Relationship between Lateral Femoral Bowing and Varus Knee Deformity Based on Two-Dimensional Assessment of Side-to-Side Differences

Abstract

PurposeThe objective was to evaluate the relationship between side-to-side differences of lateral femoral bowing and varus knee deformity based on two-dimensional (2D) assessment in unilateral total knee arthroplasty (TKA).Materials and MethodsA total of 143 patients with varus knee osteoarthritis who underwent unilateral TKA were enrolled. We evaluated the side-to-side differences of the frontal lower limb alignment by assessing lateral femoral bowing, anatomical medial distal femoral angle, and anatomical medial proximal tibial angle (aMPTA).ResultsThe average values of all anatomical indices were significantly different between the operated side and the non-operated side (p<0.05). The side-to-side difference in hip knee ankle (HKA) angle had a statistically significant correlation with that in lateral femoral bowing (intraclass correlation coefficient, 0.259; p=0.002) and that in aMPTA. Linear regression analysis showed 0.199° of side-to-side difference in lateral femoral bowing was associated with 1° of side-to-side difference in bilateral HKA angle.ConclusionsThe side-to-side difference in lateral femoral bowing showed a tendency to increase in proportion to varus knee deformity based on 2D assessment in unilateral TKA patients.

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“…To achieve this goal, we have to obtain a stable knee through optimal alignment and deformity correction. 1 2 3 4 5 6) In particular, soft-tissue balancing is known to influence the functional results and survival of the prostheses. 7 8) Despite its importance, soft-tissue balancing has been primarily based on subjective assessment by surgeons; it typically depends on training, surgical experience, and overall skills of surgeons.…”

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“…Here, the proximal femoral shaft quarter extended from 0 to 5 cm below the lesser trochanter and the distal quarter extended from 5 to 10 cm above the lateral femoral condyle’s lowest part. Femoral bowing was confirmed when the bowing was at least 5° [ 2 , 9 , 10 , 12 , 13 ].…”

“…It is a frequent practice to cut the distal femur with jigs of 5° to 6° valgus and, in fact, most instruments do not offer a wide range of jig cutting angles [ 7 , 8 ]. Some studies have pointed out that the accuracy of our implant orientation will be dramatically jeopardized in cases with femoral deformities, particularly in those involving lateral bowing [ 3 , 9 ]. Moreover, lateral femoral bowing leads especially to challenges in achieving soft-tissue balance due to strains on the collateral ligaments [ 10 , 11 ].…”

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“…The medial proximal tibial angle (MPTA) was de ned the medial angle between the tibial mechanical axis and the tangent line of the medial and lateral edges of the tibial plateau, indicating the alignment of tibia on coronal plane [12]. Moreover, the hip-kneeankle angle (HKA) of the lower extremity was the angle calculated by intersecting the line between femoral mechanical axis (from the center of the femoral head to the central point of the tibial spines) and tibial mechanical axis (from the center of the tibial spines to the center of the superior articular surface of the talus), indicating the alignment of the lower extremity [13]. The lateral distal femoral angle (LDFA), de ned as the angle between the tangent to the distal femoral condyle line and the femoral mechanical axis, representing the alignment of femoral on coronal plane [14].…”