The assessment of femoral shaft morphology in the sagittal plane in Chinese patients with osteoarthritis—a radiographic analysis

Bao, Zhengyuan; Qiao, Liang; Qin, Jianghui; Xu, Jiacheng; Zhou, Sheng; Chen, Dongyang; Shi, Dinghua; Dai, Jin; Yao, Yao; Jiang, Qing

doi:10.1186/s13018-017-0626-8

Cited by 22 publications

(21 citation statements)

References 17 publications

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“…Tang et al [ 28 ] recommend that the patients with obvious femoral bowing at the distal femur as seen on the preoperative long film should be used with caution when performing intramedullary guide in TKA. Similar results were found by Bao et al [ 19 ].…”

Section: Discussionsupporting

confidence: 92%

Is the femoral component flexion affected by the sagittal femoral shaft bowing in conventional intramedullary guided TKA?

Zhang

Wang

et al. 2021

J Orthop Surg Res

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Background The aim of the present study was to investigate the influence of sagittal femoral bowing on sagittal femoral component alignment, and whether there was correlation between sagittal femoral component alignment and coronal femoral component alignment. Methods We retrospectively reviewed 77 knees in 71 patients who had undergone primary TKA for advanced osteoarthritis. All surgeries were performed by using a standard medial parapatellar approach. The osteotomy was performed with a conventional technique using an intramedullary rod for the femur and a mechanical extramedullary guiding system for the tibia. All patients enrolled in the study were evaluated with full-length lower extremity load-bearing standing scanograms, and the patients had preoperative and postoperative radiographs of the knees. Coronal femoral bowing angle (cFBA), sagittal femoral bowing angle (sFBA), and postoperatively, mechanical tibiofemoral angle of the knee (mTFA), β angle (femoral component flexion angle) were measured. The radiographic results of both groups were compared using Student's t test. A two-sided Pearson correlation coefficient was obtained to identify the correlations between FBA in the coronal and sagittal planes, as well as FBA and age or BMI, sFBA and β angle, cFBA and mTFA. Comparison of FSB incidence between different genders was made using Chi-square test. The p value < 0.05 indicates a statistically significant difference. Results The mean sFBA, cFBA, β angle, mTFA were 9.34° ± 3.56°(range 1°–16°), 3.25° ± 3.79°(range − 7° to −17°), 3.91° ± 3.15°(range − 1° to −13°), 0.60° ± 1.95°(range − 3° to −6°), respectively. There was no correlation between age and sFBA (CC = 0.192, p = 0.194) or cFBA (CC = 0.192, p = 0.194); similarly, there was no correlation between age and sFBA (CC = 0.067, p = 0.565) or cFBA (CC = 0.069, p = 0.549). The sFBA was correlated with cFBA and β angle (CC = 0.540, p < 0.01; CC = 0.543, p < 0.01, respectively), and the cFBA was correlated with mTFA (CC = 0.430, p < 0.01). There was no significant difference (p = 0.247) of cFBA between the patients with sFSB and the patients without sFSB. Conclusions The current study showed that the sFBA was correlated with cFBA in the patients undergoing TKA and the patients with sFSB usually presented non-cFSB. We also found that sFSB could affect the femoral component alignment in the sagittal plane and cFSB could affect the femoral component alignment in the coronal plane. The sFBA or cFBA was not correlated with age, BMI, or gender.

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Section: Discussionsupporting

confidence: 92%

Is the femoral component flexion affected by the sagittal femoral shaft bowing in conventional intramedullary guided TKA?

Zhang

Wang

et al. 2021

J Orthop Surg Res

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“…Tang et al [29] recommend that the patients with obvious femoral bowing at the distal femur as seen on the preoperative long lm should be used with caution when performing intramedullary guide in TKA. Similar results were found by Bao et al [19].…”

Section: Discussionsupporting

confidence: 92%

“…The angle between the midlines drawn in the proximal and distal quarter segments was de ned as cFBA(coronal femoral bowing angle)(Fig. 1 A) [18,19,20,21]. Lateral angulation of >5°in the coronal plane was de ned as lateral FSB, also be called cFSB(coronal femoral shaft bowing).…”

Section: Radiological Evaluationmentioning

confidence: 99%

Is the Femoral Component Flexion Affected by the Sagittal Femoral Shaft Bowing in Conventional Intramedually Guided TKA?

