsukamoto H, Sasaki K, Ebina T, Nozaka K, Miyakoshi N. Evaluation of Medial Meniscal Extrusion Using Radiography. J Clin Med 2023; 12:5268. [PMID: 37629311 PMCID: PMC10456070 DOI: 10.3390/jcm12165268] [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: 07/11/2023] [Revised: 07/31/2023] [Accepted: 08/11/2023] [Indexed: 08/27/2023] Open
Abstract
Recently, there has been increasing interest in medial meniscal extrusion (MME), but few reports have evaluated MME via X-ray. In this study, the amount of MME and meniscal height at the medial border of the tibia were measured via X-ray with gradation processing. The extrusion length divided by the meniscal height yields the meniscal extrusion ratio, which was used as an index. In addition, the medial meniscal length of the part protruding from the medial border of the tibia on MRI was measured as an absolute value. Then, the correlation between the meniscal extrusion ratio and the amount of MME on MRI was examined, and there was a strong correlation between the meniscal extrusion ratio via X-ray and the amount of MME on MRI (correlation coefficient 0.860, p < 0.0001). The cut-off value of the meniscal extrusion ratio via X-ray for positive meniscal extrusion on MRI was 0.50, with an AUC of 0.9825, sensitivity of 0.9063, and specificity of 0.8663. From the present study, it was possible to measure the extrusion length and meniscal height via gradation processing, with X-ray and without MRI, and to calculate the meniscal extrusion ratio, which strongly correlates with the amount of MME on MRI.
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Affiliation(s)
- Shohei Murata
- Akita Sports Arthroscopy Knee Group (ASAKG), 1-1-1 Hondo, Akita 010-8543, Japan
- Department of Orthopedic Surgery, Kakunodate General Hospital, 3 Iwase, Senboku 014-0394, Japan
| | - Hiroaki Kijima
- Akita Sports Arthroscopy Knee Group (ASAKG), 1-1-1 Hondo, Akita 010-8543, Japan
- Department of Orthopedic Surgery, Akita University Graduate School of Medicine, 1-1-1 Hondo, Akita 010-8543, Japan
| | - Kimio Saito
- Akita Sports Arthroscopy Knee Group (ASAKG), 1-1-1 Hondo, Akita 010-8543, Japan
- Department of Orthopedic Surgery, Akita University Graduate School of Medicine, 1-1-1 Hondo, Akita 010-8543, Japan
| | - Hidetomo Saito
- Akita Sports Arthroscopy Knee Group (ASAKG), 1-1-1 Hondo, Akita 010-8543, Japan
- Department of Orthopedic Surgery, Akita University Graduate School of Medicine, 1-1-1 Hondo, Akita 010-8543, Japan
| | - Takanori Miura
- Akita Sports Arthroscopy Knee Group (ASAKG), 1-1-1 Hondo, Akita 010-8543, Japan
| | - Manabu Akagawa
- Akita Sports Arthroscopy Knee Group (ASAKG), 1-1-1 Hondo, Akita 010-8543, Japan
| | - Hiroaki Tsukamoto
- Akita Sports Arthroscopy Knee Group (ASAKG), 1-1-1 Hondo, Akita 010-8543, Japan
| | - Kana Sasaki
- Akita Sports Arthroscopy Knee Group (ASAKG), 1-1-1 Hondo, Akita 010-8543, Japan
| | - Toshihito Ebina
- Department of Orthopedic Surgery, Kakunodate General Hospital, 3 Iwase, Senboku 014-0394, Japan
| | - Koji Nozaka
- Department of Orthopedic Surgery, Akita University Graduate School of Medicine, 1-1-1 Hondo, Akita 010-8543, Japan
| | - Naohisa Miyakoshi
- Department of Orthopedic Surgery, Akita University Graduate School of Medicine, 1-1-1 Hondo, Akita 010-8543, Japan
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Nguyen HC, van Egmond N, de Visser HM, Weinans H, Sakkers RJ, Custers RJ. Visual Inspection for Lower Limb Malalignment Diagnosis Is Unreliable. Cartilage 2022; 13:59-65. [PMID: 36305650 PMCID: PMC9924985 DOI: 10.1177/19476035221113952] [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: 11/07/2022] Open
Abstract
OBJECTIVE Visual inspection of the lower limb is often part of standard clinical practice during a physical examination at the outpatient clinic. This study aims to investigate how reliable visual inspections are in terms of detecting lower limb malalignments without additional tools and physical examinations. DESIGN This study enrolled 50 patients. Each patient underwent a whole leg radiograph (WLR); in addition, a standardized digital photograph was taken of the lower limbs. Four persons (different experience levels) visually rated the digital photograph twice (unaware of the hip knee angle [HKA] on the WLR) and placed them in the category: severe valgus (>5°); moderate valgus (2°-5°); neutral, moderate varus (2°-5°); and severe varus (>5°). Visual ratings were compared with the measured HKA on WLRs for correlation using Spearman's rho. Linear ordinal regression models with significance when P < 0.05 were used to test whether body mass index (BMI), age, gender, and HKA were possible risk factors for incorrect visual HKA assessment. RESULTS Spearman's rho between the visual assessment and measured HKA on the WLR was moderate with 0.478 (P < 0.01). Women had an increased odds ratio of 3.7 (P = 0.001) for incorrect visual assessment. Higher HKA also increased the odds ratio for erroneous visual assessment with 1.4 (P = 0.003). BMI and age did not significantly increase the odds of erroneous visual leg axis assessments in this study. CONCLUSIONS Visual assessment of the lower limb alignment does not provide clinically relevant information. Lower limb malalignment diagnoses cannot be performed using only a visual inspection. Physical examination tests and radiographical assessments are advised. LEVEL OF EVIDENCE Diagnostic level II.
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Affiliation(s)
- H. Chien Nguyen
- Department of Orthopaedics, University
Medical Center Utrecht, Utrecht, The Netherlands
| | - Nienke van Egmond
- Department of Orthopaedics, University
Medical Center Utrecht, Utrecht, The Netherlands
| | - Huub M. de Visser
- Department of Orthopaedics, University
Medical Center Utrecht, Utrecht, The Netherlands
| | - Harrie Weinans
- Department of Orthopaedics, University
Medical Center Utrecht, Utrecht, The Netherlands
| | - Ralph J.B. Sakkers
- Department of Orthopaedics, University
Medical Center Utrecht, Utrecht, The Netherlands
| | - Roel J.H. Custers
- Department of Orthopaedics, University
Medical Center Utrecht, Utrecht, The Netherlands,Roel J.H. Custers, Department of
Orthopaedics, University Medical Center Utrecht, Heidelberglaan 100, 3584CX
Utrecht, The Netherlands.
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Fixed 6° distal femoral cut consistently achieves neutral alignment for Asians, Caucasians, and Native Hawaiian/Pacific Islanders. Arch Orthop Trauma Surg 2022:10.1007/s00402-022-04673-1. [PMID: 36326872 DOI: 10.1007/s00402-022-04673-1] [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: 09/05/2022] [Accepted: 10/23/2022] [Indexed: 11/05/2022]
Abstract
BACKGROUND Restoration of a neutral mechanical axis (MA) is important to the success of total knee arthroplasty (TKA). While known differences are present between Asians and Caucasians regarding native knee alignment, it is unknown whether such differences exist amongst Native Hawaiian/Other Pacific Islanders (NHPI) or if utilizing a fixed distal femoral cut of 6° can consistently achieve a neutral MA in these minority racial groups. This study examines the preoperative deformities presented by Asians, Caucasians, and NHPI, and the resulting knee alignment achieved following TKA when a fixed 6° distal femoral cut is targeted for all patients. METHODS Preoperative and postoperative MA was measured from 835 Asian, 447 Caucasian, and 163 NHPI hip-to-ankle radiographs. All patients underwent TKA in which a standard distal femoral cut of 6° valgus was targeted for all patients. Data were evaluated as continuous variables and by groupings of varus (MA < - 3°), valgus (MA > 3°), and neutral (- 3° ≤ MA ≤ 3°) alignment. RESULTS Preoperative deformity ranged from 38° varus to 29° valgus. The proportion of Asian and NHPI presenting with varus alignment prior to surgery was significantly greater than Caucasian patients in both males (Asians: 80.6%; Caucasians: 67.0%; NHPI: 79.0%, p = 0.001) and females (Asians: 66.1%; Caucasians: 45.7%; NHPI: 63.2%, p < 0.001). There was no difference in the proportion of patients (72-79%) achieving a neutral MA amongst all three racial groups. CONCLUSION NHPI appear to have similar preoperative deformities to Asians with both groups having significantly more varus alignment than Caucasians. Despite a wide range of preoperative deformity, application of a fixed distal femoral cut of 6° valgus successfully established a neutral MA equally in the majority of patients across all three racial groups.
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Kazemi SM, Qoreishi SM, Maleki A, Minaei-Noshahr R, Hosseininejad SM. Correlation of short knee and full-length X-rays in evaluating coronal plane alignment in total knee arthroplasty. J Orthop Surg Res 2022; 17:378. [PMID: 35941670 PMCID: PMC9358910 DOI: 10.1186/s13018-022-03246-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Accepted: 07/08/2022] [Indexed: 11/23/2022] Open
Abstract
Background Coronal alignment after total knee arthroplasty (TKA) would influence the implant survival. Coronal alignment could be measured on short and full-length X-rays. The goal of the current study was to assess the correlation of short and full-length X-rays to accurate prediction of the true Hip-Knee-Ankle alignment after TKA in the Iranian population. Methods Lateral distal femoral and medial proximal tibial angles, FTA, HKA, in 180 Iranian patients (243 knees without extra-articular deformities) were measured and compared on short and full-length standing X-rays of primary TKA pre/postoperatively. Results The correlation between the preoperative FTA-short and FTA-long, FTA-short and HKA, and FTA-long and HKA values in degrees were fair, good and good (r = 0.64) (r = 0.73), (r = 0.76), respectively. This correlation for postoperative aMPTA and mMPTA (r = 0.73), and FTA-short and HKA (r = 0.76) values were good and significant (P = 0.001). Also, assessing coronal alignment based on short and full-length measurements would result in varying pre/postoperative alignments (varus, neutral and valgus). Conclusion Full length X-rays could not be replaced by short knee X-rays to asses true coronal alignment in TKA; considerable portion of our cases were missorted as varus, neutral or valgus based on the FTA versus the HKA. Intraoperative fixed 5° valgus angle cut of distal femur did not result in postoperative favorable neutral alignment in all cases. Level of evidence IV.
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Affiliation(s)
- Seyyed-Morteza Kazemi
- Bone Joint and Related Tissues Research Center, Akhtar Orthopedic Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Seyyed-Mohammad Qoreishi
- Clinical Research and Development Unit, Akhtar Orthopedic Hospital, Shahid Beheshti University of Medial Science, Tehran, Iran.
| | - Arash Maleki
- Clinical Research and Development Unit, Akhtar Orthopedic Hospital, Shahid Beheshti University of Medial Science, Tehran, Iran
| | - Reza Minaei-Noshahr
- Bone Joint and Related Tissues Research Center, Akhtar Orthopedic Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Seyyed-Mohsen Hosseininejad
- Bone Joint and Related Tissues Research Center, Akhtar Orthopedic Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran.,Joint, Bone, Connective Tissue Rheumatology Research Center (JBCRC), Golestan University of Medical Sciences, Gorgān, Iran
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Butarbutar JCP, Mandagi T, Siahaan LD, Suginawan ET, Elson, Irvan. Prevalence of proximal tibia vara in Indonesian population with knee osteoarthritis. J Clin Orthop Trauma 2022; 29:101871. [PMID: 35510147 PMCID: PMC9058951 DOI: 10.1016/j.jcot.2022.101871] [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: 08/02/2021] [Revised: 04/05/2022] [Accepted: 04/13/2022] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Proximal tibia vara has drawn interest since the concept of constitutional varus was introduced. Proximal tibia vara is a condition where the knee varus tilt the tibia condyle medially and shift the tibial articular surface medially. This condition affects medial proximal tibial angle measurements and the placement of the tibial implant in knee replacement surgery. Thus, it challenged the neutral knee arthroplasty alignment target because some people may present a proximal tibia vara. This study assesses the prevalence of the proximal tibia vara and the correlation to knee osteoarthritis grade. METHODS This retrospective study was carried out from January 2021 to June 2021. Eighty-five limbs were included with the following inclusion criteria: knee osteoarthritis patients who received a long view lower extremity radiograph. The exclusions criteria were (1) patients who had undergone arthroplasty and lower extremity surgery before and (2) valgus knee deformity. The outcomes in this study were HKAA, MAD, TAD, MPTA, PTRP, LDFA, and PTS. Intraclass correlation (ICC) using two-way mixed was used to assess the reproducibility of the radiographic parameters. Multiple logistic regression was used to evaluate the correlation between knee osteoarthritis grade and radiographs parameters (MAD and TAD). RESULT A total 85 limbs from 52 patients were assessed in this study. Proximal tibia vara was found in 18 knees (21%.). The logistic regression was performed to assess the correlation between the severity of the knee osteoarthritis and radiographic parameters (MAD, TAD, LDFA, and PTS) with an overall p-value < 0.001 and pseudo-R2 = 0.29. CONCLUSION A significant portion of patients with knee osteoarthritis have proximal tibia vara, and it is a pre-existing condition. Since the pre-existing proximal tibia vara affects preoperative measurements, a long-standing lower extremity x-ray is recommended to be obtained as part of knee replacement preparation.
