1
|
Thöne P, Gruber MS, Kindermann H, Gussner W, Sadoghi P, Ortmaier R. Stem Design in Total Hip Arthroplasty Influences Ipsilateral Knee Valgus: A Retrospective Comparative Analysis of 2953 Cases. J Clin Med 2023; 12:6662. [PMID: 37892800 PMCID: PMC10607773 DOI: 10.3390/jcm12206662] [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: 09/04/2023] [Revised: 10/13/2023] [Accepted: 10/17/2023] [Indexed: 10/29/2023] Open
Abstract
BACKGROUND Total hip arthroplasty (THA) affects the biomechanics of the hip and the patient gait. The stem design influences femoral lever ratios and tissue trauma. Biomechanical changes such as these have the potential to induce knee arthritis. A varus or valgus configuration of knee arthritis is formed by asymmetric loadings. The aim of this study was to evaluate the impact of stem design in THA on knee valgus by comparing a standard implant with an implant with a short stem. METHODS A total of 2953 patients who underwent primary total knee arthroplasty for end-stage osteoarthritis between 2015 and 2021 were included in this retrospective data analysis. Patients were divided into three groups, depending on hip status (straight stem, short stem, and native joint). Leg alignment was distinguished as varus or valgus, and the degree of axial deviation was measured. Descriptive and explorative statistical analyses were performed, with a p value < 0.05 set as significant. RESULTS Ipsilateral knee valgus occurred significantly more often in patients with straight stems (57.2%) than in those with short stems (29%) and native joints (25.8%) (p < 0.001). Additionally, mean valgus deviation was significantly increased in patients with straight stems (8.9°) compared to those with short stems (6.4°) or native hip joints (6.7°). Both findings were accentuated in women. CONCLUSIONS Previous ipsilateral straight-stem THA is associated with knee valgus deformity, especially in women. Short-stem THA seems to be better suited to restoring physiological biomechanics and preventing the development of valgus osteoarthritis of the ipsilateral knee.
Collapse
Affiliation(s)
- Paul Thöne
- Medical Faculty, Johannes Kepler University Linz, 4020 Linz, Austria
- Department of Orthopedic Surgery, Ordensklinikum Linz Barmherzige Schwestern, Vinzenzgruppe Center of Orthopedic Excellence, Teaching Hospital of the Paracelsus Medical University, 5020 Salzburg, Austria
| | - Michael Stephan Gruber
- Department of Orthopedic Surgery, Ordensklinikum Linz Barmherzige Schwestern, Vinzenzgruppe Center of Orthopedic Excellence, Teaching Hospital of the Paracelsus Medical University, 5020 Salzburg, Austria
| | - Harald Kindermann
- Department of Marketing and Electronic Business, University of Applied Sciences Upper Austria, 4400 Steyr, Austria;
| | - Walter Gussner
- Department of Orthopedic Surgery, Ordensklinikum Linz Barmherzige Schwestern, Vinzenzgruppe Center of Orthopedic Excellence, Teaching Hospital of the Paracelsus Medical University, 5020 Salzburg, Austria
| | - Patrick Sadoghi
- Department of Orthopedics and Trauma, Medical University of Graz, Austria Auenbruggerplatz 5, 8036 Graz, Austria
| | - Reinhold Ortmaier
- Department of Orthopedic Surgery, Ordensklinikum Linz Barmherzige Schwestern, Vinzenzgruppe Center of Orthopedic Excellence, Teaching Hospital of the Paracelsus Medical University, 5020 Salzburg, Austria
| |
Collapse
|
2
|
Pagan CA, Karasavvidis T, Lebrun DG, Jang SJ, MacDessi SJ, Vigdorchik JM. Geographic Variation in Knee Phenotypes Based on the Coronal Plane Alignment of the Knee Classification: A Systematic Review. J Arthroplasty 2023; 38:1892-1899.e1. [PMID: 36963533 DOI: 10.1016/j.arth.2023.03.047] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Revised: 03/13/2023] [Accepted: 03/16/2023] [Indexed: 03/26/2023] Open
Abstract
BACKGROUND The extent of geographic variation in knee phenotypes remains unclear. The Coronal Plane Alignment of the Knee (CPAK) Classification proposes 9 coronal plane phenotypes based on constitutional limb alignment and joint line obliquity. This systematic review aims to examine differences in the distributions of CPAK types across geographic regions. METHODS A systematic review of the literature was performed according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Studies reporting distributions of knee phenotypes according to the CPAK classification for healthy and/or arthritic knees were included. RESULTS There were 7 studies included, accounting for 5,964 knees in 3,917 subjects. Among healthy knees (n = 1,214), CPAK type II was the most common type in Belgium (39.2%), Taiwan (39.3%), and India (25.6%). Among arthritic knees (n = 2,804), CPAK type I was the most common in France (33.4%), India (58.8%), and Japan (53.8%), whereas CPAK type II was the most common in Australia (32.8%). The proportion of CPAK type I and II knees varied significantly across geographic regions among healthy (P < .01) and arthritic knees (P < .01). CONCLUSION Significant variation in CPAK distributions exists between countries. Further work is needed to delineate racial and sexual differences in CPAK types, which were not explored in this article. A better understanding of population-level variability in knee phenotypes may enable orthopaedic surgeons to offer a more personalized approach to knee arthroplasty.
