Correctability of the knee joint observed under a stressed state

Li, Jialong; Liu, David; Baré, Jonathan; Dickison, David; Theodore, W; Miles, Brad; Li, Qing; Twiggs, Joshua

doi:10.1016/j.knee.2021.12.004

Cited by 3 publications

(2 citation statements)

References 41 publications

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“…Until now, only a few authors reported laxity values for individual phenotypes [21,29,30]. However, it is crucial to understand how much soft tissue release and balancing is necessary depending from the bony resection and the individual knee phenotype [21,[29][30][31]. Bony alignment is just one part of the static coronal knee alignment.…”

Section: Discussionmentioning

confidence: 99%

Definition of normal, neutral, deviant and aberrant coronal knee alignment for total knee arthroplasty

Hirschmann,

Khan,

Sava

et al. 2024

Knee surg. sports traumatol. arthrosc.

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PurposeOne of the most pertinent questions in total knee arthroplasty (TKA) is: what could be considered normal coronal alignment? This study aims to define normal, neutral, deviant and aberrant coronal alignment using large data from a computed tomography (CT)‐scan database and previously published phenotypes.MethodsCoronal alignment parameters from 11,191 knee osteoarthritis (OA) patients were measured based on three dimensional reconstructed CT data using a validated planning software. Based on these measurements, patients' coronal alignment was phenotyped according to the functional knee phenotype concept. These phenotypes represent an alignment variation of the overall hip knee ankle angle (HKA), femoral mechanical angle (FMA) and tibial mechanical angle (TMA). Each phenotype is defined by a specific mean and covers a range of ±1.5° from this mean. Coronal alignment is classified as normal, neutral, deviant and aberrant based on distribution frequency. Mean values and distribution among the phenotypes are presented and compared between two populations (OA patients in this study and non‐OA patients from a previously published study).ResultsThe arithmetic HKA (aHKA), combined normalised data of FMA and TMA, showed that 36.0% of knees were neutral within ±1 SD from the mean in both angles, 44.3% had either a TMA or a FMA within ±1–2 SD (normally aligned), 15.3% of the patients were deviant within ±2–3 SD and only 4.4% of them had an aberrant alignment (±3–4 SD in 3.4% and >4 SD in 1.0% of the patients respectively). However, combining the normalised data of HKA, FMA and TMA, 15.4% of patients were neutral in all three angles, 39.7% were at least normal, 27.7% had at least one deviant angle and 17.2% had at least one aberrant angle. For HKA, the males exhibited 1° varus and females were neutral. For FMA, the females exhibited 0.7° more valgus in mean than males and grew 1.8° per category (males grew 2.1° per category). For TMA, the males exhibited 1.3° more varus than females and both grew 2.3° and 2.4° (females) per category. Normal coronal alignment was 179.2° ± 2.8–5.6° (males) and 180.5 > ± 2.8–5.6° (females) for HKA, 93.1 > ± 2.1–4.2° (males) and 93.8 > ± 1.8–3.6° (females) for FMA and 86.7 > ± 2.3–4.6° (males) and 88 > ± 2.4–4.8° (females) for TMA. This means HKA 6.4 varus or 4.8° valgus (males) or 5.1° varus to 6.1° valgus was considered normal. For FMA HKA 1.1 varus or 7.3° valgus (males) or 0.2° valgus to 7.4° valgus was considered normal. For TMA HKA 7.9 varus or 1.3° valgus (males) or 6.8° varus to 2.8° valgus was considered normal. Aberrant coronal alignment started from 179.2° ± 8.4° (males) and 180.5 > ± 8.4° (females) for HKA, 93.1 > ± 6.3° (males) 93.8 > ± 5.4° (females) for FMA and 86.7 > ± 6.9° (males) and 88 > ± 7.2° (females) for TMA. This means HKA > 9.2° varus or 7.6° valgus (males) or 7.9° varus to 8.9° valgus was considered aberrant.ConclusionDefinitions of neutrality, normality, deviance as well as aberrance for coronal alignment in TKA were proposed in this study according to their distribution frequencies. This can be seen as an important first step towards a safe transition from the conventional one‐size‐fits‐all to a more personalised coronal alignment target. There should be further definitions combining bony alignment, joint surfaces' morphology, soft tissue laxities and joint kinematics.Level of EvidenceIII.

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Section: Discussionmentioning

confidence: 99%

Definition of normal, neutral, deviant and aberrant coronal knee alignment for total knee arthroplasty

Hirschmann,

Khan,

Sava

et al. 2024

Knee surg. sports traumatol. arthrosc.

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“…One limitation of these established alignment philosophies is that they are driven by the bony anatomy, with little consideration to the soft-tissue anatomy such as the ligament laxities. Li et al (2022) [4] have previously established that the correctability of a joint cannot be predicted with the bony anatomy alone and that soft tissue laxity is also required. This highlights the need for preoperative analysis of the soft tissue and bony anatomy in order to provide more holistic surgical plans.…”

Section: Introductionmentioning

confidence: 99%

Population Level Validation of a Novel Joint Distraction Radiology Protocol in Total Knee Arthroplasty Planning

Liu¹,

Jagota²,

Twiggs³

et al.

EPiC Series in Health Sciences

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A key goal of all TKA alignment strategies is to achieve joint balance. This study aims to compare the alignments achieved by preoperatively planning to a novel distracted joint gap protocol to common alignment strategies as well as to the alignment of a healthy non-arthritic population.A retrospective study comprised of 145 knees was performed. A long-leg supine CT scan, weightbearing AP knee X-ray and two distracted knee X-rays (one each in extension and flexion, making use of an ankle weight to open the joint) were taken pre-operatively. This imaging was used to perform segmentation, landmarking and 3D-to-2D registration. The medial and lateral joint gaps were determined in extension and flexion.The mean weightbearing, KA planned and distracted joint planned HKA were 4.7° (±5.9°) varus, 0.3° (±3.2°) varus, and 2.2° (±3.5°) varus. This compares to a healthy adult HKA of 1.3° (±2.3°) varus. A patient level comparison between the planned KA and distracted joint HKA found that the coronal angles of the two alignments are within 3° of each other for 64% patients, within 3-5° for 26% of patients and greater than 5° for the remaining 10% of patients.Of those compared, the planned distracted HKA was the closest to the constitutional varus HKA of a healthy population. Patient level analysis highlighted the fundamental differences between the planned KA and joint distracted alignments. By considering both hard and soft tissue, the planned joint distracted alignment allows for a more holistic foundation for pre-operative surgical planning for a given patient.

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Preoperative Joint Distraction Imaging and Planning Protocol for Total Knee Arthroplasty

Jagota,

Twiggs,

Miles

et al. 2024

The Journal of Arthroplasty

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Correctability of the knee joint observed under a stressed state

Cited by 3 publications

References 41 publications

Definition of normal, neutral, deviant and aberrant coronal knee alignment for total knee arthroplasty

Definition of normal, neutral, deviant and aberrant coronal knee alignment for total knee arthroplasty

Population Level Validation of a Novel Joint Distraction Radiology Protocol in Total Knee Arthroplasty Planning

Preoperative Joint Distraction Imaging and Planning Protocol for Total Knee Arthroplasty

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