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Song O, Seo KE, O’Sullivan DM, Park JJ. A Biomechanical Analysis of the Effect of Pilates Exercise on Female College Students with Knee Joint Deformity. THE ASIAN JOURNAL OF KINESIOLOGY 2021. [DOI: 10.15758/ajk.2021.23.3.20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND Current research on genu varum shows the favorable influence of exercise on the biomechanics of the knee joint by reducing the static malalignment and mechanical imbalances, however the transference to a more optimum gait has not been investigated.OBJECTIVES To investigate the effects of Pilates exercise on the changes of gait and lower limb malalignment in female students with genu varum.METHODS A total of 23 female college students with verified genu varum participated in this study. The participants were randomly assigned to two groups a Pilates exercise group (n=15) and a control group (n=8). The Pilates exercise group participated in 1 hour Pilates exercise 3 times per week for a total of 10 weeks. Each of the participants had an X-ray and performed gait 5 times before and after the exercise treatment. The participants kinetic and kinematic data were gathered using an eight Vicon Motion camera system and two force platforms.RESULTS For the Pilates group gait their maximum extension and internal rotation knee moment, and maximum adduction and internal rotation hip moment significantly increased, while the maximum knee moment flexion decreased. For the control group gait their maximum hip extension and hip adduction moment significantly decreased. For the Pilates group there was a significant reduction in the distance from the anatomical axis to the weight bearing line in the left leg, but there was no significant change for the control group.CONCLUSIONS The results suggest that Pilates exercise may be beneficial for females with genu varum by helping to improve both their static alignment and helping their gait to become more balanced.
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Song SK, Cho MR, Lee SH, Kim HC, Kang DW, Choi WK. Acquisition of coronal alignment according to the degree of varus deformity in total knee arthroplasty using computer-assisted navigation. J Orthop Surg (Hong Kong) 2021; 28:2309499020926268. [PMID: 32468906 DOI: 10.1177/2309499020926268] [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] [Indexed: 11/16/2022] Open
Abstract
PURPOSE We have analyzed the surgical outcomes of primary total knee arthroplasty (TKA) using computer-assisted navigation that were performed by a single surgeon in terms of postoperative coronal alignment depending on preoperative varus deformity. METHODS We conducted a retrospective study of patients who have undergone navigated primary TKA from January 2016 through December 2019. Two hundred and fifty-six cases with varus deformity of 10° or less were assigned to group 1, and 216 cases with varus deformity of more than 10° were assigned to group 2. The postoperative mechanical hip-knee-ankle (mHKA) angle was measured from scanograms which were taken preoperatively and 3 months after surgery. The postoperative mHKA angle was targeted to be 0°, and the appropriate range of coronal alignment was set as 0 ± 3°. RESULTS The Pearson correlation showed a significant correlation with the degree of preoperative varus deformity and with the absolute error of postoperative mHKA (p = 0.01). Among all patients, 64 cases (13.6%) were detected as outliers (mHKA > 0° ± 3°) at 3 months after surgery. Of the 64 cases, 25 cases (9.8%) were affiliated to group 1 and 39 cases (18.1%) were affiliated to group 2. Group 2 showed significantly higher occurrence of outliers than group 1 (p = 0.01). Multiple variables logistic regression analysis, which analyzed the difference in the occurrence rate of outliers (mHKA > 0° ± 3°), showed that the occurrence rate of group 2 was 2.04 times higher than group 1. After adjusting for patient's age, gender, and body mass index, the occurrence rate of outliers in group 2 was 2.01 times higher than group 1. CONCLUSION The benefit of computer-assisted navigation during TKA in obtaining coronal alignment within 0 ± 3° may be lessened when the preoperative varus deformity is severely advanced.
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Affiliation(s)
- Suk Kyoon Song
- Department of Orthopaedic Surgery, College of Medicine, Daegu Catholic University Hospital, Daegu, Korea
| | - Myung Rae Cho
- Department of Orthopaedic Surgery, College of Medicine, Daegu Catholic University Hospital, Daegu, Korea
| | - Seo Ho Lee
- Department of Orthopaedic Surgery, College of Medicine, Daegu Catholic University Hospital, Daegu, Korea
| | - Hee Chan Kim
- Department of Orthopaedic Surgery, College of Medicine, Daegu Catholic University Hospital, Daegu, Korea
| | - Dae Won Kang
- Department of Orthopaedic Surgery, College of Medicine, Daegu Catholic University Hospital, Daegu, Korea
| | - Won-Kee Choi
- Department of Orthopaedic Surgery, College of Medicine, Daegu Catholic University Hospital, Daegu, Korea
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Graden NR, Dean RS, Kahat DH, DePhillipo NN, LaPrade RF. True Mechanical Alignment is Found Only on Full-Limb and not on Standard Anteroposterior Radiographs. Arthrosc Sports Med Rehabil 2020; 2:e753-e759. [PMID: 33364613 PMCID: PMC7754530 DOI: 10.1016/j.asmr.2020.06.010] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2020] [Accepted: 06/21/2020] [Indexed: 02/06/2023] Open
Abstract
Purpose The purpose of this study was to compare alignment measured on standard anteroposterior (AP) radiographs versus full-length weight-bearing radiographs. Methods Patients were prospectively enrolled from June 2019 to August 2019 from a single orthopedic surgeon's practice if they were ≥ 18 years of age, obtained both AP and full-length alignment radiographs and were capable of full weight-bearing with appropriate positioning. Patients were excluded if they were < 18 years of age, had previous knee arthroplasty, previous knee or hip osteotomy, were unable to bear full weight on both limbs, and if the patient's body habitus precluded appropriate visualization of necessary landmarks on the radiographs. Tibiofemoral angles were measured on AP radiographs using 2 techniques (AP angles 1 and 2). Linear regression and paired t tests were used to compare measurements. The minimal clinically important difference was defined as < 2°. Results There were 120 patients (62 males, 58 females) with an average age of 45 ± 17 years who were enrolled. There were positive correlations between average alignment on full-length weight-bearing and AP radiographs for AP angle 1 (r = 0.72) and AP angle 2 (r = 0.76) measurement techniques (P < .001). There was a significant difference in mean alignment between full-length weight-bearing and AP measurements (AP angle 1: 2.5° difference; AP angle 2: 4.4° difference; P < .001). Frequency distributions for the minimal clinically important difference between true mechanical alignment and AP views demonstrated that 46.7% of patients had ≥ 2° difference for AP angle 1, and 78.3% of patients had ≥ 2° difference for AP angle 2. Conclusion The average absolute difference in alignment measured between standard AP radiograph and full-length weight-bearing radiograph views was significant, with 46.7% to 78.3% of patients having a greater than 2° absolute difference between these 2 views. In cases where precise objective alignment measurement is necessary, full-length weight-bearing radiographs are recommended over standard AP radiographs for presurgical planning so as to reduce potential error in over- or underestimation of the true mechanical alignment. Study Design Prospective case-comparison; Level of evidence, 1.
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Affiliation(s)
- Nathan R Graden
- Twin Cities Orthopedics, Edina, Minnesota, U.S.A.,University of Minnesota Medical School, Minneapolis, Minnesota, U.S.A
| | | | - David H Kahat
- Twin Cities Orthopedics, Edina, Minnesota, U.S.A.,University of Minnesota Medical School, Minneapolis, Minnesota, U.S.A
| | - Nicholas N DePhillipo
- Twin Cities Orthopedics, Edina, Minnesota, U.S.A.,Oslo Sports Trauma Research Center, Oslo, Norway
| | - Robert F LaPrade
- Twin Cities Orthopedics, Edina, Minnesota, U.S.A.,University of Minnesota Medical School, Minneapolis, Minnesota, U.S.A
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Gielis WP, Rayegan H, Arbabi V, Ahmadi Brooghani SY, Lindner C, Cootes TF, de Jong PA, Weinans H, Custers RJH. Predicting the mechanical hip-knee-ankle angle accurately from standard knee radiographs: a cross-validation experiment in 100 patients. Acta Orthop 2020; 91:732-737. [PMID: 32567436 PMCID: PMC8023880 DOI: 10.1080/17453674.2020.1779516] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
Background and purpose - Being able to predict the hip-knee-ankle angle (HKAA) from standard knee radiographs allows studies on malalignment in cohorts lacking full-limb radiography. We aimed to develop an automated image analysis pipeline to measure the femoro-tibial angle (FTA) from standard knee radiographs and test various FTA definitions to predict the HKAA. Patients and methods - We included 110 pairs of standard knee and full-limb radiographs. Automatic search algorithms found anatomic landmarks on standard knee radiographs. Based on these landmarks, the FTA was automatically calculated according to 9 different definitions (6 described in the literature and 3 newly developed). Pearson and intra-class correlation coefficient [ICC]) were determined between the FTA and HKAA as measured on full-limb radiographs. Subsequently, the top 4 FTA definitions were used to predict the HKAA in a 5-fold cross-validation setting. Results - Across all pairs of images, the Pearson correlations between FTA and HKAA ranged between 0.83 and 0.90. The ICC values from 0.83 to 0.90. In the cross-validation experiments to predict the HKAA, these values decreased only minimally. The mean absolute error for the best method to predict the HKAA from standard knee radiographs was 1.8° (SD 1.3). Interpretation - We showed that the HKAA can be automatically predicted from standard knee radiographs with fair accuracy and high correlation compared with the true HKAA. Therefore, this method enables research of the relationship between malalignment and knee pathology in large (epidemiological) studies lacking full-limb radiography.
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Affiliation(s)
- Willem Paul Gielis
- Department of Orthopedic Surgery, UMC Utrecht, Utrecht, The Netherlands,Correspondence:
| | - Hassan Rayegan
- Department of Mechanical Engineering, Faculty of Engineering, University of Birjand, Birjand, Iran
| | - Vahid Arbabi
- Department of Orthopedic Surgery, UMC Utrecht, Utrecht, The Netherlands,Department of Mechanical Engineering, Faculty of Engineering, University of Birjand, Birjand, Iran,Department of Biomechanical Engineering, Faculty of Mechanical, Maritime, and Materials Engineering, Delft University of Technology (TU Delft), Delft, The Netherlands
| | - Seyed Y Ahmadi Brooghani
- Department of Mechanical Engineering, Faculty of Engineering, University of Birjand, Birjand, Iran
| | - Claudia Lindner
- Division of Informatics, Imaging & Data Sciences, University of Manchester, Manchester, UK
| | - Tim F Cootes
- Division of Informatics, Imaging & Data Sciences, University of Manchester, Manchester, UK
| | - Pim A de Jong
- Department of Radiology, UMC Utrecht and Utrecht University, Utrecht, The Netherlands
| | - H Weinans
- Department of Orthopedic Surgery, UMC Utrecht, Utrecht, The Netherlands
| | - Roel J H Custers
- Department of Orthopedic Surgery, UMC Utrecht, Utrecht, The Netherlands
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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 PMCID: PMC7487480 DOI: 10.1186/s13075-020-02274-0] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [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.
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Tran DH, Hoshino H, Matsuyama Y. Morphological changes in the lower limbs with the progression of knee osteoarthritis over 6 years in a Toei cohort. Mod Rheumatol 2020; 31:743-749. [PMID: 32735180 DOI: 10.1080/14397595.2020.1804668] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
OBJECTIVES We investigated the relationship between morphological features in the lower limbs and the progression of knee osteoarthritis (OA) in 6-years. METHODS Volunteer subjects from Toei (101 women and 54 men). Knee OA was evaluated on whole-leg radiographs. Subjects were divided into group 1, no knee OA; group 2, stable knee OA that showed no progression; group 3, knee OA that had progressed over 6 years. Demographic hip and knee measurement factors were compared the three groups. RESULTS Women, age, body mass index (BMI), abductor angle of the hip, and mechanical-axis deviation were higher in group 2 than in group 1. BMI, the mechanical axis deviation were higher in group 3 than in group 1. Femoral offset was lower in group 3 than in groups 1 and 2. Men, age, condylar-hip angle, plateau-ankle angle were higher in group 2 than in group 1. Age, BMI were higher in group 3 than in groups 1. Condylar-hip and plateau-ankle angles were lower in group 3 than in group 2. CONCLUSIONS Strategies aimed at strengthening the muscles around the hip, changes in lifestyle should be implemented, especially in patients with changes in geometric indices of the hip and knee.
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Affiliation(s)
- Dung Huu Tran
- Department of Orthopaedic Surgery, Hamamatsu University School of Medicine, Shizuoka, Japan
| | - Hironobu Hoshino
- Department of Orthopaedic Surgery, Hamamatsu University School of Medicine, Shizuoka, Japan
| | - Yukihiro Matsuyama
- Department of Orthopaedic Surgery, Hamamatsu University School of Medicine, Shizuoka, Japan
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Non-weightbearing imaging and standard knee radiographs are inferior to formal alignment radiographs for calculating coronal alignment of the knee. Radiography (Lond) 2020; 27:260-265. [PMID: 32828643 DOI: 10.1016/j.radi.2020.08.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Revised: 07/31/2020] [Accepted: 08/01/2020] [Indexed: 11/20/2022]
Abstract
INTRODUCTION Realignment knee osteotomy relies on accurate preoperative assessment of coronal alignment. Weightbearing (WB) 'long-leg' (LL) radiographs are the accepted gold-standard investigation, though in practice standard knee radiographs (short leg; SL) and non-weightbearing (NWB) cross-sectional imaging such as computed tomography (CT) scanograms have been used. We compare the accuracy of SL and NWB radiographs to formal LL alignment radiographs. METHODS A prospectively maintained osteotomy database was reviewed to identify the study population. All patients underwent standardised weightbearing long-leg alignment radiographs. The series was screened consecutively until 30 patients who also underwent WB SL radiographs ('WB cohort'), and 30 with NWB SL ('NWB cohort') radiographs, were identified. Anatomic tibiofemoral angle was calculated by independent reviewers using a validated technique from both radiographs and contrasted. RESULTS 60 patients were identified as outlined in the study protocol. There were no differences in baseline demographics. Coronal alignment calculated from SL and LL radiographs differed significantly (median difference 2.1°, p < 0.001). Alignment values from weightbearing SL radiographs demonstrated markedly greater agreement with LL values than those from NWB radiographs (intraclass correlation coefficient 0.878 vs 0.657), with the NWB cohort also exhibiting greater outlier and extreme outlier incidence. CONCLUSION Our data adds to the growing evidence that SL radiographs are inadequate in the interpretation of knee alignment. In addition, we demonstrate that NWB radiographs (and by extension other NWB modalities such CT scanograms) demonstrate poorer agreement to gold-standard than WB methods. Coronal alignment of the knee cannot be reliably measured from non-weightbearing imaging modalities. IMPLICATIONS FOR PRACTICE Though potentially useful as an adjunct, non-weightbearing cross-sectional imaging and standard knee radiographs should not be used as a proxy for formal weightbearing long-leg radiographs in osteotomy planning.
