Tibia Valga Morphology in Osteoarthritic Knees: Importance of Preoperative Full Limb Radiographs in Total Knee Arthroplasty

Alghamdi, Ahmad M.; Rahmé, Michel; Lavigne, Martin; Massé, Vincent; Vendittoli, Pascal‐André

doi:10.1016/j.arth.2014.03.001

Cited by 37 publications

(33 citation statements)

References 42 publications

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“…Since valgus knees frequently have tibial mechanical axes near neutral or in valgus (Alghamdi et al. 2014, Almaawi et al. 2017), increasing femoral external rotation resulted in even greater imbalance.…”

Section: Discussionmentioning

confidence: 99%

Less gap imbalance with restricted kinematic alignment than with mechanically aligned total knee arthroplasty: simulations on 3-D bone models created from CT-scans

et al. 2019

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Background and purpose — Mechanical alignment techniques for total knee arthroplasty (TKA) introduce significant anatomic alteration and secondary ligament imbalances. We propose a restricted kinematic alignment (rKA) protocol to minimize these issues and improve TKA clinical outcomes.Patients and methods — rKA tibial and femoral bone resections were simulated on 1,000 knee CT scans from a database of patients undergoing TKA. rKA was defined by the following criteria: independent tibial and femoral cuts within 5° of the bone neutral mechanical axis, with a resulting HKA within 3° of neutral. Imbalances in the extension space, flexion space at 90°, medial compartment and lateral compartment were calculated and compared with measured resection mechanical alignment (MA) results. 2 MA techniques were simulated for rotation using the surgical transepicondylar axis (TEA) and 3° to the posterior condyles (PC).Results — Extension space imbalances ≥ 3 mm occurred in 33% of TKAs with MA technique versus 8.3% with rKA (p < 0.001). Similarly, more frequent flexion space imbalance ≥ 3mm was created by MA technique (TEA 34% or 3° PC 15%) versus rKA (6.4%, p < 0.001). Using MA with TEA or PC, there were only 49% and 63% of the knees respectively with < 3 mm of imbalance throughout the extension and flexion spaces and medial and lateral compartments versus 92% using rKA (p < 0.001).Interpretation — significantly fewer imbalances are created using rKA versus MA for TKA. rKA may be the best compromise, by helping the surgeon to preserve native knee ligament balance during TKA and avoid residual instability, whilst keeping the lower limb alignment within a safe range.

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Section: Discussionmentioning

confidence: 99%

Less gap imbalance with restricted kinematic alignment than with mechanically aligned total knee arthroplasty: simulations on 3-D bone models created from CT-scans

et al. 2019

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“…Studies done in different races of population have shown high incidence of tibial bowing with the incidence reaching up to 50%. 1 There have been studies which state that almost 50% of the extra-articular deformities at the knee were not recognized in routine short radiographs. 1 As the severity of valgus deformity correlates with that of tibial bowing, full-length radiographs are indicated in patients with preoperative severe valgus deformity.…”

Section: Discussionmentioning

confidence: 99%

“…Degree of lower limb malalignment influences the rate of structural progression of degenerative changes in an arthritic knee. 1 An important measure of lower limb alignment is the hip–knee–ankle (HKA) angle, which corresponds to the lower limb mechanical axis. In neutrally aligned limbs, the medial compartment bears 60–70% of the force across the knee during weight bearing.…”

Section: Introductionmentioning

confidence: 99%

Tibial bowing and tibial component placement in primary total knee arthroplasty in valgus knees: Are we overlooking?

Dhanasekararaja

George

Hussain

et al. 2019

J Orthop Surg (Hong Kong)

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Purpose: Tibial bowing in valgus knees with arthritis can lead to component malplacement during total knee arthroplasty (TKA). Incidence of valgus knees with medial tibial bowing, its effect on tibial component placement during primary TKA and methods to improve accuracy of the component placement were studied. Methods: Full-length weight-bearing alignment radiograph was taken in 117 patients (149 knees) with valgus deformity undergoing TKA. In these cases, the proximal tibial reference for extramedullary jig placement was planned preoperatively with reference to the tibial spines and classified as four zones. Results: The mean preoperative hip–knee–ankle (HKA) angle was 192.9° (180.3–234.5°). Bowing >3° was considered significant ( p < 0.001) and at this level of bowing, the proximal tibial reference was shifted from centre to medial. Tibial bowing <3° was considered straight and >3° as tibia valga. Tibia was bowed in 70 knees (46.97%). Severity of valgus deformity had strong positive correlation with the tibia valga ( p < 0.001). The post-operative medial proximal tibial angle (MPTA) and HKA angle were 91.63° (87.9–95.7°) and 182.6° (178.1–189.7°), respectively. The mean MPTA and post-operative HKA angle in bowed and straight tibiae were 90.35° versus 89.78° ( p = 0.547) and 181.5° versus 180.7° ( p = 0.5716), respectively, and the difference was not statistically significant. Conclusion: Medial tibial bowing is very common in valgus knees. Tibia valga has a strong positive correlation with the severity of valgus deformity. Accurate tibial component placement can be achieved with a medialized reference point for extramedullary tibial cutting jig in knees with significant tibia valga. The study has been registered in clinical trials registry – India (CTRI/2018/03/012283).

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“…Alghamdi et al described that tibia valga deformity is encountered in almost half of valgus knees, while it was rare in varus knees . Furthermore, the deformity was mainly at the proximal lesion.…”

Section: Data On the Difference From Mechanical Axis On The Coronal Pmentioning

confidence: 99%

“…A recent clinical study has also demonstrated the efficacy of the anterior border of the tibia as appropriate landmarks for the placement of extramedullary tibial guides . Valgus knees tend to have a tibia valga deformity compared to varus knees, therefore, it is another important question whether the anterior border of the tibia similarly can be used as an appropriate and reliable alignment landmark for valgus knee arthroplasty. We have now performed a follow‐on analysis of valgus knees to complement the published work on varus knees.…”

Section: Data On the Difference From Mechanical Axis On The Coronal Pmentioning

confidence: 99%

Anterior tibial border as a landmark for extramedullary alignment guides for total knee arthroplasty in valgus knees

Kawahara

Fukagawa

Murakami

et al. 2015

Journal Orthopaedic Research

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Tibia Valga Morphology in Osteoarthritic Knees: Importance of Preoperative Full Limb Radiographs in Total Knee Arthroplasty

Cited by 37 publications

References 42 publications

Less gap imbalance with restricted kinematic alignment than with mechanically aligned total knee arthroplasty: simulations on 3-D bone models created from CT-scans

Less gap imbalance with restricted kinematic alignment than with mechanically aligned total knee arthroplasty: simulations on 3-D bone models created from CT-scans

Tibial bowing and tibial component placement in primary total knee arthroplasty in valgus knees: Are we overlooking?

Anterior tibial border as a landmark for extramedullary alignment guides for total knee arthroplasty in valgus knees

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