No impact of under-correction and joint line obliquity on clinical outcomes of total knee arthroplasty for the varus knee

Rames, Richard D.; Mathison, Michael; Meyer, Zachary; Barrack, Robert L.; Nam, Denis

doi:10.1007/s00167-017-4507-9

Cited by 25 publications

(43 citation statements)

References 36 publications

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“…The HKA was defined as the angle between the mechanical axes of the femur and tibia. A HKA greater than or equal to 3° was defined as varus knee deformity [13]. The TTA was defined as the angle between the tibia anatomical axis and talus upper surface.…”

Section: Methodsmentioning

confidence: 99%

The effect of varus knee deformities on the ankle alignment in patients with knee osteoarthritis

et al. 2019

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Background We evaluated the compensatory change in ankle alignment due to knee malalignment and its relationship with varus knee deformities, as well as sex differences in compensation. Methods From October 2016 to September 2017, 103 patients with end-stage knee osteoarthritis underwent primary total knee arthroplasty (TKA). Ninety-five knees (78 patients) were included. The hip-knee-ankle angle (HKA) and ankle alignment and tilt were evaluated with full-leg standing anteroposterior radiographs. The ankle alignment was estimated according to the tibiotalar angle, tibial anterior surface angle (TAS), and lateral distal tibial angle. The talar tilt angle (TT), anatomical talocrural angle, angle between the tibial plateau and distal tibial plafond, angles between the ground and distal tibial plafond, and angles between the ground and upper talus were measured to evaluate ankle tilt. The patients were separated into two sex-based groups; correlations between the HKA and ankle parameters were estimated. Results The mean HKA in men and women was 8.16 ± 4.36° and 7.69 ± 5.93°, respectively. The relative tilt of the talus and distal tibia plafond to the ground was increased when varus knee deformities progressed. In women, there was a positive correlation between the knee alignment and TAS ( r = − 0.295, p = 0.016). As the knee mechanical axis became more varus, the distal tibia plafond became more valgus. In women, a negative correlation was observed between the HKA and TT ( r = − 0.359, p = 0.003). Compensatory changes in the ankle alignment and TT to knee alignment were not observed in men. Conclusion Compensatory ankle changes should be considered before TKA.

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Section: Methodsmentioning

confidence: 99%

The effect of varus knee deformities on the ankle alignment in patients with knee osteoarthritis

et al. 2019

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“…Rassir et al [22] and William et al [36] discovered that the alignment had a large influence on PROMS postoperatively. While Slevin et al [26] and Rames et al [27] did not investigate the same results. In our research, no correlations were found between the alignment of components at 1 week after surgery and PROMS at 2 years after surgery, which is consistent with the latter results (Table S3).…”

Section: Discussionmentioning

confidence: 86%

“…This, to some extent, reminds doctors to avoid medial over-hang of the tibial component, even if over-hang is inevitable during surgery. The relationship between the alignment and the PROMS after surgery remains unclear [7,[22][23][24][25][26][27]36]. Rassir et al [22] and William et al [36] discovered that the alignment had a large influence on PROMS postoperatively.…”

Section: Discussionmentioning

confidence: 99%

“…However, the relationship between the malalignment of components and PROMS following TKA remains controversial. Some studies have shown that the malalignment of components can cause poor PROMS [22][23][24][25], while some have shown that it does not cause poor PROMS [7,26,27]. Regarding aseptic loosening, many studies have shown that the malalignment of components can result in aseptic loosening in the long-term follow-up, but only a few studies have reported the relationship between the alignment of components and TBR in the short-term follow-up [14,28,29].…”

Section: Introductionmentioning

confidence: 99%

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Tibial component coverage affects tibial bone resorption and patient-reported outcome measures for patients following total knee arthroplasty