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Unal M, Ercan S, Budeyri A, Toprak U, Şalkaci A. Anatomical axis validation of lower extremity for different deformities: A radiological study. SAGE Open Med 2020; 8:2050312120923822. [PMID: 32595969 PMCID: PMC7297126 DOI: 10.1177/2050312120923822] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2019] [Accepted: 04/13/2020] [Indexed: 11/27/2022] Open
Abstract
Aim: The aim of this study was to derive a pure, unbiased, reliable and accurate objective relationship between the local knee axis measurements through a short knee anteroposterior roentgenogram and the lower limb axis measurement through an orthoroentgenogram. Patients and Methods: Radiographs of 114 patients (114 knees) were evaluated by two independent raters for measurement of lower limb axis on an orthoroentgenogram and the local knee axis on short knee anteroposterior X-ray, which was derived by cropping the orthoroentgenogram by a blinded radiology assistant. The raters measured at two different time-points separated by an interval of 30-day period. Intra-rater and inter-rater reliabilities were calculated by intra-class correlation coefficients and three models were built to establish the relationships of X-ray anatomical axis with orthoroentgenogram anatomical axis, orthoroentgenogram anatomical axis with orthoroentgenogram mechanical axis and X-ray anatomical axis with orthoroentgenogram mechanical axis. Results: For three different measurements, intra-class correlation coefficients of Rater 2 were higher than 0.90 which shows perfect reliability, while that for Rater 1 was low. Furthermore, first measurements were more consistent than the second measurement. There was a strong positive correlation in all the three models except for varus cases in the last. Conclusion: The standardized correlation derived between the two different techniques for measuring knee alignment is fairly comparable with the studies in the past and would serve as a reliable template for future studies concerning relationships between the two, in addition to helping knee surgeons make more reliable and accurate interpretations through local knee axis measurements.
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Affiliation(s)
- Meric Unal
- Department of Sports Medicine, Faculty of Medicine, Suleyman Demirel University, Isparta, Turkey.,Department of Orthopaedics and Traumatology, Isparta City Hospital, Isparta, Turkey
| | - Sabriye Ercan
- Department of Sports Medicine, Faculty of Medicine, Suleyman Demirel University, Isparta, Turkey
| | - Aydin Budeyri
- Department of Orthopaedics and Traumatology, Faculty of Medicine, SANKO University, Gaziantep, Turkey
| | - Uğur Toprak
- Department of Radiology, Faculty of Medicine, Osmangazi University, Eskişehir, Turkey
| | - Abdülkerim Şalkaci
- Department of Radiology, Faculty of Medicine, Suleyman Demirel University, Isparta, Turkey
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Ueyama H, Minoda Y, Sugama R, Ohta Y, Nakamura S, Takemura S, Nakamura H. Peri-prosthetic bone mineral density after simultaneous bilateral total knee arthroplasty under oral bisphosphonate therapy - A comparison between mobile- and fixed-bearing prostheses. Knee 2020; 27:767-776. [PMID: 32563435 DOI: 10.1016/j.knee.2020.04.011] [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: 12/25/2019] [Revised: 03/17/2020] [Accepted: 04/10/2020] [Indexed: 02/02/2023]
Abstract
BACKGROUND Peri-prosthetic bone mineral density (BMD) decreases after total knee arthroplasty (TKA). We aimed to specifically compare peri-prosthetic BMD changes between mobile- and fixed-bearing prostheses in patients undergoing oral bisphosphonate therapy, hypothesizing that mobile-bearing components would have a favorable effect on postoperative peri-prosthetic BMD. METHODS This prospective cohort study investigated 30 patients who underwent simultaneous bilateral TKA for primary knee osteoarthritis between December 2007 and September 2012. All patients underwent mobile-bearing TKA in one knee and fixed-bearing TKA in the other and received oral alendronate therapy at a dosage of 35 mg/week. Peri-prosthetic and lumbar spine BMDs were measured using dual X-ray absorptiometry scans, with peri-prosthetic BMD changes being compared between the two prostheses in each patient at six months and one, two, three, and five years post-operation. RESULTS Clinical results did not significantly differ between two prostheses. Relative change of lumbar spine BMD was significantly greater at five years post-operation than at one year post-operation (p = 0.01), and was significantly correlated at five years post-operation with peri-prosthetic BMD in the central femur (r = 0.39, p = 0.002), posterior femur (r = 0.39, p = 0.002), and medial tibia (r = 0.42, p = 0.007). CONCLUSIONS There was no difference in peri-prosthetic BMD changes between two prostheses in patients undergoing oral bisphosphonate therapy. Our results suggest that the influence of oral bisphosphonate therapy might offset the influence of prosthetic design. Thus, oral bisphosphonate therapy may be more effective than prosthetic design selection in preventing post-TKA peri-prosthetic BMD loss. LEVEL OF EVIDENCE II.
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Affiliation(s)
- Hideki Ueyama
- Department of Orthopedic Surgery, Osaka City University Graduate School of Medicine, 1-4-3 Asahimachi, Abeno, Osaka, Japan.
| | - Yukihide Minoda
- Department of Orthopedic Surgery, Osaka City University Graduate School of Medicine, 1-4-3 Asahimachi, Abeno, Osaka, Japan
| | - Ryo Sugama
- Department of Orthopedic Surgery, Osaka City University Graduate School of Medicine, 1-4-3 Asahimachi, Abeno, Osaka, Japan
| | - Yoichi Ohta
- Department of Orthopedic Surgery, Osaka City University Graduate School of Medicine, 1-4-3 Asahimachi, Abeno, Osaka, Japan
| | - Suguru Nakamura
- Department of Orthopedic Surgery, Osaka City University Graduate School of Medicine, 1-4-3 Asahimachi, Abeno, Osaka, Japan
| | - Susumu Takemura
- Department of Orthopedic Surgery, Osaka City University Graduate School of Medicine, 1-4-3 Asahimachi, Abeno, Osaka, Japan
| | - Hiroaki Nakamura
- Department of Orthopedic Surgery, Osaka City University Graduate School of Medicine, 1-4-3 Asahimachi, Abeno, Osaka, Japan
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Oh SM, Bin SI, Kim JY, Lee BS, Kim JM. Short knee radiographs can be inadequate for estimating TKA alignment in knees with bowing. Knee Surg Relat Res 2020; 32:9. [PMID: 32660638 PMCID: PMC7219205 DOI: 10.1186/s43019-019-0020-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2019] [Accepted: 11/19/2019] [Indexed: 02/05/2023] Open
Abstract
Purpose The aim of this study was to compare the discrepancy of alignment categorization in total knee arthroplasty (TKA) between the anatomical femorotibial angle (aFTA) measured on short knee radiographs and the mechanical hip–knee–ankle axis angle (mHKA) measured on full-length radiographs in knees with and without bowing. Methods From January 2014 to June 2017, 107 of 526 osteoarthritic knees at our hospital were found to have femoral or tibial bowing. Bowing was defined as a femoral bowing angle (FBA) > 3° or < − 3° or a tibial bowing angle (TBA) > 2° or < − 2° in full-length preoperative radiographs. Among 419 knees without bowing, we selected 107 knees as a control group using propensity-score matching. Postoperative alignments were categorized by aFTA in short knee radiographs and mHKA in full-length radiographs into neutral (2° ≤ aFTA≤7°, − 3° ≤ mHKA≤3°), varus (aFTA< 2°, mHKA<− 3°), and valgus (aFTA> 7°, mHKA> 3°) alignments. We compared the categorization of alignments between knees with and without bowing using the McNemar test and used logistic regression to find factors for the alignment discordance. Results Coronal alignment was discordant in 26.2% of the knees with bowing and 13.1% of the knees without bowing (p < 0.001). FBAs were a significant factor affecting the discordance of alignment categorization (OR = 1.152, 95%CI 1.038–1.279, p = 0.008). Conclusion Short knee radiographs are insufficient for estimating coronal alignment after TKA, particularly in knees with femoral bowing. Level of evidence: III Retrospective comparative study.
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Affiliation(s)
- Sung-Mok Oh
- Nanoori Hospital, 156, Jange-ro 156, Bupyung-gu, Incheon, 21353, Republic of Korea
| | - Seong-Il Bin
- Department of Orthopedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Republic of Korea.
| | - Jae-Young Kim
- Department of Orthopedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Republic of Korea
| | - Bum-Sik Lee
- Department of Orthopedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Republic of Korea
| | - Jong-Min Kim
- Department of Orthopedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Republic of Korea
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Pejhan S, Chong HC, Tennant LM, Acker SM. A comparison of knee joint moments during high flexion squatting and kneeling postures in healthy individuals. Work 2019; 65:79-88. [PMID: 31868714 DOI: 10.3233/wor-193060] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Deep knee bending has been reported as an occupational hazard to workers who have to adopt such postures. High knee joint moments have been associated with knee osteoarthritis initiation and progression. OBJECTIVE This study aimed to compare four high knee flexion postures (dorsiflexed and plantarflexed kneeling, and flat-foot and heels-up squatting) to determine which one results in lower knee joint flexion and ab/adduction moments. METHODS Forty-three participants performed five trials of each posture. Peak (for descent/ascent) and mean (for the static hold) external knee flexion and ab/adduction moments were analyzed for each posture using 2-way ANOVAs and post-hoc pairwise comparisons. RESULTS It was observed that the flat-foot squat resulted in significantly lower knee flexion moment compared to the other three postures (4.63±0.99 % BW·H during the static phase, and 5.83±1.24 % BW·H and 5.94±1.24 % BW·H during descent and ascent phases, respectively). During ascent phase, significant differences was indicated in peak adduction moments for the flat-foot squat in comparison to both styles of kneeling. CONCLUSIONS When high knee flexion is required but posture is not dictated, flat-foot squat will reduce exposures to high knee moments.
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Affiliation(s)
- Shabnam Pejhan
- Department of Kinesiology, University of Waterloo, Waterloo, ON, Canada
| | - Helen C Chong
- Department of Kinesiology, University of Waterloo, Waterloo, ON, Canada
| | - Liana M Tennant
- Department of Kinesiology, University of Waterloo, Waterloo, ON, Canada
| | - Stacey M Acker
- Department of Kinesiology, University of Waterloo, Waterloo, ON, Canada
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Xie K, Han X, Jiang X, Wang L, Ai S, Yu Z, Hao Y, Wu H, Qu X, Yan M. The fibular shaft axis and medial cortex of the proximal fibula are reliable landmarks for the mechanical axis of the tibia in patients with knee osteoarthritis. Knee 2019; 26:1386-1394. [PMID: 31575514 DOI: 10.1016/j.knee.2019.08.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2018] [Revised: 05/28/2019] [Accepted: 08/19/2019] [Indexed: 02/02/2023]
Abstract
BACKGROUND This study aimed to evaluate the validity of proximal fibular anatomic landmarks for measuring the coronal tibial mechanical axis in patients with knee osteoarthritis and to investigate individual factors associated with their reliability. METHODS A total of 106 knees in 96 patients were retrospectively reviewed. The angles between the tibial mechanical axis and fibular shaft axis (TFA), medial cortex of the proximal fibular shaft (MTA), and lateral cortex of the proximal fibular shaft (LTA) were measured from full-leg standing digital anteroposterior radiographs. An angle within three degrees was considered reliable. The association between the above three angles and individual factors, such as age, sex, body mass index (BMI), and varus-valgus knee malalignment, was determined to investigate individual factors associated with their reliability. RESULTS The median TFA, MTA, and LTA were 1.52°, 1.56°, and 2.62°, respectively. The reliability rates of TFA, MTA, and LTA were 73.6% (95% CI: 65.19-81.98%), 82.1% (74.77-89.38%), and 58.5% (49.11-67.87%), respectively. The reliability of TFA and MTA was not associated with individual variables. The reliability of LTA was associated with BMI. Among patients with BMI greater than 25.3 kg/m2, LTA was considered reliable in 65.7%; this rate was significantly higher than that among patients with BMI less than 25.3 kg/m2. CONCLUSIONS The fibular shaft axis and medial cortex of the proximal fibular shaft are reliable landmarks of the mechanical axis of the tibia. However, the reliability of the lateral cortex of the proximal fibular shaft is less satisfactory, especially in patients with BMI less than 25.3 kg/m2.
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Affiliation(s)
- 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
| | - 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
| | - 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
| | - 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
| | - Songtao Ai
- Department of Radiology, 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
| | - Yongqiang Hao
- 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
| | - Xinhua Qu
- Department of Bone and Joint Surgery, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, 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.
