Effect of Total Hip Arthroplasty on Ipsilateral Lower Limb Alignment and Knee Joint Space Width: Minimum 5-Year Follow-up

Abstract

Background This study aimed to 1) assess the effect of total hip arthroplasty (THA) on coronal limb alignment, namely, the hip–knee–ankle angle (HKA), 2) identify factors that determine changes in the HKA, and 3) determine whether alignment changes influence the knee joint space width. Methods We retrospectively evaluated 266 limbs of patients who underwent THA. Three types of prostheses with neck shaft angles (NSAs) of 132°, 135°, and 138° were used. Several radiographic parameters were measured in the preoperative and final radiographs (at least 5 years after THA). A paired t -test was used to confirm the effect of THA on HKA change. Multiple regression analysis was performed to identify radiographic parameters related to HKA changes following THA and changes in knee joint space width. Subgroup analyses were performed to reveal the effect of NSA change on the HKA change, and the proportion of total knee arthroplasty usage and changes in radiographic parameters between maintained joint space and narrowed joint space groups were compared. Results The preoperative mean HKA was 1.4° varus and increased to 2.7° varus after THA. This change was related to changes in the NSA, lateral distal femoral angle, and femoral bowing angle. In particular, in the group with a decrease in NSA of > 5°, the preoperative mean HKA was largely changed from 1.4° varus to 4.6° varus after THA. The prostheses with NSA of 132° and 135° also led to greater varus HKA changes than those with an NSA of 138°. Narrowing of the medial knee joint space was related to changes in the varus direction of the HKA, decrease in NSA, increase in femoral offset. Conclusion A large reduction in NSA can lead to considerable varus limb alignment after THA, which can have adverse effects on the medial compartment of the ipsilateral knee.

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“…16 The medial knee contact force increased with increasing HKA angle with knee OA, resulting in the medial JSN. 17 In addition, because of the increase in peak KAM and KAM impulse, the medial region was exposed to higher stresses caused by altered force alignment. 18 This may potentially exacerbate the loss of medial knee cartilage and worsening of medial bone marrow lesions.…”

“…Meanwhile, strong correlations were found between hip-knee-ankle (HKA) angle and medial knee contact force and knee adduction moment 16 . The medial knee contact force increased with increasing HKA angle with knee OA, resulting in the medial JSN 17 . In addition, because of the increase in peak KAM and KAM impulse, the medial region was exposed to higher stresses caused by altered force alignment 18 .…”