et al. 2021

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Purpose The aim of this study is to investigate the prognostic value of tibial component coverage (over-hang and under-hang) and the alignment of total knee arthroplasty (TKA) components 1 week after surgery. We select patient-reported outcome measures (PROMS) (the Knee Society score (KSS score) and the Western Ontario and McMaster Universities Osteoarthritis Index-pain score (WOMAC pain score)) and tibial bone resorption (TBR) 2 years after surgery as the end points. Methods The study retrospectively analyzed 109 patients undergoing TKA (fixed-bearing prosthesis with asymmetrical tibial tray) from January 2014 to December 2017 in Huashan Hospital. By using standard long-leg X-rays, anteroposterior (AP) and lateral X-rays of the knee, tibial component coverage (under-hang or over-hang), AP tibial-femoral anatomical angle (AP-TFA), AP femoral angle (AP-FA), AP tibial angle (AP-TA), and lateral tibial angle (L-TA) were measured at 1 week after surgery, while TBR was measured through postoperative 1-week and 2-year AP and lateral radiographs of the knee on three sides (medial side, lateral side on AP radiograph, and anterior side on lateral radiograph). The Pearson correlation analysis, simple linear regression, multiple linear regression, the Student’s t test, and one-way ANOVA together with Tukey’s post hoc test (or Games-Howell post hoc test) were used in the analyses. Results Tibial under-hang was more likely to appear in our patients following TKA (42%, medially, 39%, laterally, and 25%, anteriorly). In multivariate linear regression analysis of TBR, tibial under-hang (negative value) 1 week after surgery was positively correlated with TBR 2 years later on the medial (p = 0.003) and lateral (p = 0.026) side. Tibial over-hang (positive value) 1 week after surgery on the medial side was found negatively related with KSS score (p = 0.004) and positively related with WOMAC pain score (p = 0.036) 2 years later in multivariate linear regression analysis of PROMS. Both scores were better in the anatomically sized group than in the mild over-hang group (or severe over-hang) (p < 0.001). However, no significant relationship was found between the alignment of TKA components at 1 week after surgery and the end points (TBR and PROMS) 2 years later. Conclusion Under-hang of the tibial component on both the medial and lateral sides can increase the risk of TBR 2 years later. Over-hang of tibial component on the medial side decreases the PROMS (KSS score and WOMAC pain score) 2 years later. An appropriate size of tibial component during TKA is extremely important for patient’s prognosis, while the alignment of components might not be as important.

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“…Previous studies 14,15 showed inconsistent results, a retrospective study was conducted to better identify the association between mechanical alignment and post-operative HSS score after primary TKA in this study. The most important finding of the current study was that we found no significant association between post-operative lower limb mechanical alignment and HSS score for patients in Chinese with pre-operative constitutional varus knee caused by combined deformities.…”

Section: Discussionmentioning

confidence: 98%

Association of HSS score and mechanical alignment after primary TKA of patients suffering from constitutional varus knee that caused by combined deformities: a retrospective study

Zhang

Chai

Zhao

et al. 2021

Sci Rep

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For pre-operative osteoarthritis (OA) patients with varus knee, previous studies showed inconsistent results. Therefore, we conducted this study to better identify the association of Hospital for Special Surgery (HSS) score and mechanical alignment. 44 patients (51 knees) with constitutional varus knee caused by combined deformities (LDFA (lateral distal femoral angle) > 90°and MPTA (medial proximal tibial angle) < 85°)) were selected and analyzed with a mean follow-up period of 14 months after total knee arthroplasty (TKA). From January 2015 to December 2016, patients were collected consecutively after primary TKA. After filtering, fifty-one knees (44patients) were analyzed with a mean follow-up period of 14 months. All patients were divided into two groups based on post-operative hip-knee-ankle (HKA) acute angle: varus mechanical alignment (VMA) group (HKA < − 3°) and neutral mechanical axis (NMA) group (− 3° ≤ HKA ≤ 3°). 30 knees were included in the NMA group, and 21 knees in the VMA group. Comparisons of HSS between NMA group and VMA group were performed. After adjusting for age and Body Mass Index (BMI) confounders, Compared with NMA group, the HSS score in VMA group decreased by 0.81 units (95% CI, − 3.37 to 1.75) p = 0.5370). For pre-operative constitutional varus knee caused by combined deformities in chinese populations, no significant association between post-operative lower limb mechanical alignment and HSS score was found.

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No impact of under-correction and joint line obliquity on clinical outcomes of total knee arthroplasty for the varus knee

Abstract: III.

Cited by 25 publications

References 36 publications

The effect of varus knee deformities on the ankle alignment in patients with knee osteoarthritis

The effect of varus knee deformities on the ankle alignment in patients with knee osteoarthritis

Tibial component coverage affects tibial bone resorption and patient-reported outcome measures for patients following total knee arthroplasty

Association of HSS score and mechanical alignment after primary TKA of patients suffering from constitutional varus knee that caused by combined deformities: a retrospective study

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