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Jeon SW, Kim KI, Song SJ. Robot-Assisted Total Knee Arthroplasty Does Not Improve Long-Term Clinical and Radiologic Outcomes. J Arthroplasty 2019; 34:1656-1661. [PMID: 31036450 DOI: 10.1016/j.arth.2019.04.007] [Citation(s) in RCA: 69] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2019] [Revised: 04/01/2019] [Accepted: 04/03/2019] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Whether robot-assisted total knee arthroplasty (TKA) improves the accuracy of radiographic alignment leading to improved patient satisfaction and implant survivorship in the long term has thus far been inconclusive. METHODS We retrospectively compared the long-term clinical and radiological outcomes of 84 knees that had undergone robot-assisted TKA using ROBODOC vs 79 knees that had undergone conventional TKA. The mean duration of the follow-up period was 129.1 months (range: 108-147 months). Clinical outcomes were evaluated using the Knee Society Score and 36-item Short Form Survey, as well as by assessing the range of motion, operation time, and complications. Radiologic outcomes were evaluated by assessing the hip-knee-ankle angle, coronal and sagittal alignments of the femoral and tibial components, and any radiologic abnormalities such as loosening or osteolysis. RESULTS There was no significant difference in clinical outcomes between the two groups. The prevalence of an outlier for the hip-knee-ankle angle in the robot-assisted group was 10.7%, whereas it was 16.5% in the conventional group (P = .172). The other component alignments (α°, β°, γ°, δ°) revealed a tendency toward a lower rate of outliers in the robot-assisted group, but without statistical significance (P > .05). In addition, there was no significant difference in complications, including revision surgery, between both groups. CONCLUSION Robot-assisted TKA does not improve long-term clinical or radiologic outcomes compared with conventional TKA.
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Affiliation(s)
- Sang-Woo Jeon
- Department of Orthopedic Surgery, Kyung Hee University Hospital at Gangdong, Seoul, Republic of Korea
| | - Kang-Il Kim
- Department of Orthopedic Surgery, Kyung Hee University Hospital at Gangdong, Seoul, Republic of Korea; Department of Orthopaedic Surgery, School of Medicine, Kyung Hee University, Seoul, Republic of Korea
| | - Sang Jun Song
- Department of Orthopaedic Surgery, School of Medicine, Kyung Hee University, Seoul, Republic of Korea
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Correlation of Short Knee Radiographs and Full-length Radiographs in Patients Undergoing Total Knee Arthroplasty. J Am Acad Orthop Surg 2019; 27:e516-e521. [PMID: 30216247 DOI: 10.5435/jaaos-d-18-00272] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
INTRODUCTION The clinical success and longevity of a primary total knee arthroplasty (TKA) in large part depend on our ability to control coronal alignment. However, controversy exists regarding which radiographs to use for the most accurate interpretation. The study assesses the accuracy of coronal alignment measurements using a single short knee radiograph (SKR) in comparison with full-length radiographs (FLRs). METHODS Using our institutional database, we retrieved radiographs of all patients who have had pre- and postoperative FLRs for their primary TKA in 2014. The following measurements were obtained on both short and long radiographs: femoral-tibial angle (FTA), anatomic lateral distal femoral angle, medial proximal tibial angle, condylar-plateau angle, and condylar-plateau distance. A reliability analysis was conducted between the pre- and postoperative SKRs and FLRs using the intraclass correlation coefficient (ICC). RESULTS Radiographs of 236 limbs were included in the analysis. The FTA showed an ICC of 0.84 and 0.69 on the pre- and postoperative radiographs, respectively. Good ICC was seen in the lateral distal femoral angle in both the pre- and postoperative radiographs; these were 0.70 and 0.67, respectively. Also, the medial proximal tibial angle showed good to excellent correlation, with an ICC of 0.83 on the preoperative and 0.66 on the postoperative radiographs. CONCLUSION This study illustrates that SKRs could be an appropriate substitute for FLRs for the evaluation of primary TKA coronal alignment, especially in the postoperative assessment of these patients. LEVEL OF EVIDENCE Level III.
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Andrews SN, Beeler DM, Parke EA, Nakasone CK, Stickley CD. Fixed Distal Femoral Cut of 6° Valgus in Total Knee Arthroplasty: A Radiographic Review of 788 Consecutive Cases. J Arthroplasty 2019; 34:755-759. [PMID: 30616977 DOI: 10.1016/j.arth.2018.12.013] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2018] [Revised: 11/29/2018] [Accepted: 12/11/2018] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND In place of the mechanical axis (MA), the use of the variable tibiofemoral angle is frequently used to plan measured resection bony cuts during total knee arthroplasty (TKA). This angle, coupled with operator-dependent variability of intramedullary distal femoral cutting guides, has the potential for catastrophic outcomes. Therefore, a simpler, fixed femoral cut of 6° valgus may be more appropriate when direct measurement of the MA is not possible. METHODS This was a retrospective study of 788 consecutive TKAs, in which the distal femoral cut was set to 6° valgus. The preoperative and 6-week postoperative MA were measured on hip-to-ankle radiographs. Data were evaluated as a group as well as grouped by preoperative deformity (MA < -3°, -3° < MA < 3°, 3° < MA). RESULTS Following TKA, MA alignment for all patients was 0.0° ± 2.3° (range, -7.0° to 8.0°). When grouped by pre-TKA alignment, 548 patients were considered varus (MA < -3°), 137 were neutral (-3° < MA < 3°), and 103 patients were valgus (3° < MA). When evaluating the post-TKA alignment achieved in the 3 groups, neutral alignment (-3° < MA < 3°) was established in 86.5% of varus patients, 86.1% of neutral patients, and 82.5% of valgus patients. CONCLUSION A standard distal femoral cut of 6° resulted in a neutral MA in 86% of patients. While no single technique will be correct for all deformities, in the absence of sophisticated preoperative planning aids, this simple technique could provide a more reliable surgical technique than the measured tibiofemoral angle.
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Affiliation(s)
- Samantha N Andrews
- Department of Kinesiology and Rehabilitation Sciences, University of Hawaii, Honolulu, Hawaii; Bone and Joint Clinic, Straub Medical Center, Honolulu, Hawaii
| | - Derek M Beeler
- Department of Kinesiology and Rehabilitation Sciences, University of Hawaii, Honolulu, Hawaii
| | - Elizabeth A Parke
- Department of Kinesiology and Rehabilitation Sciences, University of Hawaii, Honolulu, Hawaii
| | - Cass K Nakasone
- Bone and Joint Clinic, Straub Medical Center, Honolulu, Hawaii
| | - Christopher D Stickley
- Department of Kinesiology and Rehabilitation Sciences, University of Hawaii, Honolulu, Hawaii
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Jeon SW, Choi CH, Jung M, Chun YM, Kim SJ, Jin S, Kim SH. The Fate of the Contralateral Knee in Patients With a Lateral Discoid Meniscus. Arthroscopy 2019; 35:500-506. [PMID: 30611591 DOI: 10.1016/j.arthro.2018.07.045] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2018] [Revised: 07/26/2018] [Accepted: 07/30/2018] [Indexed: 02/02/2023]
Abstract
PURPOSE To analyze the survivorship of the lateral meniscus (LM) in the contralateral knee after surgery for symptomatic torn discoid lateral meniscus (DLM) and to determine its associated factors. METHODS Two hundred ninety-six patients who underwent arthroscopic meniscectomy for torn symptomatic DLM were reviewed retrospectively. Patients were classified into subgroups based on demographic, clinical, and radiologic variables. The survivorship analysis of the LM on the contralateral knee was calculated using the Kaplan-Meier method, and comparison among the subgroups was conducted using the log-rank test. The predicted prognostic factors associated with survivorship were determined using Cox proportional hazard regression analysis. RESULTS Of the 296 patients, 51 (17%) had arthroscopic surgery in the contralateral knee during the study period. The group ≥40 years old had significantly worse survival than the group <40 (log-rank test, P < .001). In terms of radiologic variables, the group with Kellgren-Lawrence grade 3 or 4 had significantly poorer survivorship than that with grade 1 or 2 (log-rank test, P = .045). Age ≥40 years was associated with poorer survivorship (hazard ratio, 3.235; 95% confidence interval, 1.782-5.875; P < .001). Kellgren-Lawrence grades 3 and 4 in the contralateral knee were associated with poorer survival (hazard ratio, 2.071; 95% confidence interval, 1.061-4.043; P = .033). The cumulative survival rate at 10 years of the LM in the contralateral knee after surgery for symptomatic torn DLM was 81%. CONCLUSIONS Patients with a lateral discoid meniscus have a risk of a similar condition in the contralateral knee. Increased risks of symptomatology are associated with age and degenerative changes. LEVEL OF EVIDENCE Level IV, retrospective uncontrolled case series.
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Affiliation(s)
- Sang-Woo Jeon
- Department of Orthopaedic Surgery, Yonsei University College of Medicine, and Arthroscopy and Joint Research Institute, Yonsei University Health System, Seoul, Republic of Korea
| | - Chong Hyuk Choi
- Department of Orthopaedic Surgery, Yonsei University College of Medicine, and Arthroscopy and Joint Research Institute, Yonsei University Health System, Seoul, Republic of Korea
| | - Min Jung
- Department of Orthopaedic Surgery, Yonsei University College of Medicine, and Arthroscopy and Joint Research Institute, Yonsei University Health System, Seoul, Republic of Korea
| | - Yong-Min Chun
- Department of Orthopaedic Surgery, Yonsei University College of Medicine, and Arthroscopy and Joint Research Institute, Yonsei University Health System, Seoul, Republic of Korea
| | - Sung-Jae Kim
- Department of Orthopaedic Surgery, Yonsei University College of Medicine, and Arthroscopy and Joint Research Institute, Yonsei University Health System, Seoul, Republic of Korea; Department of Orthopaedic Surgery, Yonsesarang Hospital, Seoul, Republic of Korea
| | - Seokhwan Jin
- Department of Orthopaedic Surgery, Yonsei University College of Medicine, and Arthroscopy and Joint Research Institute, Yonsei University Health System, Seoul, Republic of Korea
| | - Sung-Hwan Kim
- Department of Orthopaedic Surgery, Yonsei University College of Medicine, and Arthroscopy and Joint Research Institute, Yonsei University Health System, Seoul, Republic of Korea; Department of Orthopaedic Surgery, Gangnam Severance Hospital, Seoul, Republic of Korea.
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Northon S, Boivin K, Laurencelle L, Hagemeister N, de Guise JA. Quantification of joint alignment and stability during a single leg stance task in a knee osteoarthritis cohort. Knee 2018; 25:1040-1050. [PMID: 30415977 DOI: 10.1016/j.knee.2018.08.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2018] [Revised: 08/01/2018] [Accepted: 08/18/2018] [Indexed: 02/02/2023]
Abstract
BACKGROUND Knee osteoarthritis alters joint stability but its kinematics during functional weight-bearing tasks remain unclear. We propose and validate an assessment technique for the quantification of knee alignment and stability in patients during a short single leg stance task. METHODS Three-dimensional knee kinematics were acquired non-invasively from 31 knee osteoarthritis patients (subdivided as moderate or severe) and 15 asymptomatic individuals during six short single-leg stance tasks. Data of participants achieving ≥3 trials were retained. From flexion-extension signals, a data treatment method compared the average between-trial root-mean-square error (RMSE) across trial triplets, and the average within-trial range of movement (RoM) for two data windows. From secondary knee motions (ab/adduction and int/external rotations, anteroposterior and mediolateral translations), we extracted measures characterizing alignments (mean), largest deviations (maximum, minimum), and extent of micro-adjustments (RoM, length of knee excursion). Their sensitivity to disease and severity was determined using an ANOVA, and between-trial repeatability using ICC2,3. RESULTS Ninety-four percent of patients achieved ≥3 trials. The retained trial triplet and window reduced the RMSE (2.15 to 1.54) and RoM (4.9° to 1.77°) for flexion-extension. Mean, minimum, and maximum measures were sensitive to disease for anteroposterior translations, and to severity for ab/adduction (P < 0.05). High repeatability was found for those measures (ICC ≥0.84). RoM and length of knee excursion, although sensitive to disease for anteroposterior translations, had lower ICC. CONCLUSION The proposed technique is feasible and exposed measures of knee alignment sensitive to knee osteoarthritis, for instance, an anterior femoral shift and an increased adduction malalignment with greater severity.
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Affiliation(s)
- Stéphane Northon
- Département des sciences de l'activité physique de l'Université du Québec à Trois-Rivières, 3351, boul. des Forges, Trois-Rivières, Québec G9A 5H7, Canada; Groupe de recherche sur les affections neuro-musculo-squelettiques, 3351, boul. des Forges, Trois-Rivières, Québec G9A 5H7, Canada
| | - Karine Boivin
- Département des sciences de l'activité physique de l'Université du Québec à Trois-Rivières, 3351, boul. des Forges, Trois-Rivières, Québec G9A 5H7, Canada; Groupe de recherche sur les affections neuro-musculo-squelettiques, 3351, boul. des Forges, Trois-Rivières, Québec G9A 5H7, Canada.
| | - Louis Laurencelle
- Département des sciences de l'activité physique de l'Université du Québec à Trois-Rivières, 3351, boul. des Forges, Trois-Rivières, Québec G9A 5H7, Canada
| | - Nicola Hagemeister
- Laboratoire en imagerie et orthopédie, Centre de recherche du Centre hospitalier de l'Université de Montréal, 900, rue Saint-Denis, Pavillon R, Montréal, Québec H2X 0A9, Canada; École de technologie supérieure, Département de génie de la production automatisée, 1100, rue Notre-Dame Ouest, Montréal, Québec H3C 1K3, Canada
| | - Jacques A de Guise
- Laboratoire en imagerie et orthopédie, Centre de recherche du Centre hospitalier de l'Université de Montréal, 900, rue Saint-Denis, Pavillon R, Montréal, Québec H2X 0A9, Canada; École de technologie supérieure, Département de génie de la production automatisée, 1100, rue Notre-Dame Ouest, Montréal, Québec H3C 1K3, Canada
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Evaluation of a distractor to increase joint space of the stifle joint in dogs: a cadaveric study. Vet Comp Orthop Traumatol 2017; 28:179-85. [DOI: 10.3415/vcot-14-04-0058] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2014] [Accepted: 02/26/2015] [Indexed: 11/17/2022]
Abstract
SummaryObjective: To evaluate the technical feasibility and efficacy of a joint distraction technique to increase the stifle joint space and assess potential soft tissue damage due to the distraction.Methods: Twenty stifle joints of twelve canine cadavers without evidence of disease were radiographically evaluated by medio-lateral, cranio-caudal and varus-valgus stressed projections. Joint distraction was applied with loads from 40 N up to 200 N, and the joint space achieved was measured on radiographic images. Distraction plus distension with saline was subsequently applied and measured. Varus-valgus stressed projections were repeated after distraction to evaluate a potential increase in joint laxity.Results: Distraction produced a significant increase of the joint space for most of the evaluated loads. Distraction plus distension produced a significant increase for most of the loads compared to the distraction alone. No ensuing joint laxity could be inferred from the post-distraction radiographic evaluation.Clinical significance: Stifle distraction produces an increase of the joint space, which is wider when intra-articular saline is injected. This may be potentially useful for improving joint structure visualization and facilitating arthroscopic procedures, thus reducing the potential for iatrogenic damage to intra articular structures. No soft tissue damage could be inferred by radiographic pre- and post-procedure comparison. Further clinical studies are required to evaluate potential neurovascular complications.
