Coronal shaft bowing of the femur affects varus inclination of the surgical transepicondylar axis in varus knee osteoarthritis

Nejima, Shuntaro; Kumagai, Ken; Kobayashi, Hideo; Yamada, S.; Akamatsu, Tomotaka; Ogino, Tomoaki; Sotozawa, Masaichi; Inaba, Yutaka

doi:10.1007/s00167-020-06025-1

Cited by 6 publications

(25 citation statements)

References 14 publications

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“…indicated that sTEA was perpendicular to femoral mechanical axis in the coronal plane after a study of 60 Japanese OA knees. However, they did not clarify the lower extremity alignment and femoral bowing of the patients, which are very common in Asian populations and may have an effect on the coronal orientation of sTEA 8,13 . This study found that the sTEA coronal angle was widely distributed and was influenced by femoral bowing, especially lateral femoral bowing.…”

Section: Discussionmentioning

confidence: 64%

“…The sTEA has long been considered the closest reference axis to knee flexion‐extension axis that can be used in clinical practice 5,7 . The orientation of sTEA in coronal plane is believed to be perpendicular to mechanical axis, 6,7 which makes sTEA play an important role in the treatment of patients with bone defects and TKA revisions since the availability of original anatomical landmarks is limited 8 . Kobayashi et al 7 .…”

Section: Discussionmentioning

confidence: 99%

“…This feature does not change even in osteoarthritic (OA) knees 7 . Therefore, sTEA is often used in the coronal plane to assess the perpendicular position of the femoral component to femoral mechanical axis, especially in patients with large bone defects or in TKA revision cases 8 . It is also noted that sTEA is influenced by the lower extremity alignment, with both varus and valgus alignment resulting in a change in the orientation of sTEA in the coronal plane 9 …”

Section: Introductionmentioning

confidence: 99%

“…Nejima et al . indicated that the orientation of sTEA in the coronal plane was influenced by lateral femoral bowing in OA patients with varus knees after a study of 82 knees using two‐dimensional (2D) computed tomography (CT) 8 . Three‐dimensional (3D) CT could localize the orientation of sTEA more accurately than 2D CT 16 .…”

Section: Introductionmentioning

confidence: 99%

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Surgical Transepicondylar Axis Is Not a Reliable Reference when there Was Lateral Femoral Bowing

Liu

Lei

Guo

et al. 2022

Orthopaedic Surgery

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Objective The surgical transepicondylar axis (sTEA) is believed to be a consistent reference for femoral rotation axis, and the reliability of its orientation seriously affects the accuracy and outcome of total knee arthroplasty (TKA). This study was designed to investigate the relationship between the orientation of sTEA and femoral bowing angle (FBA) and posterior condylar line (PCL) using three‐dimensional (3D) computed tomography (CT) reconstruction models to verify its reliability. Methods This study retrospectively collected lower extremity images of 443 southern Chinese osteoarthritic patients (347 women, 96 men; 234 left, 209 right; mean age 66.5 ± 9.3 years) from August 2016 to June 2018. The hip–knee‐ankle angle (HKA) was measured on anteroposterior weight‐bearing full lower extremity standing radiographs. Measurements on 3D CT models of the femurs included lateral angle between the femoral mechanical axis and sTEA coronal angle, angle between sTEA and distal joint line (distal condylar axis angle, DCA); angle between sTEA and PCL (sTEA axial angle); angle between anatomical axis of proximal femur and anatomical axis of distal femur in the plane they form (actual FBA) and its projection on the coronal (lateral FBA) and sagittal (anterior FBA) planes. The correlations between sTEA coronal angle, sTEA axial angle and actual FBA, lateral FBA, anterior FBA, HKA, DCA were explored using the Spearman correlation test. Results The mean value of actual FBA is (14.4 ± 3.6)°, of lateral FBA is (6.0 ± 4.0)°, and of anterior FBA is (12.7 ± 3.0)°. The mean value of sTEA coronal angle is (88.7 ± 3.6)°, of sTEA axial angle is (2.1 ± 2.8)°. The sTEA coronal angle was positively correlated with actual FBA (r = 0.320, P < 0.01), lateral FBA (r = 0.448, P < 0.01), anterior FBA (r = 0.113, P < 0.05), HKA (r = 0.482, P < 0.01) and DCA (r = 0.486, P < 0.01). The sTEA axial angle was positively correlated with DCA (r = 0.168, P < 0.01), but not significantly correlated with all FBAs and HKA (NS). Conclusion The sTEA cannot be used as a stable reference when there was an obvious femoral bowing deformity. As the lateral femoral bowing increases, the orientation of sTEA becomes more varus, no matter the knee is varus or valgus.