Collapse
Affiliation(s)
- Cale A Pagan
- Adult Reconstruction and Joint Replacement Service, Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, New York
| | - Theofilos Karasavvidis
- Adult Reconstruction and Joint Replacement Service, Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, New York
| | - Drake G Lebrun
- Adult Reconstruction and Joint Replacement Service, Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, New York
| | - Seong J Jang
- Adult Reconstruction and Joint Replacement Service, Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, New York; Weill Cornell College of Medicine, New York, New York
| | - Samuel J MacDessi
- Sydney Knee Specialists, Kogarah, New South Wales, Australia; St. George and Sutherland Clinical School, University of New South Wales, St George Hospital, Kogarah, New South Wales, Australia; Department of Orthopaedic Surgery, St George Private Hospital, Kogarah, New South Wales, Australia
| | - Jonathan M Vigdorchik
- Adult Reconstruction and Joint Replacement Service, Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, New York
| |
Collapse
|
3
|
Batailler C, Naaim A, Daxhelet J, Lustig S, Ollivier M, Parratte S. Impact of the diaphyseal femoral deformity on the lower limb alignment in osteoarthritic varus knees. Bone Jt Open 2023; 4:262-272. [PMID: 37051842 PMCID: PMC10085644 DOI: 10.1302/2633-1462.44.bjo-2023-0024.r1] [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: 04/14/2023] Open
Abstract
The impact of a diaphyseal femoral deformity on knee alignment varies according to its severity and localization. The aims of this study were to determine a method of assessing the impact of diaphyseal femoral deformities on knee alignment for the varus knee, and to evaluate the reliability and the reproducibility of this method in a large cohort of osteoarthritic patients. All patients who underwent a knee arthroplasty from 2019 to 2021 were included. Exclusion criteria were genu valgus, flexion contracture (> 5°), previous femoral osteotomy or fracture, total hip arthroplasty, and femoral rotational disorder. A total of 205 patients met the inclusion criteria. The mean age was 62.2 years (SD 8.4). The mean BMI was 33.1 kg/m2 (SD 5.5). The radiological measurements were performed twice by two independent reviewers, and included hip knee ankle (HKA) angle, mechanical medial distal femoral angle (mMDFA), anatomical medial distal femoral angle (aMDFA), femoral neck shaft angle (NSA), femoral bowing angle (FBow), the distance between the knee centre and the top of the FBow (DK), and the angle representing the FBow impact on the knee (C'KS angle). The FBow impact on the mMDFA can be measured by the C'KS angle. The C'KS angle took the localization (length DK) and the importance (FBow angle) of the FBow into consideration. The mean FBow angle was 4.4° (SD 2.4; 0 to 12.5). The mean C'KS angle was 1.8° (SD 1.1; 0 to 5.8). Overall, 84 knees (41%) had a severe FBow (> 5°). The radiological measurements showed very good to excellent intraobserver and interobserver agreements. The C'KS increased significantly when the length DK decreased and the FBow angle increased (p < 0.001). The impact of the diaphyseal femoral deformity on the mechanical femoral axis is measured by the C'KS angle, a reliable and reproducible measurement.