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26
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Bennett HJ, Shen G, Cates HE, Zhang S. Effects of toe-in and toe-in with wider step width on level walking knee biomechanics in varus, valgus, and neutral knee alignments. Knee 2017; 24:1326-1334. [PMID: 28970124 DOI: 10.1016/j.knee.2017.08.058] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2017] [Revised: 08/23/2017] [Accepted: 08/27/2017] [Indexed: 02/02/2023]
Abstract
BACKGROUND Increased peak external knee adduction moments exist for individuals with knee osteoarthritis and varus knee alignments, compared to healthy and neutrally aligned counterparts. Walking with increased toe-in or increased step width have been individually utilized to successfully reduce 1st and 2nd peak knee adduction moments, respectfully, but have not previously been combined or tested among all alignment groups. The purpose of this study was to compare toe-in only and toe-in with wider step width gait modifications in individuals with neutral, valgus, and varus alignments. METHODS Thirty-eight healthy participants with confirmed varus, neutral, or valgus frontal-plane knee alignment through anteroposterior radiographs, performed level walking in normal, toe-in, and toe-in with wider step width gaits. A 3×3 (group×intervention) mixed model repeated measures ANOVA compared alignment groups and gait interventions (p<0.05). RESULTS The 1st peak knee adduction moment was reduced in both toe-in and toe-in with wider step width compared to normal gait. The 2nd peak adduction moment was increased in toe-in compared to normal and toe-in with wider step width. The adduction impulse was also reduced in toe-in and toe-in with wider step width compared to normal gait. Peak knee flexion and external rotation moments were increased in toe-in and toe-in with wider step width compared to normal gait. CONCLUSION Although the toe-in with wider step width gait seems to be a viable option to reduce peak adduction moments for varus alignments, sagittal, and transverse knee loadings should be monitored when implementing this gait modification strategy.
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Affiliation(s)
- Hunter J Bennett
- Department of Human Movement Sciences, Old Dominion University, Norfolk, VA, USA
| | - Guangping Shen
- Department of Kinesiology, Recreation, and Sport Studies, The University of Tennessee, Knoxville, TN, USA
| | | | - Songning Zhang
- Department of Kinesiology, Recreation, and Sport Studies, The University of Tennessee, Knoxville, TN, USA.
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Ohi H, Iijima H, Aoyama T, Kaneda E, Ohi K, Abe K. Association of frontal plane knee alignment with foot posture in patients with medial knee osteoarthritis. BMC Musculoskelet Disord 2017; 18:246. [PMID: 28592232 PMCID: PMC5463360 DOI: 10.1186/s12891-017-1588-z] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2017] [Accepted: 05/17/2017] [Indexed: 11/22/2022] Open
Abstract
Background To examine the association of radiographic frontal plane knee alignment with three-dimensional foot posture in patients with medial knee osteoarthritis (OA). Methods Participants in orthopedic clinics with Kellgren/Lawrence (K/L) grade ≥1 (88 patients and 88 knees; age, 61–91 years; 65.9% female) were enrolled. An anteroposterior radiographic view was used to assess the anatomical axis angle (AAA) after subtracting a sex-specific correction factor. The three-dimensional foot posture was also evaluated. Results Multiple regression analyses showed that increased corrected AAA (i.e., valgus direction) was independently associated with a decrease in the hallux valgus angle (regression coefficient: −0.40 per degree, 95% confidence interval [CI]: −0.72, −0.09; P = 0.013) and increase in the pronation angle of the calcaneus relative to floor (regression coefficient: 0.33 per degree, 95% CI: 0.10, 0.56; P = 0.005) adjusted for age, sex, and body mass index. The relationship between the corrected AAA and hallux valgus angle strengthened (regression coefficient: −0.60 per degree, 95% CI: −1.08, −0.13; P = 0.014) in varus-aligned knees examined separately (63 knees). The other foot postures (navicular height, navicular height/foot length, and rearfoot angle) were not significantly associated with corrected AAA. Conclusions Radiographic frontal plane knee alignment was associated with hallux valgus angle and calcaneus angle relative to the floor in patients with medial knee OA, particularly in varus-aligned knees. These results indicate a connection between altered frontal knee alignment and foot posture, which may be helpful in understanding the pathogenesis of altered foot posture observed in patients with knee OA.
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Affiliation(s)
- Hiroshi Ohi
- Graduate School of Health and Welfare, Niigata University of Health and Welfare, Niigata, Japan.,Ohi Manufacturing Co., Ltd., Kyoto, Japan
| | - Hirotaka Iijima
- Department of Physical Therapy, Human Health Sciences, Graduate School of Medicine, Kyoto University, Kyoto, Japan. .,Department of System Design Engineering, Keio University, Yokohama, Japan. .,Japan Society for the Promotion of Science, Tokyo, Japan.
| | - Tomoki Aoyama
- Department of Physical Therapy, Human Health Sciences, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | | | - Kazuko Ohi
- Graduate School of Health and Welfare, Niigata University of Health and Welfare, Niigata, Japan.,Ohi Manufacturing Co., Ltd., Kyoto, Japan
| | - Kaoru Abe
- Graduate School of Health and Welfare, Niigata University of Health and Welfare, Niigata, Japan
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Maricar N, Parkes MJ, Callaghan MJ, Hutchinson CE, Gait AD, Hodgson R, Felson DT, O'Neill TW. Structural predictors of response to intra-articular steroid injection in symptomatic knee osteoarthritis. Arthritis Res Ther 2017; 19:88. [PMID: 28482926 PMCID: PMC5423020 DOI: 10.1186/s13075-017-1292-2] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2016] [Accepted: 04/07/2017] [Indexed: 12/13/2022] Open
Abstract
Background The aim was to examine if structural factors could affect response to intra-articular steroid injections (IASI) in knee osteoarthritis (OA). Method Persons with painful knee OA participated in an open-label trial of IASI where radiographic joint space narrowing (JSN) and Kellgren-Lawrence (KL) grade, whole-organ magnetic resonance imaging (MRI) scores (WORMS) and quantitative assessment of synovial tissue volume (STV) were assessed on baseline images. Participants completed the Knee Injury and Osteoarthritis Outcome Score (KOOS) and a question about knee pain with a visual analogue scale for pain during nominated activity (VASNA), and Outcome Measures in Rheumatology (OMERACT)-Osteoarthritis Research Society International (OARSI) criteria were used to assess responder status within 2 weeks (short term) and 6 months (longer term). Regression models were used to examine predictors of short and longer term response to IASI. Results Subjects (n = 207) attended and had IASI. Information on responder status was available on 199 participants. Of these, 188 subjects, mean age 63.2 years (standard deviation (SD) 10.3), 97 (51.6%) female, had x-rays and 120 had MRI scans available. Based on the OMERACT-OARSI criteria, 146 (73.4%) participants responded to therapy and 40 (20.1%) were longer term responders. A few factors were associated with a reduced KOOS-pain and VASNA response though none were associated with OMERACT-OARSI responder status in the short term. Higher MRI meniscal damage (odds ratio (OR) = 0.74; 95% CI 0.55 to 0.98), increasing KL maximal grade (OR = 0.43; 95% CI 0.23 to 0.82) and joint space narrowing (JSN) maximal score (OR = 0.60; 95% CI 0.36 to 0.99) were each associated with a lower odds of longer term responder status. Baseline synovitis was not associated with treatment response. The predicted probability of longer term response decreased from 38% to 12% as baseline maximal JSN increased from grade 0 to 3. Conclusion Compared with those who have mild structural damage, persons with more severe knee damage on either MRI or x-ray are less likely to respond to knee IASI. Trial registration ISRCTN.com, ISRCTN07329370. Registered 21 May 2010. Retrospectively registered
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Affiliation(s)
- Nasimah Maricar
- Arthritis Research UK Centre for Epidemiology, Division of Musculoskeletal and Dermatological Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, University of Manchester, Manchester, UK.,NIHR Manchester Musculoskeletal Biomedical Research Unit, Central Manchester University Hospitals NHS Foundation Trust, Manchester Academic Health Sciences Centre, Manchester, UK.,Department of Physiotherapy, Salford Royal Hospital NHS Foundation Trust, Manchester, UK
| | - Matthew J Parkes
- Arthritis Research UK Centre for Epidemiology, Division of Musculoskeletal and Dermatological Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, University of Manchester, Manchester, UK.,NIHR Manchester Musculoskeletal Biomedical Research Unit, Central Manchester University Hospitals NHS Foundation Trust, Manchester Academic Health Sciences Centre, Manchester, UK
| | - Michael J Callaghan
- Arthritis Research UK Centre for Epidemiology, Division of Musculoskeletal and Dermatological Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, University of Manchester, Manchester, UK.,NIHR Manchester Musculoskeletal Biomedical Research Unit, Central Manchester University Hospitals NHS Foundation Trust, Manchester Academic Health Sciences Centre, Manchester, UK.,Department of Health Professions, Manchester Metropolitan University, Manchester, UK
| | | | - Andrew D Gait
- Centre for Imaging Sciences, Institute of Population Health, The University of Manchester, Manchester, UK
| | - Richard Hodgson
- Centre for Imaging Sciences, Institute of Population Health, The University of Manchester, Manchester, UK
| | - David T Felson
- Arthritis Research UK Centre for Epidemiology, Division of Musculoskeletal and Dermatological Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, University of Manchester, Manchester, UK.,NIHR Manchester Musculoskeletal Biomedical Research Unit, Central Manchester University Hospitals NHS Foundation Trust, Manchester Academic Health Sciences Centre, Manchester, UK.,Clinical Epidemiology Unit, Boston University School of Medicine, Boston, MA, USA
| | - Terence W O'Neill
- Arthritis Research UK Centre for Epidemiology, Division of Musculoskeletal and Dermatological Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, University of Manchester, Manchester, UK. terence.o'.,NIHR Manchester Musculoskeletal Biomedical Research Unit, Central Manchester University Hospitals NHS Foundation Trust, Manchester Academic Health Sciences Centre, Manchester, UK. terence.o'.,Department of Rheumatology, Salford Royal Hospital NHS Foundation Trust, Manchester, UK. terence.o'
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BENNETT HUNTERJ, ZHANG SONGNING, SHEN GUANGPING, WEINHANDL JOSHUAT, PAQUETTE MAXR, REINBOLT JEFFREY, COE DAWNP. Effects of Toe-In and Wider Step Width in Stair Ascent with Different Knee Alignments. Med Sci Sports Exerc 2017; 49:563-572. [DOI: 10.1249/mss.0000000000001140] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Stickley CD, Wages JJ, Hetzler RK, Andrews SN, Nakasone CK. Standard Radiographs Are Not Sufficient for Assessing Knee Mechanical Axis in Patients With Advanced Osteoarthritis. J Arthroplasty 2017; 32:1013-1017. [PMID: 27810307 DOI: 10.1016/j.arth.2016.09.024] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2016] [Revised: 08/13/2016] [Accepted: 09/12/2016] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND The use of standard radiographs, and measured tibiofemoral angle (TFA), to assess lower extremity alignment is commonly practiced despite limited knowledge of its relationship to the mechanical axis (MA), as measured on hip-to-ankle (HTA) radiographs. This study assessed the predictive accuracy of previously developed equations, developed gender-specific regression equations using predictors from standard radiographs, and the clinical effectiveness of these equations in a large sample of cases using HTA radiographs as a gold standard. METHODS The MA was measured on HTA radiographs, whereas TFA and femoral angle were measured on standard radiographs in 788 cases diagnosed with knee osteoarthritis. RESULTS Multiple regression analyses indicated that TFA, femoral angle, and height were the strongest factors associated with the predicting MA, accounting for 83% of the variance for men and 86% for women, but were able to predict only the actual MA within ±3° in 66% of men and 69% of women. When applied to previously reported regression equations with similar results, the best predicative accuracy obtained within ±3° was 61% and 63% of men and women, respectively. CONCLUSION Standard radiographs are not sufficient for determining MA, and HTA radiographs should be used while making surgical decisions aimed at correcting alignment to within ±3° or for assessing alignment post-total knee arthroplasty. In addition, surgical alignment outcomes reported in previous research using standard radiographs should be viewed with caution.