Zhang¹,

Wang²,

Xu³

et al. 2021

Preprint

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Background: The aim of the present study was to investigate the influence of sagittal femoral bowing on sagittal femoral component alignment, and whether there was correlation between sagittal femoral component alignment and coronal femoral component alignment.Methods: We retrospectively reviewed 77 knees in 71 patients who had undergone primary TKA for advanced osteoarthritis.All surgeries were performed by using a standard medial parapatellar approach. The osteotomy was performed with a conventional technique using an intramedullar rod for the femur and a mechanical extramedullar guiding system for the tibia. All patients enrolled in the study were evaluated with full-length lower extremity load-bearing standing scanograms and the patients had preoperative and postoperative radiographs of the knees. cFBA(coronal femoral bowing angle), sFBA(sagittal femoral bowing angle),and postoperatively, mTFA(mechanical tibiofemoral angle of the knee), β angle(femoral component flexion angle) were measured. The radiographic results of both groups were compared using Student's t test. A two-sided Pearson correlation coefficient was obtained to identify the correlations between FBA in the coronal and sagittal planes, as well as FBA and age or BMI, sFBA and β angle, cFBA and mTFA. Comparison of FSB incidence between different genders was using chi-square test. The p value <0.05 indicates a statistically significant difference.Results: The mean sFBA, cFBA, β angle, mTFA were 9.34°±3.56°(range 1°-16°), 3.25°±3.79°(range -7°-17°), 3.91°±3.15°(range -1°-13°), 0.60°±1.95°(range -3°-6°), respectively. There was no correlation between age and sFBA(CC=0.192, p=0.194) or cFBA(CC=0.192, p=0.194), similarly, there was no correlation between age and sFBA(CC=0.067, p=0.565) or cFBA(CC=0.069, p=0.549). The sFBA was correlated with cFBA and β angle(CC=0.540, p<0.01; CC=0.543, p<0.01; respectively) and the cFBA was correlated with mTFA(CC=0.430, p<0.01). There was no significant difference(p=0.247) of cFBA between the patients with sFSB and the patients without sFSB. Conclusions: The current study showed that the sFBA was correlated with cFBA in the patients undergoing TKA and the patients with sFSB usually presented non-cFSB. We also found that sFSB could affect the femoral component alignment in the sagittal plane and cFSB could affect the femoral component alignment in the coronal plane. The sFBA or cFBA was not correlated with age, BMI or gender.

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“…Sixth, we only analyzed coronal bowing. However, the results from a previous study on femoral bowing indicated a poor correlation between the parameters in the coronal and sagittal planes [31]. Moreover, in other studies on bowing [19,23,24] or reporting on the category of the alignment after TKA [20][21][22] in the coronal plane, only the parameters measured on films of the coronal plane were used.…”

Section: Oh Et Al Knee Surgery and Related Researchmentioning

confidence: 99%

Short knee radiographs can be inadequate for estimating TKA alignment in knees with bowing

Bin

Lee

et al. 2020

Knee Surg & Relat Res

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The aim of this study was to compare the discrepancy of alignment categorization in total knee arthroplasty (TKA) between the anatomical femorotibial angle (aFTA) measured on short knee radiographs and the mechanical hipknee-ankle axis angle (mHKA) measured on full-length radiographs in knees with and without bowing. Methods: From January 2014 to June 2017, 107 of 526 osteoarthritic knees at our hospital were found to have femoral or tibial bowing. Bowing was defined as a femoral bowing angle (FBA) > 3°or < − 3°or a tibial bowing angle (TBA) > 2°o r < − 2°in full-length preoperative radiographs. Among 419 knees without bowing, we selected 107 knees as a control group using propensity-score matching. Postoperative alignments were categorized by aFTA in short knee radiographs and mHKA in full-length radiographs into neutral (2°≤ aFTA≤7°, − 3°≤ mHKA≤3°), varus (aFTA< 2°, mHKA< − 3°), and valgus (aFTA> 7°, mHKA> 3°) alignments. We compared the categorization of alignments between knees with and without bowing using the McNemar test and used logistic regression to find factors for the alignment discordance. Results: Coronal alignment was discordant in 26.2% of the knees with bowing and 13.1% of the knees without bowing (p < 0.001). FBAs were a significant factor affecting the discordance of alignment categorization (OR = 1.152, 95%CI 1.038-1.279, p = 0.008). Conclusion: Short knee radiographs are insufficient for estimating coronal alignment after TKA, particularly in knees with femoral bowing. Level of evidence: III: Retrospective comparative study.

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The assessment of femoral shaft morphology in the sagittal plane in Chinese patients with osteoarthritis—a radiographic analysis

Cited by 22 publications

References 17 publications

Is the femoral component flexion affected by the sagittal femoral shaft bowing in conventional intramedullary guided TKA?

Is the femoral component flexion affected by the sagittal femoral shaft bowing in conventional intramedullary guided TKA?

Is the Femoral Component Flexion Affected by the Sagittal Femoral Shaft Bowing in Conventional Intramedually Guided TKA?

Short knee radiographs can be inadequate for estimating TKA alignment in knees with bowing

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