The pre-diseased coronal alignment can be predicted from conventional radiographs taken of the varus arthritic knee

Colyn, William; Cleymans, A; Bruckers, Liesbeth; Truijen, Jan; Smeets, Karen; Bellemans, Johan

doi:10.1007/s00402-022-04709-6

Cited by 6 publications

(4 citation statements)

References 25 publications

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“…Regarding the femoral implant position, a mean mLDFA of approximately 89° preoperatively and approximately 90° intra-and postoperatively was observed without any signiicant diference. These results are in accordance with several previous studies proposing that the causative factor for varus deformity in knee osteoarthritis is often a bony defect of the medial tibial plateau, a pathologically decreased mMPTA or a combination of both [2,6]. In contrast, the distal femoral bone coniguration is within physiological values in most cases only requiring femoral resurfacing without distinct reorientation of the femoral component [26].…”

Section: Discussionsupporting

confidence: 92%

Postoperative full leg radiographs exhibit less residual coronal varus deformity compared to intraoperative measurements in robotic arm-assisted total knee arthroplasty with the MAKO™ system

Glowalla

Langer

Lenze

et al. 2023

Knee Surg Sports Traumatol Arthrosc

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Purpose Robotic arm-assisted total knee arthroplasty (raTKA), currently a major trend in knee arthroplasty, aims to improve the accuracy of implant positioning and limb alignment. However, it is unclear whether and to what extent manual radiographic and navigation measurements with the MAKO™ system correlate. Nonetheless, a high agreement would be crucial to reliably achieve the desired limb alignment. Methods Thirty-six consecutive patients with osteoarthritis and a slight-to-moderate varus deformity undergoing raTKA were prospectively included in this study. Prior to surgery and at follow-up, a full leg radiograph (FLR) under weight-bearing conditions was performed. In addition, a computed tomography (CT) scan was conducted for preoperative planning. The hip–knee–ankle angle (HKA), mechanical lateral distal femur angle (mLDFA), mechanical medial proximal tibial angle (mMPTA) and joint line convergence angle (JLCA) were measured in the preoperative and follow-up FLR as well as in the CT scout (without weight-bearing) by three independent raters. Furthermore, the HKA was intraoperatively assessed with the MAKO™ system before and after raTKA. Results Significantly higher HKA values were identified for intraoperative deformity assessment using the MAKO system compared to the preoperative FLR and CT scouts (p = 0.006; p = 0.05). Intraoperative assessment of the HKA with final implants showed a mean residual varus deformity of 3.2° ± 1.9°, whereas a significantly lower residual varus deformity of 1.4° ± 1.9° was identified in the postoperative FLR (p < 0.001). The mMPTA was significantly higher in the preoperative FLR than in the CT scouts (p < 0.001). Intraoperatively, the mMPTA was adjusted to a mean of 87.5° ± 0.9° with final implants, while significantly higher values were measured in postoperative FLRs (p < 0.001). Concerning the mLDFA, no significant differences could be identified. Conclusion The clinical importance of this study lies in the finding that there is a difference between residual varus deformity measured intraoperatively with the MAKO™ system and those measured in postoperative FLRs. This has implications for preoperative planning as well as intraoperative fine-tuning of the implant position during raTKA to avoid overcorrection of knees with slight-to-moderate varus osteoarthritis. Level of evidence Level IV.

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Section: Discussionsupporting

confidence: 92%

Postoperative full leg radiographs exhibit less residual coronal varus deformity compared to intraoperative measurements in robotic arm-assisted total knee arthroplasty with the MAKO™ system

Glowalla

Langer

Lenze

et al. 2023

Knee Surg Sports Traumatol Arthrosc

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“…However, in varus knees, the MA is shifted medially, such that more pronounced varus knees will have larger MADs. Hence, the typical epicentre of the compressive load, associated with the location of the load-bearing axis, is progressively shifting medially during the arthritic process (Colyn et al, 2022;Colyn et al, 2023;Eckstein et al, 2008;). It was also found that the Cart.Th in the medial plateau was consistently thinner than in the lateral plateau.…”