Collapse
Affiliation(s)
- Cécile Batailler
- Department of Orthopaedic Surgery, Croix-Rousse Hospital, Lyon University Hospital, Lyon, France
- Claude Bernard Lyon 1 University, Villeurbanne, France
| | | | - Jeremy Daxhelet
- Department of Orthopaedic Surgery, Clinique Saint-Luc Bouge, Namur, Belgium
| | - Sébastien Lustig
- Department of Orthopaedic Surgery, Croix-Rousse Hospital, Lyon University Hospital, Lyon, France
- Claude Bernard Lyon 1 University, Villeurbanne, France
| | - Matthieu Ollivier
- Institute of Movement and Locomotion, Department of Orthopedics and Traumatology, St. Marguerite Hospital, Marseille, France
| | - Sebastien Parratte
- Institute of Movement and Locomotion, Department of Orthopedics and Traumatology, St. Marguerite Hospital, Marseille, France
- Department of Orthopaedic Surgery, International Knee and Joint Centre, Abu Dhabi, United Arab Emirates
| |
Collapse
|
4
|
Mulpur P, Desai KB, Mahajan A, Masilamani ABS, Hippalgaonkar K, Reddy AVG. Radiological Evaluation of the Phenotype of Indian Osteoarthritic Knees based on the Coronal Plane Alignment of the Knee Classification (CPAK). Indian J Orthop 2022; 56:2066-2076. [PMID: 36507214 PMCID: PMC9705643 DOI: 10.1007/s43465-022-00756-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Accepted: 09/15/2022] [Indexed: 02/04/2023]
Abstract
Background Understanding constitutional alignment of the lower limb is essential to optimize alignment strategies during total knee arthroplasty. The coronal plane alignment of knee (CPAK) classification system was proposed as a comprehensive assessment tool based on coronal alignment and variations in joint line obliquity (JLO). This prospective observational cross-sectional study aimed to evaluate the phenotype of knees in the Indian population based on the CPAK system. Methods Two cohorts of individuals (250 young healthy volunteers and 250 elderly patients with knee osteoarthritis) underwent radiological assessment with long-leg radiographs and were classified based on the CPAK system. Measurements included the mechanical and arithmetic hip-knee-ankle angles (mHKA, aHKA), joint line obliquity (JLO), lateral distal femoral angle (mLDFA) and medial proximal tibial angle (mMPTA). Knees were grouped into 9 CPAK phenotypes based on aHKA and JLO. Results A total of 1000 knees were evaluated. In cohort-1 of healthy young adults, most knees were distributed in the CPAK class II phenotype (128 knees, 25.6%) followed by CPAK Type I (106 knees, 21.2%). In cohort-2 of elderly arthritic adults, most knees were distributed in Type I (294 knees, 58.8%) with constitutional varus and apex-distal joint line orientation. Conclusion The majority of the study population was found to have constitutional varus alignment. In addition, a high proportion of patients in both categories, especially arthritic patients undergoing TKA, were found to have varus alignment with an apex-distal oblique joint line. This classification may help optimize component positioning to restore constitutional alignment and joint line orientation during TKA.
Collapse
Affiliation(s)
- Praharsha Mulpur
- Sunshine Bone and Joint Institute, Sunshine Hospitals, PG Road, opposite Parsi Dharamsala, Paradise, Sappu Bagh Apartments, Jogani, Ramgopalpet, Secunderabad, Hyderabad, Telangana 500003 India
| | - Keyur B. Desai
- Sunshine Bone and Joint Institute, Sunshine Hospitals, PG Road, opposite Parsi Dharamsala, Paradise, Sappu Bagh Apartments, Jogani, Ramgopalpet, Secunderabad, Hyderabad, Telangana 500003 India
| | - Aakarsh Mahajan
- Sunshine Bone and Joint Institute, Sunshine Hospitals, PG Road, opposite Parsi Dharamsala, Paradise, Sappu Bagh Apartments, Jogani, Ramgopalpet, Secunderabad, Hyderabad, Telangana 500003 India
| | - A. B. Suhas Masilamani
- Sunshine Bone and Joint Institute, Sunshine Hospitals, PG Road, opposite Parsi Dharamsala, Paradise, Sappu Bagh Apartments, Jogani, Ramgopalpet, Secunderabad, Hyderabad, Telangana 500003 India
| | - Kushal Hippalgaonkar
- Sunshine Bone and Joint Institute, Sunshine Hospitals, PG Road, opposite Parsi Dharamsala, Paradise, Sappu Bagh Apartments, Jogani, Ramgopalpet, Secunderabad, Hyderabad, Telangana 500003 India
| | - A. V. Gurava Reddy
- Sunshine Bone and Joint Institute, Sunshine Hospitals, PG Road, opposite Parsi Dharamsala, Paradise, Sappu Bagh Apartments, Jogani, Ramgopalpet, Secunderabad, Hyderabad, Telangana 500003 India
| |
Collapse
|
5
|
Functional knee phenotypes of OA patients undergoing total knee arthroplasty are significantly more varus or valgus than in a non-OA control group. Knee Surg Sports Traumatol Arthrosc 2022; 30:2609-2616. [PMID: 34379167 DOI: 10.1007/s00167-021-06687-5] [Citation(s) in RCA: 25] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Accepted: 07/29/2021] [Indexed: 10/20/2022]
Abstract