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Affiliation(s)
- Christopher D Stickley
- Department of Kinesiology and Rehabilitation Sciences, University of Hawaii, Honolulu, Hawaii; Department of Anatomy, Biochemistry and Physiology, John A Burns School of Medicine, University of Hawaii, Honolulu, Hawaii
| | - Jennifer J Wages
- Department of Kinesiology and Rehabilitation Sciences, University of Hawaii, Honolulu, Hawaii; Colorado Springs Orthopaedic Group, Colorado Springs, Colorado
| | - Ronald K Hetzler
- Department of Kinesiology and Rehabilitation Sciences, University of Hawaii, Honolulu, Hawaii
| | - Samantha N Andrews
- Department of Kinesiology and Rehabilitation Sciences, University of Hawaii, Honolulu, Hawaii
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Nielsen KA, Thomsen MG, Latifi R, Kallemose T, Husted H, Troelsen A. Does post-operative knee awareness differ between knees in bilateral simultaneous total knee arthroplasty? Predictors of high or low knee awareness. Knee Surg Sports Traumatol Arthrosc 2016; 24:3352-3358. [PMID: 26860099 DOI: 10.1007/s00167-016-4013-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2015] [Accepted: 01/20/2016] [Indexed: 02/06/2023]
Abstract
PURPOSE To evaluate the difference in post-operative knee awareness between knees in patients undergoing bilateral simultaneous total knee arthroplasty (TKA) and to assess factors predicting high or low knee awareness. METHODS This study was conducted on 99 bilateral simultaneous TKAs performed at our institution from 2008 to 2012. All patients received one set of questionnaires [Forgotten Joint Score (FJS) and Oxford Knee Score (OKS)] for each knee. Based on the FJS, the patients' knees were divided into two groups: "best" and "worst" knees. The median of the absolute difference in FJS and OKS within each patient was calculated. Multivariate linear regression was performed to identify factors affecting FJS. RESULTS The difference between knees was 1 point (CI 0-5) for the FJS and 1 point (CI 0-2) for the OKS. The FJS for females increased (decreasing awareness) with increasing age. Males had the highest FJS (lowest awareness) at the age of 67. An increase in the FJS (lower knee awareness) of 12.0 points was found for Kellgren-Lawrence (K-L) grades 3 + 4 compared with K-L grades 1 + 2. A preoperative anatomical alignment of 3° valgus resulted in the lowest FJS (highest knee awareness) with decreasing knee awareness for decreasing tibio-femoral angles. Post-operative alignment did not significantly affect FJS. CONCLUSION Knee awareness did not differ significantly between the "best" and the "worst" knee. Bilateral simultaneous TKA can be performed without compromising the result in one of the knees. Knee awareness after primary TKA was influenced by age, gender, preoperative knee alignment, and severity of OA. LEVEL OF EVIDENCE III.
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Affiliation(s)
| | - Morten Grove Thomsen
- Department of Orthopedic Surgery, Copenhagen University Hospital Hvidovre, Hvidovre, Denmark
| | - Roshan Latifi
- Department of Orthopedic Surgery, Copenhagen University Hospital Hvidovre, Hvidovre, Denmark
| | - Thomas Kallemose
- Department of Orthopedic Surgery, Copenhagen University Hospital Hvidovre, Hvidovre, Denmark
| | - Henrik Husted
- Department of Orthopedic Surgery, Copenhagen University Hospital Hvidovre, Hvidovre, Denmark
| | - Anders Troelsen
- Department of Orthopedic Surgery, Copenhagen University Hospital Hvidovre, Hvidovre, Denmark
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Goulston L, Sanchez-Santos M, D'Angelo S, Leyland K, Hart D, Spector T, Cooper C, Dennison E, Hunter D, Arden N. A comparison of radiographic anatomic axis knee alignment measurements and cross-sectional associations with knee osteoarthritis. Osteoarthritis Cartilage 2016; 24:612-22. [PMID: 26700504 PMCID: PMC4819520 DOI: 10.1016/j.joca.2015.11.009] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2015] [Revised: 11/02/2015] [Accepted: 11/17/2015] [Indexed: 02/02/2023]
Abstract
OBJECTIVE Malalignment is associated with knee osteoarthritis (KOA), however, the optimal anatomic axis (AA) knee alignment measurement on a standard limb radiograph (SLR) is unknown. This study compares one-point (1P) and two-point (2P) AA methods using three knee joint centre locations and examines cross-sectional associations with symptomatic radiographic knee osteoarthritis (SRKOA), radiographic knee osteoarthritis (RKOA) and knee pain. METHODS AA alignment was measured six different ways using the KneeMorf software on 1058 SLRs from 584 women in the Chingford Study. Cross-sectional associations with principal outcome SRKOA combined with greatest reproducibility determined the optimal 1P and 2P AA method. Appropriate varus/neutral/valgus alignment categories were established using logistic regression with generalised estimating equation models fitted with restricted cubic spline function. RESULTS The tibial plateau centre displayed greatest reproducibility and associations with SRKOA. As mean 1P and 2P values differed by >2°, new alignment categories were generated for 1P: varus <178°, neutral 178-182°, valgus >182° and for 2P methods: varus <180°, neutral 180-185°, valgus >185°. Varus vs neutral alignment was associated with a near 2-fold increase in SRKOA and RKOA, and valgus vs neutral for RKOA using 2P method. Nonsignificant associations were seen for 1P method for SRKOA, RKOA and knee pain. CONCLUSIONS AA alignment was associated with SRKOA and the tibial plateau centre had the strongest association. Differences in AA alignment when 1P vs 2P methods were compared indicated bespoke alignment categories were necessary. Further replication and validation with mechanical axis alignment comparison is required.
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Affiliation(s)
- L.M. Goulston
- MRC Lifecourse Epidemiology Unit, Faculty of Medicine, University of Southampton, Southampton, UK
| | - M.T. Sanchez-Santos
- Oxford NIHR Musculoskeletal Biomedical Research Unit, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK,Arthritis Research UK Sports Exercise and Osteoarthritis Centre of Excellence, University of Oxford, UK
| | - S. D'Angelo
- MRC Lifecourse Epidemiology Unit, Faculty of Medicine, University of Southampton, Southampton, UK
| | - K.M. Leyland
- Oxford NIHR Musculoskeletal Biomedical Research Unit, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK,Arthritis Research UK Sports Exercise and Osteoarthritis Centre of Excellence, University of Oxford, UK
| | - D.J. Hart
- Department of Twin Research & Genetic Epidemiology, King's College London, London, UK
| | - T.D. Spector
- Department of Twin Research & Genetic Epidemiology, King's College London, London, UK
| | - C. Cooper
- MRC Lifecourse Epidemiology Unit, Faculty of Medicine, University of Southampton, Southampton, UK
| | - E.M. Dennison
- MRC Lifecourse Epidemiology Unit, Faculty of Medicine, University of Southampton, Southampton, UK
| | - D. Hunter
- Oxford NIHR Musculoskeletal Biomedical Research Unit, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK,Chromatic Innovation Limited, Leamington Spa, UK
| | - N.K. Arden
- MRC Lifecourse Epidemiology Unit, Faculty of Medicine, University of Southampton, Southampton, UK,Oxford NIHR Musculoskeletal Biomedical Research Unit, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK,Arthritis Research UK Sports Exercise and Osteoarthritis Centre of Excellence, University of Oxford, UK,Address correspondence and reprint requests to: N.K. Arden, Oxford NIHR Musculoskeletal Biomedical Research Unit, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Windmill Road, Headington, Oxford, OX3 7LD, UK. Tel: 44-(0)1865-737859; Fax: 44-(0)1865-227966.
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The Inadequacy of Short Knee Radiographs in Evaluating Coronal Alignment After Total Knee Arthroplasty. J Arthroplasty 2016; 31:878-82. [PMID: 26410551 DOI: 10.1016/j.arth.2015.08.015] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2015] [Revised: 08/21/2015] [Accepted: 08/25/2015] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Prior studies have associated coronal alignment after total knee arthroplasty (TKA) with implant survivorship. Results have been based on either the femorotibial angle (FTA) on a short knee film or the hip-knee-ankle angle (HKA) on a full-length radiograph. The purpose of this study was to determine if the FTA on short knee radiographs can accurately predict the true HKA alignment after TKA. METHODS Two orthopedic surgeons measured the FTA, HKA, medial proximal tibial angle, and lateral distal femoral angle in 262 patients who had both short and full-length standing radiographs before and/or after primary TKA. Overall coronal alignment was considered neutral if the FTA was between 2.4° and 7.2° on short knee x-rays or if the HKA was between -3° and 3° on full-length films. RESULTS Preoperatively, 13.9% (26/187) of knees had a neutral FTA on short films, but 50% (13/26) of those were in varus or valgus on full-length films. Postoperatively, 51.4% (106/206) of knees had a neutral FTA on short films, but 27.4% (29/106) of those knees were in varus or valgus on full-length films. When comparing alignment classifications (neutral, varus, or valgus) based on the short vs full-length images, 13.9% (26/187) of patients had discordant classifications on preoperative imaging, and 33.0% (68/206) had discordant classifications on postoperative imaging. CONCLUSION A significant proportion of patients were misclassified as varus, valgus, or neutral based on the FTA when compared to the HKA. Short knee x-rays serve as an inaccurate proxy for full-length films when assessing coronal alignment after TKA.
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Tipton SC, Sutherland J, Schwarzkopf R. Using the Anatomical Axis as an Alternative to the Mechanical Axis to Assess Knee Alignment. Orthopedics 2015; 38:e1115-20. [PMID: 26652333 DOI: 10.3928/01477447-20151123-01] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2015] [Accepted: 04/20/2015] [Indexed: 02/03/2023]
Abstract
The treatment of knee osteoarthritis and the preparation for total knee arthroplasty require repetitive imaging to guide preoperative planning and operative technique. Full-length standing anteroposterior images are the gold standard in assessing the alignment of the limb via the measurement of the mechanical axis of the knee. The anatomical axis can be obtained from a more limited image of the knee, and as such is less expensive and exposes the patient to less ionizing radiation. The objective of this cross-sectional prospective study was to examine the extent to which the anatomical axis measured on a fixed-flexed posteroanterior (Rosenberg view) radiograph correlates with the mechanical axis. The data of 209 total knee arthroplasty radiographs were analyzed to compare the preoperative correlation between the mechanical and anatomical axis. The anatomical axis correlated with the mechanical axis when it was measured from both the standing full-length anteroposterior radiograph and from a fixed-flexed posteroanterior radiograph. Using an angle of offset found from linear regression, these correlations become closer. Body mass index and Kellgren-Lawrence grade were not found to have a significant effect. It is the conclusion of this study that the anatomical axis, as measured from a limited knee radiography, may serve as a plausible estimate of the mechanical axis when done with a neutral angle of offset, and that offset angle depends on gender and the imaging technique used to determine the anatomical axis.
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Beckwée D, Vaes P, Shahabpour M, Muyldermans R, Rommers N, Bautmans I. The Influence of Joint Loading on Bone Marrow Lesions in the Knee: A Systematic Review With Meta-analysis. Am J Sports Med 2015; 43:3093-107. [PMID: 25634907 DOI: 10.1177/0363546514565092] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Bone marrow lesions (BMLs) are considered as predictors of pain, disability, and structural progression of knee osteoarthritis. The relationship between knee loading and BMLs is not yet completely understood. PURPOSE To summarize the available evidence regarding the relationship between joint loading and the prevalence and progression of BMLs in the tibiofemoral joint. STUDY DESIGN Meta-analysis. METHODS Three databases (PubMed, Web of Science, and The Cochrane Library) were systematically screened for studies encompassing BMLs and changes in knee loading. A methodological quality assessment was conducted, and a meta-analysis computing overall odds ratios (ORs) was performed where possible. RESULTS A total of 29 studies involving 7641 participants were included. Mechanical loading was categorized as body weight and composition, compartmental load, structural lesion, and physical activity. High compartmental loads and structural lesions increased the risk for BMLs (overall ORs ranging from 1.56 [95% CI, 1.13-2.15] to 8.2 [95% CI, 4.4-15.1]; P = .006). Body weight increased the risk for BMLs to a lesser extent (overall OR, 1.03; 95% CI, 1.01-1.05; P = .007). Contradictory results for the effect of physical activity on BMLs were found. CONCLUSION Augmented compartmental loads and structural lesions increased the risk of the presence or progression of BMLs. Body weight increased the risk for BMLs to a lesser extent. Contradictory results for the effect of physical activity on BMLs may be explained by a dose-response relationship, knee alignment, and structural lesions. CLINICAL RELEVANCE It has been shown that unloading the knee temporarily may induce beneficial effects on osteoarthritis-related structural changes. Therefore, an early recognition of BMLs in the aging athlete's knee may provide information to counter the onset and aggravation of symptomatic knee osteoarthritis by reducing the knee load.