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Section: Discussionmentioning

confidence: 64%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Surgical Transepicondylar Axis Is Not a Reliable Reference when there Was Lateral Femoral Bowing

Liu

Lei

Guo

et al. 2022

Orthopaedic Surgery

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“…In daily practice, we often see anterior and lateral bowing of the femur [1]. The bowing of the femur might affect the surgical plan and outcomes in cases requiring internal fixation surgery for fractures [2,3], or implant insertion for hip and knee arthroplasty [4,5]. Several reports have shown that femoral bowing is correlated with patient characteristics such as aging, race, osteoarthritis, and osteoporosis [1,[6][7][8][9][10].…”

Section: Introductionmentioning

confidence: 99%

Lateral Bowing of Femur Associated With Older Age, Shorter Stature, and Lower Bone Mineral Density

Furihata¹,

Ishikawa²,

Katsuragi³

et al. 2021

Cureus

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We often encounter elderly patients with femur bowing. According to literature, femoral bowing is correlated with patient characteristics such as aging, race, atypical femoral fracture (AFF), and osteoporosis. However, the clear relationships between these factors and femoral bowing are still unknown. In addition, most previous reports have been based only on X-rays and may not provide accurate information due to femur rotation and inter-operator reliability when compared to the information obtained using computed tomography (CT) scans. The purpose of this study was to examine the factors associated with anterior and lateral bowing in detail, by using three-dimensional preoperative measurement software Zed Hip®︎ (LEXI Co. Ltd., Tokyo, Japan). A total of 364 patients with trochanteric hip or femoral neck fractures, or osteoarthritis, treated in our hospital were included in this study. Of these, 61 patients older than 50 years, who had complete CT volume data for the entire length of the femur on the healthy side and bone mineral density (BMD) measured by trunk dual-energy X-ray absorptiometry (DXA), were investigated. There were 13 males and 48 females, aged 53-97 years (mean 78.7±10.8 years). We defined the starting and ending points of the femoral diaphysis to measure anterior bowing (AB) and lateral bowing (LB) of the femoral diaphysis. The correlation between AB or LB with each patient's characteristics (age, height, weight, lumbar BMD, and femoral BMD) was examined retrospectively. AB did not correlate with any of the patient parameters. LB weakly positively correlated with age and was negatively correlated with height and femoral (greater trochanter) bone density. Weight was in no correlation with either AB or LB. A novel three-dimensional approach was used for measurements that may be more accurate than plain two-dimensional radiographs.

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Seven phenotypes of varus osteoarthritic knees can be identified in the coronal plane

Mullaji

Shah

Bhoskar

et al. 2021

Knee Surg Sports Traumatol Arthrosc

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Purpose Recommendations for resecting distal femur and proximal tibia in mechanical and anatomical alignment techniques are standardized. Kinematic alignment propagates individualizing resection planes. Whether significant variation exists, to warrant departure from standardized resection planes, has not been shown thus far in a large cohort of knees and with a wide range of varus deformity. The null hypothesis of this study was that there was no phenotypic variation in varus osteoarthritic knees. The aim of this paper was to determine whether distinct phenotypes could be identified, based on variations in coronal femoral and tibial morphology, which could aid in surgical planning and categorizing varus knees for future studies. Methods 2129 full-leg weightbearing radiographs were analyzed (1704 preoperative; 425 of contralateral arthritic knee). Measurements made were of HKA (hip-knee-ankle angle), VCA (valgus correction angle), mLDFA (lateral mechanical distal femoral angle), aLDFA (lateral anatomical distal femoral angle), MPTA (medial proximal tibial angle), MNSA (medial neck shaft angle), TAMA (angle between tibial mechanical and anatomical axes), and TPDR (percentage length of tibia proximal to extra-articular deformity). Results Seven distinct types were identified covering 2021 knees, reducible to 4 broad phenotypes: 11% were Type 1 'Neutral' knees showing values close to reported normal knees (mean VCA 5.5°, mLDFA 87°, aLDFA 81°). 38% were Type 2 'Intra-articular varus' with medial intra-articular bone loss (mean mLDFA 90.9°, MPTA 85.4°, VCA of 5.7°). 41% were Type 3 'Extra-articular varus' with extra-articular deformity (EAD). Type 3a had proximal tibial EAD; Type 3b had tibial diaphyseal EAD; Type 3c had femoral EAD (mean VCA 8.7°, HKA 166°), and severe medial bone loss (mean mLDFA 92°, MPTA 83°). 9% were Type 4 'Valgoid type' with features of valgus knees: Type 4a had medial femoral bowing (mean VCA 2.9°); Type 4b had significant distal femoral valgus (mean mLDFA 85.3°, aLDFA 78.6°). Conclusions The null hypothesis that there was no phenotypic variation in varus osteoarthritic knees was rejected as considerable variation was found in coronal morphology of femur and tibia. Four broad phenotypic groups could be identified. Plane of the knee joint articular surface was quite variable. This has relevance to planning and performance of corrective osteotomies, unicompartmental and total knee arthroplasty. Level of Evidence III, retrospective cohort study.

show abstract

Coronal shaft bowing of the femur affects varus inclination of the surgical transepicondylar axis in varus knee osteoarthritis

Cited by 6 publications

References 14 publications

Surgical Transepicondylar Axis Is Not a Reliable Reference when there Was Lateral Femoral Bowing

Surgical Transepicondylar Axis Is Not a Reliable Reference when there Was Lateral Femoral Bowing

Lateral Bowing of Femur Associated With Older Age, Shorter Stature, and Lower Bone Mineral Density

Seven phenotypes of varus osteoarthritic knees can be identified in the coronal plane

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