PURPOSE The aim of this study was to analyse the coronal alignment of a large population of patients undergoing total knee arthroplasty using a modern classification of the knee phenotypes found in a population of non-osteoarthritic individuals. METHODS Five hundred and four navigated total knee arthroplasties were included in the OA group. The following angles were measured with a computer image-free navigation system: mechanical femorotibial angle measured on the medial side without stress and with maximum manual stress to reduce deformation, and medial distal femoral mechanical angle. The native medial distal femoral and medial proximal tibial angles (coronal orientation of the femoral or tibial joint line after correction of wear) were calculated. The data were analysed as categorical data. These data were then compared with those published in a non-arthritic population, considered as a control non-OA group. The main criterion was the percentage of subjects with normal overall coronal alignment, defined by the association of a normal native medial distal femoral angle and a normal native medial proximal tibial angle. The secondary criteria were the percentages of subjects with normal medial femorotibial mechanical angle, normal native medial distal femoral angle and normal native medial proximal tibial angle. The influence of gender on primary and secondary criteria in the study group was analysed. The most frequent phenotypes in the study group were identified. RESULTS Normal overall coronal alignment was found in 66 patients in the OA group (12.7%) and 76 patients in the non-OA-group (24.7%) (p < 0.01 after adjustment by gender). There were fewer normal patients in the OA-group than in the non-OA-group for medial femorotibial mechanical angle, native medial distal femoral angle and native medial proximal tibial angle. In females, there were significantly fewer normal medial femorotibial mechanical angle. In males, there were significantly more cases with native medial distal femoral varus and in females more cases with native medial distal femoral valgus. There was no significant influence of gender on native medial proximal tibial angle. There was a wider distribution of the phenotypes in the OA-group than in the non-OA-group. CONCLUSION The distribution of functional phenotypes of the knee in patients undergoing total knee arthroplasty is different from those found in a reference non-osteoarthritic population. LEVEL OF EVIDENCE Level III-retrospective cohort study.
Collapse
|
6
|
Elsheikh R, Makram AM, Makram OM, Tamer A, Hafez MA. Femoral bowing in the Arab population: A cross-sectional study and literature review. TRANSLATIONAL RESEARCH IN ANATOMY 2022. [DOI: 10.1016/j.tria.2021.100160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
|
7
|
Akasaki Y, Kitade K, Motomura G, Hamai S, Ikemura S, Fujii M, Kawahara S, Nakashima Y. Morphological changes affecting ipsilateral and contralateral leg alignment after total hip arthroplasty. J Orthop 2020; 23:73-77. [PMID: 33442222 DOI: 10.1016/j.jor.2020.12.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Accepted: 12/23/2020] [Indexed: 11/29/2022] Open
Abstract
Background It is still unclear whether morphological changes in hip disorders is a pathogenic or independent factor for the variations in leg alignment. The purpose of this study was to elucidate the characteristics of the change in leg alignment after total hip arthroplasty (THA) and the morphological factors affecting the ipsilateral and contralateral leg alignment. Methods Both pre-operative and post-operative bilateral whole-leg radiographs in the standing position were taken in 100 patients who underwent THA. Hip-knee-ankle angle (HKAA), joint line convergence angle (JLCA), height of the hip center, lateral width to the hip center, femoral offset, and leg length discrepancy were measured. After the pre-operative legs were divided into the varus, neutral, or valgus groups, correlations between the change in HKAA and each hip morphological parameter were assessed. Results The mean change in HKAA on the THA side was 0.8° in the varus direction, which was significantly correlated with JLCA change. On the leg ipsilateral to THA, if the pre-operative alignment was valgus, the medial shift of the hip center was significantly correlated with the varus change in HKAA. On the side contralateral to THA, the change in leg length discrepancy was a significant correlative factor to the varus change in HKAA, if the pre-operative alignment was valgus or neutral. Conclusion The significant morphological parameters affecting the ipsilateral and contralateral leg alignment after THA were medial shifting of the hip center and the change in leg length discrepancy, respectively. Level of evidence Level Ⅳ, Retrospective cohort study.
