Radiological Evaluation of the Phenotype of Indian Osteoarthritic Knees based on the Coronal Plane Alignment of the Knee Classification (CPAK)

Mulpur, Praharsha; Desai, Keyur B.; Mahajan, Aakarsh; Masilamani, A. B. Suhas; Hippalgaonkar, Kushal; Reddy, A V Gurava

doi:10.1007/s43465-022-00756-8

Cited by 29 publications

(21 citation statements)

References 29 publications

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“…The present findings are in accordance with previous studies demonstrating that either CPAK phenotypes I or II were the most commonly observed knee phenotypes in both healthy knees [12, 18, 21] and arthritic patients undergoing TKA [14, 18, 21, 31, 37, 40]. A recent study evaluating the CPAK phenotype distribution among 8739 osteoarthritic knees, identified CPAK phenotype I and II as the predominant phenotypes, with incidences of 28.1% and 27.3% respectively [14].…”

Section: Discussionsupporting

confidence: 94%

“…Traditionally, alignment strategies have solely focused on classifying knees into a neutral, varus, or valgus alignment and aimed to restore knees to neutral mechanical alignment [28, 48]. However, multiple recent studies have emphasized the substantial variability in coronal plane phenotypes, highlighting the necessity of re‐evaluation of traditional alignment strategies for knee arthroplasty [8, 10, 12, 13, 15, 17, 18, 21, 31]. Recently, the Coronal Plane Alignment of the Knee (CPAK) classification was introduced [18].…”

Section: Introductionmentioning

confidence: 99%

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Knees with anteromedial osteoarthritis show a substantial phenotypic variation prior and following medial unicompartmental knee arthroplasty

ten Noever de Brauw,

Bayoumi,

Ruderman

et al. 2023

Knee surg. sports traumatol. arthrosc.

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Purpose The primary aim of this study was to evaluate the phenotypic variation using the Coronal Plane Alignment of the Knee (CPAK) classification among 1000 knees with anteromedial osteoarthritis (OA) both prior to and following medial unicompartmental knee arthroplasty (UKA). The secondary aim of this study was to investigate whether knees maintained their preoperative CPAK phenotype and to evaluate the phenotypic alterations following medial UKA. Methods The CPAK classification was used to analyze 1000 knees that underwent medial UKA as treatment for anteromedial OA. Knees were categorized into nine distinct CPAK phenotypes based on their arithmetic hip-knee-ankle angle (aHKA), which estimates the pre-arthritic alignment, and joint line obliquity (JLO), both pre-and postoperatively. Phenotypic variation was analyzed by sex and age, and the phenotypic alterations following medial UKA were evaluated by phenotype. Results Preoperatively, CPAK phenotype I had the highest prevalence (45.0%). Among males, the preoperative prevalence of CPAK phenotype I was significantly higher compared to females (53.2% vs. 35.0%, respectively; p ≤ .001), whereas females exhibited a significantly higher occurrence of CPAK phenotype V compared to males (9.8% vs. 4.4%, respectively; p ≤ .015). Following medial UKA, CPAK phenotype II had the highest prevalence (53.3%). Overall, 45.1% of knees maintained their preoperative CPAK phenotype following medial UKA, which was most frequently observed among CPAK phenotype II (67.7%) and III (65.8%). Conclusion There is a substantial variation in CPAK phenotypes among knees with anteromedial OA, as well as following treatment with medial UKA. This variability challenges the assumption of uniform characteristics among knees with an identical wear pattern associated with anteromedial OA and emphasizes the complexity and variability of this specific form of OA. Level of evidence III, Retrospective cohort study. KeywordsUnicompartmental knee arthroplasty • Osteoarthritis • Coronal Plane Alignment of the Knee (CPAK) • Knee phenotypes • Knee alignment • Robotic-assisted surgery * G. V. ten Noever de Brauw

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Section: Discussionsupporting

confidence: 94%

Section: Introductionmentioning

confidence: 99%

Knees with anteromedial osteoarthritis show a substantial phenotypic variation prior and following medial unicompartmental knee arthroplasty

ten Noever de Brauw,

Bayoumi,

Ruderman

et al. 2023

Knee surg. sports traumatol. arthrosc.