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Affiliation(s)
- David Beckwée
- Department of Rehabilitation Sciences Research, Vrije Universiteit Brussel, Brussels, Belgium
| | - Peter Vaes
- Department of Rehabilitation Sciences Research, Vrije Universiteit Brussel, Brussels, Belgium
| | - Maryam Shahabpour
- Department of Radiology, Universitair Ziekenhuis Brussel, Brussels, Belgium
| | - Ronald Muyldermans
- Department of Rehabilitation Sciences Research, Vrije Universiteit Brussel, Brussels, Belgium
| | - Nikki Rommers
- Department of Rehabilitation Sciences Research, Vrije Universiteit Brussel, Brussels, Belgium
| | - Ivan Bautmans
- Department of Frailty in Ageing Research, Vrije Universiteit Brussel, Brussels, Belgium
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Lee SA, Choi SH, Chang MJ. How accurate is anatomic limb alignment in predicting mechanical limb alignment after total knee arthroplasty? BMC Musculoskelet Disord 2015; 16:323. [PMID: 26507615 PMCID: PMC4623901 DOI: 10.1186/s12891-015-0756-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2015] [Accepted: 10/05/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Anatomic limb alignment often differs from mechanical limb alignment after total knee arthroplasty (TKA). We sought to assess the accuracy, specificity, and sensitivity for each of three commonly used ranges for anatomic limb alignment (3-9°, 5-10° and 2-10°) in predicting an acceptable range (neutral ± 3°) for mechanical limb alignment after TKA. We also assessed whether the accuracy of anatomic limb alignment was affected by anatomic variation. METHODS This retrospective study included 314 primary TKAs. The alignment of the limb was measured with both anatomic and mechanical methods of measurement. We also measured anatomic variation, including the femoral bowing angle, tibial bowing angle, and neck-shaft angle of the femur. All angles were measured on the same full-length standing anteroposterior radiographs. The accuracy, specificity, and sensitivity for each range of anatomic limb alignment were calculated and compared using mechanical limb alignment as the reference standard. The associations between the accuracy of anatomic limb alignment and anatomic variation were also determined. RESULTS The range of 2-10° for anatomic limb alignment showed the highest accuracy, but it was only 73 % (3-9°, 65 %; 5-10°, 67 %). The specificity of the 2-10° range was 81 %, which was higher than that of the other ranges (3-9°, 69 %; 5-10°, 67 %). However, the sensitivity of the 2-10° range to predict varus malalignment was only 16 % (3-9°, 35 %; 5-10°, 68 %). In addition, the sensitivity of the 2-10° range to predict valgus malalignment was only 43 % (3-9°, 71 %; 5-10°, 43 %). The accuracy of anatomical limb alignment was lower for knees with greater femoral (odds ratio = 1.2) and tibial (odds ratio = 1.2) bowing. CONCLUSIONS Anatomic limb alignment did not accurately predict mechanical limb alignment after TKA, and its accuracy was affected by anatomic variation. Thus, alignment after TKA should be assessed by measuring mechanical alignment rather than anatomic alignment.
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Affiliation(s)
- Seung Ah Lee
- Department of Physical Medicine and Rehabilitation, College of Medicine, Kyung Hee University, Seoul, Republic of Korea.
| | - Sang-Hee Choi
- Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
| | - Moon Jong Chang
- Joint Reconstruction Center, Gwangmyeong Saeum Hospital, Gyeonggi-do, Republic of Korea.
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A 21 % conversion rate to total knee arthroplasty of a first-generation patellofemoral prosthesis at a mean follow-up of 9.7 years. INTERNATIONAL ORTHOPAEDICS 2015; 39:1857-64. [DOI: 10.1007/s00264-015-2941-1] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/27/2015] [Accepted: 06/24/2015] [Indexed: 10/23/2022]
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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] [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.
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Sensitivity of different measures of frontal plane alignment to medial and lateral joint space narrowing: From the osteoarthritis initiative. Semin Arthritis Rheum 2015; 45:268-74. [PMID: 26250956 DOI: 10.1016/j.semarthrit.2015.06.015] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2015] [Revised: 04/21/2015] [Accepted: 06/19/2015] [Indexed: 11/20/2022]
Abstract
OBJECTIVES To explore cross-sectional relationships between a new radiographic measure of the femorotibial angle (FTA), the hip-knee-ankle angle (HKA), and the goniometry; to quantify sex differences between measures; and to evaluate the sensitivity of these measures to medial and lateral joint space narrowing (JSN). METHODS Concurrent validity was evaluated in 2123 knees from the osteoarthritis (OA) initiative using Pearson correlation coefficients (r) and Bland-Altman plots (offsets). Diagnostic validity with respect to JSN was evaluated using areas under the receiver-operating characteristic curves (AUC) and standardized mean differences (SMD). Analyses were stratified by sex and JSN. RESULTS JSN and sex contributed significantly to regression models predicting offsets between measures (p < 0.001), after controlling for age, BMI, and OA severity. There were weak correlations between FTA vs. goniometry (r: 0.16-0.22), and moderate correlations between FTA vs. HKA (r: 0.25-0.53) and HKA vs. goniometry (r: 0.40-0.67). The offset between the new FTA measure and HKA was larger in females than males (p < 0.001). Offsets between radiographic measures and goniometry also varied by sex and JSN (FTA: 2.9°-7.6°; HKA: 0.5°-2.4°). AUC (0.74-0.91) and SMD (0.53-3.80) between JSN strata were largest for FTA, whereas diagnostic validity was moderate for HKA (AUC: 0.69-0.80; SMD: 0.43-2.04) and weakest for handheld goniometry (AUC: 0.56-0.63; SMD: 0.07-0.90). CONCLUSIONS Compared to HKA, goniometry demonstrated poor diagnostic validity with respect to JSN. The new FTA measure, in contrast, represented a reasonable surrogate of radiographic disease severity (JSN). The new FTA measure was skewed in the varus direction when compared to HKA and more so in females. This requires cautious interpretation when measurements are related to previous studies.
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Maderbacher G, Schaumburger J, Baier C, Zeman F, Springorum HR, Dornia C, Grifka J, Keshmiri A. Predicting knee rotation by the projection overlap of the proximal fibula and tibia in long-leg radiographs. Knee Surg Sports Traumatol Arthrosc 2014; 22:2982-8. [PMID: 25253236 DOI: 10.1007/s00167-014-3327-4] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2014] [Accepted: 09/12/2014] [Indexed: 11/30/2022]
Abstract
PURPOSE Rotation of the lower limbs in long-leg radiographs has a significant impact on imaging the mechanical femorotibial angle, the femoral anatomic mechanical angle, the mechanical lateral distal femoral angle (mLDFA) and the mechanical medial proximal tibial angle (mMPTA). In this study, we assessed the rotation of the lower limbs in conventional radiographs and hypothesized that the relative position of the proximal fibula to the proximal tibia on long-leg radiographs is related to the rotation of the knee joint. METHODS Radiological examinations in different rotational positions of the knee joint (incremental 40° internal to 40° external rotation) were imitated by 50 computed tomography scans (50 patients, 25 men and 25 women). The extent of the projection overlaps of the fibula, the fibular tip and the distance from the fibular tip to the lateral cortex were determined for every rotational position. RESULTS Multiple regression analysis showed a very strong correlation between the measured fibular parameters and knee rotation between 20° of internal rotation and 40° of external rotation (R (2) ~ 0.94, p < 0.001). By means of these results, we created a formula for predicting knee rotation: [Formula: see text]This strong correlation could not be found between 20° and 40° of internal rotation. DISCUSSION Because incorrect internal and external rotation negatively influence the correct measurement of angles (mechanical femorotibial angle, femoral anatomic mechanical angle, the mLDFA and the mMPTA), long-leg radiographs should be assessed for proper rotation angles before measurement. Using the provided formula rotation of the lower limb in weight-bearing, long-leg radiographs can be reliably predicted. LEVEL OF EVIDENCE Diagnostic study, Level II.
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Affiliation(s)
- Günther Maderbacher
- Department of Orthopaedic Surgery, University of Regensburg, Regensburg, Germany,
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An update on risk factors for cartilage loss in knee osteoarthritis assessed using MRI-based semiquantitative grading methods. Eur Radiol 2014; 25:883-93. [DOI: 10.1007/s00330-014-3464-7] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2014] [Revised: 09/20/2014] [Accepted: 10/01/2014] [Indexed: 02/01/2023]
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Maderbacher G, Keshmiri A, Schaumburger J, Springorum HR, Zeman F, Grifka J, Baier C. Accuracy of bony landmarks for restoring the natural joint line in revision knee surgery: an MRI study. INTERNATIONAL ORTHOPAEDICS 2014; 38:1173-81. [PMID: 24570152 DOI: 10.1007/s00264-014-2292-3] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/08/2014] [Accepted: 01/27/2014] [Indexed: 01/28/2023]
Abstract
PURPOSE Restoring the joint line (JL) improves clinical and functional outcome in total knee arthroplasty (TKA). Therefore, anatomical landmarks to approximate the JL have been published. So far, the natural deviation of the JL 90° to the mechanical tibial axis has not been considered. Thus, we designed this study to: (1) determine the natural JL of knees in healthy persons in respect to the mechanical tibial axis, (2) validate and double-check intra-operative bony landmarks already been published in respect to the natural JL and (3) find possible correlations between distances from bony landmarks to the JL and femoral and tibial width. METHODS Eighty MRI scans of knees of healthy persons were examined by two independent observers. Distances from the tip of the fibular head (FH), the medial (ME) and lateral (LE) epicondyles and the adductor tubercle (AT) to the JL within the medial and lateral compartment were measured. Further, we determined the orientation of the JL in respect to the mechanical axis of the tibia. Interobserver correlations were calculated. Differences were analyzed using Student's t test. Linear regression models were calculated to analyze correlations. RESULTS Interobserver correlation was excellent. Mean JL deviation was 4.2° varus. Distance between the FH, ME, LE and AT to the JL within the medial compartment was 12.2, 33.9, 33.4 and 45.4 mm, respectively. Within in the lateral compartment, distances were 15.3, 31.0, 30.6 and 42.3 mm to the JL. Strong correlation was found between femoral width and distances from the AT, ME and LE to the JL. CONCLUSION In TKA, the JL is usually altered due to the classic resection technique, which does not respect the natural deviation of the JL. Estimating the natural JL by adding absolute values to bony landmarks, as proposed in the literature, is not recommended. According to our data, the JL can be best estimated by adding the calculated value: 6.40 + (width femur [mm] × 0.49) to the AT.
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Affiliation(s)
- Günther Maderbacher
- Department of Orthopaedic Surgery, University of Regensburg, Regensburg, Germany,
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Ishimaru D, Sugiura N, Akiyama H, Watanabe H, Matsumoto K. Alterations in the chondroitin sulfate chain in human osteoarthritic cartilage of the knee. Osteoarthritis Cartilage 2014; 22:250-8. [PMID: 24280246 DOI: 10.1016/j.joca.2013.11.010] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2013] [Revised: 11/05/2013] [Accepted: 11/15/2013] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To determine whether the structure of chondroitin sulfate (CS) in cartilage is reflected by the degree of cartilage degeneration in patients with osteoarthritis (OA) of the knee and to determine how CS biosynthesis affects cartilage degeneration. DESIGN Two osteoarthritic cartilage samples were obtained from medial femoral condyle (MFC) and lateral femoral condyle (LFC) of 24 knees with end-stage OA. The samples were assigned to two groups as follows: lesion and remote cartilage were adjacent to and remote from the osteoarthritic cartilage, respectively. Histological grade was determined according to the Mankin score. The CS concentration and chain length were determined using high-performance liquid chromatography (HPLC) and gel filtration chromatography, respectively. Expression of the gene encoding CS glycosyltransferase was evaluated using a real-time quantitative polymerase chain reaction (qPCR) assay. These results were compared between lesion and remote cartilage. RESULTS The Mankin score indicated that lesion cartilage was more degraded compared with remote cartilage. Although the CS levels varied among individuals, the mean CS concentration and chain length were significantly lower and shorter in lesion cartilage than in remote cartilage, respectively (concentration: 12.04 vs 14.84 μg/mg wet weight, P = 0.021; chain length: 5.36 vs 6.19 kDa, P = 0.026). Three genes encoding CS glycosyltransferases (CHPF, CSGALNACT1, CSGALNACT2) were expressed at lower levels in lesion cartilage. CONCLUSIONS In the osteoarthritic knee, the CS concentration and chain length were reduced closer to the more degraded cartilage with decreasing CS glycosyltransferase gene expression. Inhibition of CS glycosyltransferase gene expression may reduce CS chain length, which may contribute to OA progression.
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Affiliation(s)
- D Ishimaru
- Department of Orthopaedic Surgery, Gifu University, Graduate School of Medicine, Gifu, Japan.
| | - N Sugiura
- Institute for Molecular Science of Medicine, Aichi Medical University, Nagakute, Aichi, Japan.
| | - H Akiyama
- Department of Orthopaedic Surgery, Gifu University, Graduate School of Medicine, Gifu, Japan.
| | - H Watanabe
- Institute for Molecular Science of Medicine, Aichi Medical University, Nagakute, Aichi, Japan.
| | - K Matsumoto
- Department of Orthopaedic Surgery, Gifu University, Graduate School of Medicine, Gifu, Japan.
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Donner R, Menze BH, Bischof H, Langs G. Global localization of 3D anatomical structures by pre-filtered Hough forests and discrete optimization. Med Image Anal 2013; 17:1304-14. [PMID: 23664450 PMCID: PMC3807803 DOI: 10.1016/j.media.2013.02.004] [Citation(s) in RCA: 70] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2012] [Revised: 01/28/2013] [Accepted: 02/11/2013] [Indexed: 02/04/2023]
Abstract
The accurate localization of anatomical landmarks is a challenging task, often solved by domain specific approaches. We propose a method for the automatic localization of landmarks in complex, repetitive anatomical structures. The key idea is to combine three steps: (1) a classifier for pre-filtering anatomical landmark positions that (2) are refined through a Hough regression model, together with (3) a parts-based model of the global landmark topology to select the final landmark positions. During training landmarks are annotated in a set of example volumes. A classifier learns local landmark appearance, and Hough regressors are trained to aggregate neighborhood information to a precise landmark coordinate position. A non-parametric geometric model encodes the spatial relationships between the landmarks and derives a topology which connects mutually predictive landmarks. During the global search we classify all voxels in the query volume, and perform regression-based agglomeration of landmark probabilities to highly accurate and specific candidate points at potential landmark locations. We encode the candidates' weights together with the conformity of the connecting edges to the learnt geometric model in a Markov Random Field (MRF). By solving the corresponding discrete optimization problem, the most probable location for each model landmark is found in the query volume. We show that this approach is able to consistently localize the model landmarks despite the complex and repetitive character of the anatomical structures on three challenging data sets (hand radiographs, hand CTs, and whole body CTs), with a median localization error of 0.80 mm, 1.19 mm and 2.71 mm, respectively.
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Affiliation(s)
- René Donner
- Computational Image Analysis and Radiology Lab, Department of Radiology, Medical University of Vienna, Austria; Institute for Computer Graphics and Vision, Graz University of Technology, Austria.