Collapse
Affiliation(s)
- Yukio Akasaki
- Department of Orthopaedic Surgery, Kyushu University, 3-1-1, Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
| | - Kazuki Kitade
- Department of Orthopaedic Surgery, Kyushu University, 3-1-1, Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
| | - Goro Motomura
- Department of Orthopaedic Surgery, Kyushu University, 3-1-1, Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
| | - Satoshi Hamai
- Department of Orthopaedic Surgery, Kyushu University, 3-1-1, Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
| | - Satoshi Ikemura
- Department of Orthopaedic Surgery, Kyushu University, 3-1-1, Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
| | - Masanori Fujii
- Department of Orthopaedic Surgery, Kyushu University, 3-1-1, Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
| | - Shinya Kawahara
- Department of Orthopaedic Surgery, Kyushu University, 3-1-1, Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
| | - Yasuharu Nakashima
- Department of Orthopaedic Surgery, Kyushu University, 3-1-1, Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
| |
Collapse
|
8
|
Nayak M, Kumar V, Yadav R, Maredupaka S, Srivastava DN, Malhotra R, Pandit H. Coronal Alignment of the Lower Extremity: A Gender-Based Radio-Graphic Analysis in Indian Patients. Indian J Orthop 2020; 54:504-512. [PMID: 32549966 PMCID: PMC7271308 DOI: 10.1007/s43465-020-00050-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2019] [Accepted: 02/10/2020] [Indexed: 02/04/2023]
Abstract
BACKGROUND Variation in the shape of the femur and tibia has been shown to influence hip-kneeankle-axis angle (HKAA) and bears a role in reconstructive surgeries such as total knee arthroplasty (TKA). However, data on the axial alignment of the lower extremity specific to sex largely remains unavailable. Thus, we conducted a study with an aim to measure alignment and calculate differences in both the sexes in Indian population. MATERIALS AND METHODS The following radiological parameters were measured from weight-bearing long leg radiographs of 966 limbs of Indian subjects via a morphometric software (Matlab R2009a) (1) Hip-Knee-Ankle angle (HKAA), (2) femoral bowing, (3) tibial bowing, (4) condylar plateau angle (CPA). The knees were classified according to the Kellegren and Lawrence grading and the differences between both the sexes were calculated with appropriate statistical tests. RESULTS 56.04% of the subjects were female. An increase in the mean age was observed for both the genders with an increase in the severity of OA. Height did not show any significant association with the alignment of the limb. The mean HKAA observed was - 5.88° ± 0.35° in females and - 4.99° ± 0.41° in males. The overall mean femoral bow and tibial bow was - 1.26° ± 0.24°, - 1.60° ± 0.18° in females and - 1.09 ± 0.28, - 1.47° ± 0.21° in males. The mean condylar plateau angle was higher in females - 2.67 ± 0.34 as compared to males - 2.35° ± 0.39°. A greater lateral bow was seen in males at higher grades of OA for femur and at lower grades of OA for tibia. CONCLUSION This study provides gender-based differences in the various axial radio-graphic parameters in a long leg radio-graphs in Indian population which might help in a better understanding of the etiopathogenesis of osteoarthritis and also help planning and execution of reconstructive surgeries such as TKA.
Collapse
Affiliation(s)
- Mayur Nayak
- Department of Orthopaedics, All India Institute of Medical Sciences (AIIMS), New Delhi, 110029 India
| | - Vijay Kumar
- Department of Orthopaedics, All India Institute of Medical Sciences (AIIMS), New Delhi, 110029 India
| | - Rahul Yadav
- Department of Orthopaedics, All India Institute of Medical Sciences (AIIMS), New Delhi, 110029 India
| | - Siddhartha Maredupaka
- Department of Orthopaedics, All India Institute of Medical Sciences (AIIMS), New Delhi, 110029 India
| | - Deep Narayan Srivastava
- Department of Radiodiagnosis, All India Institute of Medical Sciences (AIIMS), New Delhi, 110029 India
| | - Rajesh Malhotra
- Department of Orthopaedics, All India Institute of Medical Sciences (AIIMS), New Delhi, 110029 India
| | - Hemant Pandit
- Chapel Allerton Hospital, University of Leeds, Leeds, UK
| |
Collapse
|