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“…This was in contrast to MacDessi’s population, who found CPAK Type II as the most common type (32.2%) overall. Other studies also showed the highest proportion of knee morphotypes with an apex distal JLO in the osteoarthritic population, but a very low number of CPAK Type VI knees [12, 27, 46]. We found even more knees were apex distal (76.3%) than in the cohorts of MacDessies et al (67.0%) or Steele et al (72.0%), but less than reported in the Asian population by En‐Hsu et al (89.3%) [12].…”

Section: Discussionmentioning

confidence: 96%

Gender‐specific distribution of knee morphology according to CPAK and functional phenotype classification: analysis of 8739 osteoarthritic knees prior to total knee arthroplasty using artificial intelligence

Huber,

Mitterer,

Vallant

et al. 2023

Knee surg. sports traumatol. arthrosc.

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Purpose Osteoarthritis of the knee is commonly associated with malalignment of the lower limb. Recent classiications, as the Coronal Plane Alignment of the Knee (CPAK) and Functional Phenotype classiication, describe the bony knee morphology in addition to the overall limb alignment. Data on distribution of these classiications is not suicient in large populations. The aim of this study was to analyse the preoperative knee morphology with regard to the aforementioned classiications in long leg radiographs prior to total knee arthroplasty surgery using Artiicial Intelligence. Methods The cohort comprised 8739 preoperative long leg radiographs of 7456 patients of all total knee arthroplasty surgeries between 2009 and 2021 from our institutional database. The automated measurements were performed with the validated Artiicial Intelligence software LAMA (ImageBiopsy Lab, Vienna) and included standardized axes and angles [hip-knee-ankle angle (HKA), mechanical lateral distal femur angle (mLDFA), mechanical medial proximal tibia angle (mMPTA), mechanical axis deviation (MAD), anatomic mechanic axis deviation (AMA) and joint line convergence angle (JLCA)]. CPAK and functional phenotype classiications were performed and all measurements were analysed for gender, age, and body mass index (BMI) within these subgroups.

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“…Significant racial variability exists, with constitutional varus (CPAK Type I) being the most common phenotype in Asian and Indian populations. 18-20…”

Section: Overviewmentioning

confidence: 99%

“…significant racial variability exists, with constitutional varus (cpak type i) being the most common phenotype in asian and indian populations. [18][19][20] sagittal and axial alignment in tka, although clearly important for knee function, have not been examined as extensively as coronal alignment patterns, particularly regarding clinical outcomes and survivorship. [21][22][23][24][25][26][27] sagittal alignment of the knee is highly variable among individuals, particularly tibial slope.…”

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confidence: 99%

The language of knee alignment

MacDessi

Oussedik

Abdel

et al. 2023

The Bone & Joint Journal

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Orthopaedic surgeons are currently faced with an overwhelming number of choices surrounding total knee arthroplasty (TKA), not only with the latest technologies and prostheses, but also fundamental decisions on alignment philosophies. From ‘mechanical’ to ‘adjusted mechanical’ to ‘restricted kinematic’ to ‘unrestricted kinematic’ — and how constitutional alignment relates to these — there is potential for ambiguity when thinking about and discussing such concepts. This annotation summarizes the various alignment strategies currently employed in TKA. It provides a clear framework and consistent language that will assist surgeons to compare confidently and contrast the concepts, while also discussing the latest opinions about alignment in TKA. Finally, it provides suggestions for applying consistent nomenclature to future research, especially as we explore the implications of 3D alignment patterns on patient outcomes. Cite this article: Bone Joint J 2023;105-B(2):102–108.

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Radiological Evaluation of the Phenotype of Indian Osteoarthritic Knees based on the Coronal Plane Alignment of the Knee Classification (CPAK)

Cited by 29 publications

References 29 publications

Knees with anteromedial osteoarthritis show a substantial phenotypic variation prior and following medial unicompartmental knee arthroplasty

Knees with anteromedial osteoarthritis show a substantial phenotypic variation prior and following medial unicompartmental knee arthroplasty

Gender‐specific distribution of knee morphology according to CPAK and functional phenotype classification: analysis of 8739 osteoarthritic knees prior to total knee arthroplasty using artificial intelligence

The language of knee alignment

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