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Laxafoss E, Jacobsen S, Gosvig KK, Sonne-Holm S. The alignment of the knee joint in relationship to age and osteoarthritis: the Copenhagen Osteoarthritis Study. Skeletal Radiol 2013; 42:531-40. [PMID: 22965223 DOI: 10.1007/s00256-012-1509-z] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2012] [Revised: 06/30/2012] [Accepted: 08/19/2012] [Indexed: 02/02/2023]
Abstract
INTRODUCTION The aim of the present study was to describe the changes in the axis of the knee joint in both radiologically osteoarthritic and non-osteoarthritic knees, on the basis of angles measurable in standardized clinical short knee radiographs, in a cross sectional study of an epidemiological cohort. DESIGN From the third inclusion of the Copenhagen City Heart Study, 4,151 subjects were selected for standardized radiography of the knees. After censuring the inclusion, the resulting cohort was comprised of 3,488 individuals. Images were analyzed for radiological knee joint osteoarthritis (OA) and the anatomical femorotibial axis of the knee joint was measured. RESULTS The prevalence of knee joint OA in males was 27.9% and 27.5%, for the left and right knees respectively. In females this was 32.8% and 36.4%. The mean knee joint angles were 4.11° in males; and 5.45° in females. A difference of 1.3° was found between the genders. In non-osteoarthritic knees the increase in valgus orientation in relationship to increasing age was found to be 0.03° and 0.04° per year, respectively, for males and females. Likewise, Kellgren and Lawrence found that OA was seen to influence a shift towards varus of 0.55°-0.76° per level of OA. CONCLUSION Stratification in accordance with morphological severity of OA documented a clear tendency for the axis of the diseased knees to depart from the mean, primarily in the direction of varus. In knees exhibiting no signs of radiographic osteoarthritis we found a significant relationship between increasing age and a shift in the anatomical axis in the direction of valgus.
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Affiliation(s)
- Erling Laxafoss
- Department of Orthopaedic Surgery, Copenhagen University Hospital of Hvidovre, Kettegaards Allé 30, 2650, Hvidovre, Denmark.
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Armenis E, Pefanis N, Tsiganos G, Karagounis P, Tokatlidou C, Baltopoulos P. The impact of knee surface alignment on ankle sprain occurrence. Foot Ankle Spec 2012; 5:382-8. [PMID: 23064473 DOI: 10.1177/1938640012463054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Knee position provides useful information for the anatomical alignment of the lower extremity. Analyzing the geometric components of this alignment should yield useful information about how these factors affect the occurrence of an ankle sprain. The aim of this study is to investigate the correlation among these anthropometric characteristics and the possible future occurrence of ankle sprain injuries. MATERIAL AND METHODS A total of 60 elite athletes (25.2 ± 3.2 years) participated in the current study. The data used for measuring knee surface alignment were the following: anatomical alignment angle (AA), condylar hip angle (CH), tibial plateau angle (PA), and joint surface (condylar plateau) angle (CP). Standardized radiography was used in all measurements. All knee alignment measurements were made on digital radiographs. The study lasted for 18 months. A logistic regression (probit) was used for the statistical analysis of the outcomes. A significance level of P = .05 was considered. RESULTS The knee angle factors (AA, CH, PA, and CP) proved to be statistically nonsignificant (P > .05). CONCLUSIONS The geometric knee surface alignment factors do not seem to be a decisive factor that would increase the probability of spraining an ankle. LEVELS OF EVIDENCE PROGNOSTIC LEVEL IV: Case Series.
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Hayashi D, Englund M, Roemer FW, Niu J, Sharma L, Felson DT, Crema MD, Marra MD, Segal NA, Lewis CE, Nevitt MC, Guermazi A. Knee malalignment is associated with an increased risk for incident and enlarging bone marrow lesions in the more loaded compartments: the MOST study. Osteoarthritis Cartilage 2012; 20:1227-33. [PMID: 22874524 PMCID: PMC3448813 DOI: 10.1016/j.joca.2012.07.020] [Citation(s) in RCA: 62] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2012] [Revised: 06/30/2012] [Accepted: 07/28/2012] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To examine the relationship of knee malalignment with occurrence of incident and enlarging bone marrow lesions (BMLs) and regression of BMLs. METHODS Subjects from the Multicenter Osteoarthritis Study aged 50-79 years with or at high risk of knee osteoarthritis were studied. Full-limb radiographs were taken at baseline and hip-knee-ankle mechanical axis was measured. Baseline and 30-month magnetic resonance imaging (MRI) of knees (n = 1782) were semiquantitatively assessed for BMLs. Outcome was defined as a change in BML score in femoral/tibial condyle in medial/lateral compartments. Medial compartment in varus alignment and lateral compartment in valgus alignment were combined to form 'more loaded' compartment, while lateral compartment in valgus and medial compartment in varus were combined to form 'less loaded' compartment. Relative risk (RR) of BML score increase or decrease in relation to malalignment was estimated using a log linear regression model with the Poisson assumption, adjusting for age, gender, body mass index, physical activity scale for the elderly, race and clinic site. Further, results were stratified by ipsilateral meniscal and cartilage status at baseline. RESULTS Baseline varus alignment was associated with higher risk of BML score increase from baseline to follow-up in the medial compartment [adjusted RRs (95%CI): 1.5 (1.2-1.9)] and valgus alignment in the lateral compartment [1.4 (1.0-2.1)]. Increase in BML score was more likely in the more loaded compartments [1.7 (1.4-2.0)] in malaligned knees. Regardless of ipsilateral cartilage or meniscus status, adjusted RR for BML score increase was higher in the more loaded compartments of malaligned knees than those with neutral alignment. Decrease in BML score was less likely in the more loaded compartments in malaligned knees [0.8 (0.7-1.0)]. CONCLUSION Knee malalignment is associated with increased risk of incident and enlarging BMLs in the more loaded compartments of the tibiofemoral joint.
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Affiliation(s)
- Daichi Hayashi
- Quantitative Imaging Center, Department of Radiology, Boston University School of Medicine, Boston, MA 02118, USA
| | - Martin Englund
- Clinical Epidemiology Research & Training Unit, Boston University School of Medicine, Boston, MA 02118, USA,Lund University, SE-221 85 Lund, Sweden
| | - Frank W. Roemer
- Quantitative Imaging Center, Department of Radiology, Boston University School of Medicine, Boston, MA 02118, USA,Department of Radiology, Klinikum Augsburg, Augsburg 86156, Germany
| | - Jingbo Niu
- Clinical Epidemiology Research & Training Unit, Boston University School of Medicine, Boston, MA 02118, USA
| | - Leena Sharma
- Division of Rheumatology, Northwestern University, Chicago, IL 60611, USA
| | - David T. Felson
- Clinical Epidemiology Research & Training Unit, Boston University School of Medicine, Boston, MA 02118, USA
| | - Michel D. Crema
- Quantitative Imaging Center, Department of Radiology, Boston University School of Medicine, Boston, MA 02118, USA,Department of Radiology, Hospital do Coração (HCor) and Teleimagem, São Paulo, SP, Brazil
| | - Monica D. Marra
- Quantitative Imaging Center, Department of Radiology, Boston University School of Medicine, Boston, MA 02118, USA
| | - Neil A. Segal
- Department of Orthopaedics and Rehabilitation, The University of Iowa, Iowa City, IA 52242, USA
| | - Cora E. Lewis
- Division of Preventive Medicine, University of Alabama at Birmingham, Birmingham, AL 35205, USA
| | - Michael C. Nevitt
- Department of Epidemiology and Biostatistics, University of California at San Francisco, San Francisco, CA 94107, USA
| | - Ali Guermazi
- Quantitative Imaging Center, Department of Radiology, Boston University School of Medicine, Boston, MA 02118, USA
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Validity of clinical measures of frontal plane knee alignment: data from the Osteoarthritis Initiative. ACTA ACUST UNITED AC 2012; 17:459-65. [PMID: 22683009 DOI: 10.1016/j.math.2012.05.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2011] [Revised: 05/01/2012] [Accepted: 05/08/2012] [Indexed: 11/23/2022]
Abstract
Clinicians frequently assess frontal plane knee alignment of patients suspected of having knee osteoarthritis. However, there is little data to indicate whether simple to obtain clinical measures frontal plane alignment indicate the actual bony alignment of the knee or the extent and type of knee osteoarthritis. The purpose of this study was to assess the validity of goniometric measures of frontal plan knee position as a simple clinical tool to assess lower limb alignment and tibiofemoral OA status. Data from the Osteoarthritis Initiative were used to assess concurrent and diagnostic validity of goniometric measures. Data from 142 persons with symptomatic knee OA were used to examine concurrent validity, based on comparison to whole limb radiographs. Diagnostic validity was examined using data from 1390 persons with symptomatic knee OA, based on comparison to tibiofemoral joint space narrowing obtained from standardized radiographs. Associations between goniometric measures and whole limb radiographs were moderate (r = 0.43 for right knee and r = 0.46 for left knee). Goniometric measurements explained approximately 20% of the variation in lower limb alignment as measured by whole limb radiography suggesting that simple clinical measures of lower limb alignment contain too much error for inferring actual lower limb alignment. Diagnostic validity indicated positive likelihood ratios of 3.3 or less for detecting isolated severe medial or lateral joint space narrowing and a high rate of misclassification. Simple clinical assessments of frontal plane lower limb alignment or tibiofemoral OA status, in isolation, contain substantial error and likely do not inform clinical practice.
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49
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Zifchock RA, Kirane Y, Hillstrom H. Are joint structure and function related to medial knee OA pain? A pilot study. Clin Orthop Relat Res 2011; 469:2866-73. [PMID: 21769678 PMCID: PMC3171541 DOI: 10.1007/s11999-011-1969-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2010] [Accepted: 06/28/2011] [Indexed: 01/31/2023]
Abstract
BACKGROUND Although the severity of knee osteoarthritis (OA) usually is assessed using different measures of joint structure, function, and pain, the relationships between these measures are unclear. PURPOSE Therefore, we: (1) examined the relationships between the measures of knee structure (flexion-extension range of motion, radiographic tibiofemoral angle, and medial joint space), function (Knee Osteoarthritis Outcome Scores [KOOS], peak adduction angle, and moment), and pain (visual analog scale [VAS]); and (2) identified variables that best predicted knee pain. METHODS We assessed 15 patients with medial knee OA using VAS pain, KOOS questionnaire, 3-D gait analysis, and radiographic examination. Parameter relationships were assessed using Pearson correlation, and variables most predictive of knee pain were determined using a stepwise multiple regression. RESULTS Subjective measurements correlated (|r| ≥ 0.54) with one another, as did most of the objective measurements (|r| ≥ 0.56) except for adduction moment which did not correlate with any variable. All variables correlated (|r| > 0.54) with VAS knee pain except peak adduction moment. Medial joint space and peak adduction angle best predicted knee pain, accounting for approximately three-quarters of the model variance (r(2) = 0.73). CONCLUSIONS Medial joint space and peak adduction angle may be useful for predicting knee pain in patients with medial knee OA. Therapies that target these structural and functional variables may reduce knee pain in this population. CLINICAL RELEVANCE Increasing the medial joint space and limiting the peak knee adduction angle may be critical in achieving effective pain relief in patients with varus knee OA.
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Affiliation(s)
- Rebecca Avrin Zifchock
- Leon Root, MD Motion Analysis Laboratory, Department of Rehabilitation, Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021 USA
| | - Yatin Kirane
- Leon Root, MD Motion Analysis Laboratory, Department of Rehabilitation, Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021 USA
| | - Howard Hillstrom
- Leon Root, MD Motion Analysis Laboratory, Department of Rehabilitation, Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021 USA
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50
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Systematic review of the concurrent and predictive validity of MRI biomarkers in OA. Osteoarthritis Cartilage 2011; 19:557-88. [PMID: 21396463 PMCID: PMC3268360 DOI: 10.1016/j.joca.2010.10.029] [Citation(s) in RCA: 148] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2010] [Revised: 09/14/2010] [Accepted: 10/17/2010] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To summarize literature on the concurrent and predictive validity of MRI-based measures of osteoarthritis (OA) structural change. METHODS An online literature search was conducted of the OVID, EMBASE, CINAHL, PsychInfo and Cochrane databases of articles published up to the time of the search, April 2009. 1338 abstracts obtained with this search were preliminarily screened for relevance by two reviewers. Of these, 243 were selected for data extraction for this analysis on validity as well as separate reviews on discriminate validity and diagnostic performance. Of these 142 manuscripts included data pertinent to concurrent validity and 61 manuscripts for the predictive validity review. For this analysis we extracted data on criterion (concurrent and predictive) validity from both longitudinal and cross-sectional studies for all synovial joint tissues as it relates to MRI measurement in OA. RESULTS Concurrent validity of MRI in OA has been examined compared to symptoms, radiography, histology/pathology, arthroscopy, CT, and alignment. The relation of bone marrow lesions, synovitis and effusion to pain was moderate to strong. There was a weak or no relation of cartilage morphology or meniscal tears to pain. The relation of cartilage morphology to radiographic OA and radiographic joint space was inconsistent. There was a higher frequency of meniscal tears, synovitis and other features in persons with radiographic OA. The relation of cartilage to other constructs including histology and arthroscopy was stronger. Predictive validity of MRI in OA has been examined for ability to predict total knee replacement (TKR), change in symptoms, radiographic progression as well as MRI progression. Quantitative cartilage volume change and presence of cartilage defects or bone marrow lesions are potential predictors of TKR. CONCLUSION MRI has inherent strengths and unique advantages in its ability to visualize multiple individual tissue pathologies relating to pain and also predict clinical outcome. The complex disease of OA which involves an array of tissue abnormalities is best imaged using this imaging tool.
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