Section: Icc 95% CI Sem Mdcmentioning

confidence: 99%

“…An increased varus alignment is associated with an increasing distance between the centre of the knee and the load-bearing axis, also defined as the MAD (see Fig. 1) (Colyn et al, 2022). It was hypothesised that as the VOI gets closer to the load bearing axis (Fig.…”

Section: Introductionmentioning

confidence: 98%

Microstructural adaptations of the subchondral bone are related to the mechanical axis deviation in end stage varus OA knees

Colyn

Azari²,

Bellemans³

et al. 2023

eCM

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Recent studies highlighted the crucial contribution of subchondral bone to OA development. Yet, only limited data have been reported on the relation between alteration to cartilage morphology, structural properties of the subchondral bone plate (SBP) and underlying subchondral trabecular bone (STB). Furthermore, the relationship between the morphometry of the cartilage and bone in the tibial plateau and the OA-induced changes in the joint’s mechanical axis remains unexplored. Therefore, a visualisation and quantification of cartilage and subchondral bone microstructure in the medial tibial plateau was performed. End stage knee-OA patients with varus alignment and scheduled for total knee arthroplasty (TKA) underwent preoperative fulllength radiography to measure the hip-knee-ankle angle (HKA) and the mechanical-axis deviation (MAD). 18 tibial plateaux were μ-CT scanned (20.1 μm/voxel). Cartilage thickness, SBP, and STB microarchitecture were quantified in 10 volumes of interest (VOIs) in each medial tibial plateau. Significant differences (p < 0.001) were found for cartilage thickness, SBP, and STB microarchitecture parameters among the VOIs. Closer to the mechanical axis, cartilage thickness was consistently smaller, while SBP thickness and STB bone volume fraction (BV/TV) were higher. Moreover, trabeculae were also more superior-inferiorly oriented, i.e. perpendicular to the transverse plane of the tibial plateau. As cartilage and subchondral bone changes reflect responses to local mechanical loading patterns in the joint, the results suggested that region-specific subchondral bone adaptations were related to the degree of varus deformity. More specifically, subchondral sclerosis appeared to be most pronounced closer to the mechanical axis of the knee.

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“…Recently, an equation has been proposed that considers all factors influencing phenotype change: Kellgren-Lawrence grade, current CPAK phenotype, LDFA, MPTA, JLO, and JLCA. It has been validated for CPAK phenotypes I and II, which constitute most of the population (55). However, further large-scale studies are needed to validate it comprehensively.…”

Section: Knee Phenotypesmentioning

confidence: 99%

Joint line and knee osteotomy

Pratobevera,

Seil,

Menetrey

2024

EFORT Open Reviews

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This review explores the intricate relationship between knee osteotomy and frontal plane joint line orientation, emphasizing the dynamic nature of the joint line’s influence on knee forces and kinematics. Consideration of coronal alignments, knee phenotypes, and associated angles (medial proximal tibial angle (MTPA), lateral distal femoral angle (LDFA), joint line convergence angle (JLCA)) becomes crucial in surgical planning to avoid joint line deformities. The double-level osteotomy is to be considered a valid option, especially for severe deformities; however, the target patient cannot be selected solely based on high predicted postoperative joint line obliquity (JLO) and MPTA.

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The pre-diseased coronal alignment can be predicted from conventional radiographs taken of the varus arthritic knee

Cited by 6 publications

References 25 publications

Postoperative full leg radiographs exhibit less residual coronal varus deformity compared to intraoperative measurements in robotic arm-assisted total knee arthroplasty with the MAKO™ system

Postoperative full leg radiographs exhibit less residual coronal varus deformity compared to intraoperative measurements in robotic arm-assisted total knee arthroplasty with the MAKO™ system

Microstructural adaptations of the subchondral bone are related to the mechanical axis deviation in end stage varus OA knees

Joint line and knee osteotomy

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