Varus morphology and its surgical implication in osteoarthritic knee and total knee arthroplasty
Abstract Background Knee varus alignment represents a notorious cause of knee osteoarthritis. It can be caused by tibial deformity, combined tibial–femoral deformity and/or ligament imbalance. Understanding malalignment is crucial in total knee arthroplasty to restore frontal plane neutral mechanica...
| Main Authors: | , , , , , , |
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| Format: | Article |
| Language: | English |
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BMC
2022-06-01
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| Series: | Journal of Orthopaedic Surgery and Research |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s13018-022-03184-4 |
| _version_ | 1798037890391867392 |
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| author | Chiara Suardi Davide Stimolo Luigi Zanna Christian Carulli Matassi Fabrizio Roberto Civinini Matteo Innocenti |
| author_facet | Chiara Suardi Davide Stimolo Luigi Zanna Christian Carulli Matassi Fabrizio Roberto Civinini Matteo Innocenti |
| author_sort | Chiara Suardi |
| collection | DOAJ |
| description | Abstract Background Knee varus alignment represents a notorious cause of knee osteoarthritis. It can be caused by tibial deformity, combined tibial–femoral deformity and/or ligament imbalance. Understanding malalignment is crucial in total knee arthroplasty to restore frontal plane neutral mechanical axis. The aim of this study was to determine which factor contributes the most to varus osteoarthritic knee and its related surgical implications in performing a total knee arthroplasty. Methods We retrospectively evaluated 140 patients operated for total knee arthroplasty due to a varus knee. Full-leg hip to ankle preoperative X-rays were taken. Radiological parameters recorded were: mechanical axis deviation, hip–knee–ankle, anatomical–mechanical angle, medial neck shaft angle, mechanical lateral distal femoral angle (mLDFA), medial proximal tibial angle (MPTA), joint line convergence angle (JLCA), lateral proximal femoral angle, lateral distal tibial angle (LDTA), femoral bowing, and length of tibia and femur. We also determined ideals tibial and femoral cuts in mm according to mechanical alignment technique. A R2 was calculated based on the linear regression between the predicted values and the observed data. Results The greatest contributor to arthritic varus (R = 0.444) was MPTA. Minor contributors were mLDFA (R = 0.076), JLCA (R = 0.1554), LDTA (R = 0.065), and femoral bowing (R = 0.049). We recorded an average of 7.6 mm in lateral tibial cut thickness to restore neutral alignment. Conclusions The radiological major contributor to osteoarthritic varus knee alignment is related to proximal tibia deformity. As a surgical consequence, during performing total knee arthroplasty, the majority of the correction should therefore be made on tibial cut. |
| first_indexed | 2024-04-11T21:32:44Z |
| format | Article |
| id | doaj.art-1474e11138b84e34bad94f0f8fcb5337 |
| institution | Directory Open Access Journal |
| issn | 1749-799X |
| language | English |
| last_indexed | 2024-04-11T21:32:44Z |
| publishDate | 2022-06-01 |
| publisher | BMC |
| record_format | Article |
| series | Journal of Orthopaedic Surgery and Research |
| spelling | doaj.art-1474e11138b84e34bad94f0f8fcb53372022-12-22T04:01:54ZengBMCJournal of Orthopaedic Surgery and Research1749-799X2022-06-011711710.1186/s13018-022-03184-4Varus morphology and its surgical implication in osteoarthritic knee and total knee arthroplastyChiara Suardi0Davide Stimolo1Luigi Zanna2Christian Carulli3Matassi Fabrizio4Roberto Civinini5Matteo Innocenti6Orthopaedic Clinic CTO, University of FlorenceOrthopaedic Clinic CTO, University of FlorenceOrthopaedic Clinic CTO, University of FlorenceOrthopaedic Clinic CTO, University of FlorenceOrthopaedic Clinic CTO, University of FlorenceOrthopaedic Clinic CTO, University of FlorenceOrthopaedic Clinic CTO, University of FlorenceAbstract Background Knee varus alignment represents a notorious cause of knee osteoarthritis. It can be caused by tibial deformity, combined tibial–femoral deformity and/or ligament imbalance. Understanding malalignment is crucial in total knee arthroplasty to restore frontal plane neutral mechanical axis. The aim of this study was to determine which factor contributes the most to varus osteoarthritic knee and its related surgical implications in performing a total knee arthroplasty. Methods We retrospectively evaluated 140 patients operated for total knee arthroplasty due to a varus knee. Full-leg hip to ankle preoperative X-rays were taken. Radiological parameters recorded were: mechanical axis deviation, hip–knee–ankle, anatomical–mechanical angle, medial neck shaft angle, mechanical lateral distal femoral angle (mLDFA), medial proximal tibial angle (MPTA), joint line convergence angle (JLCA), lateral proximal femoral angle, lateral distal tibial angle (LDTA), femoral bowing, and length of tibia and femur. We also determined ideals tibial and femoral cuts in mm according to mechanical alignment technique. A R2 was calculated based on the linear regression between the predicted values and the observed data. Results The greatest contributor to arthritic varus (R = 0.444) was MPTA. Minor contributors were mLDFA (R = 0.076), JLCA (R = 0.1554), LDTA (R = 0.065), and femoral bowing (R = 0.049). We recorded an average of 7.6 mm in lateral tibial cut thickness to restore neutral alignment. Conclusions The radiological major contributor to osteoarthritic varus knee alignment is related to proximal tibia deformity. As a surgical consequence, during performing total knee arthroplasty, the majority of the correction should therefore be made on tibial cut.https://doi.org/10.1186/s13018-022-03184-4Varus kneeTotal knee arthroplastyLower limb alignmentMedial proximal tibial angle |
| spellingShingle | Chiara Suardi Davide Stimolo Luigi Zanna Christian Carulli Matassi Fabrizio Roberto Civinini Matteo Innocenti Varus morphology and its surgical implication in osteoarthritic knee and total knee arthroplasty Journal of Orthopaedic Surgery and Research Varus knee Total knee arthroplasty Lower limb alignment Medial proximal tibial angle |
| title | Varus morphology and its surgical implication in osteoarthritic knee and total knee arthroplasty |
| title_full | Varus morphology and its surgical implication in osteoarthritic knee and total knee arthroplasty |
| title_fullStr | Varus morphology and its surgical implication in osteoarthritic knee and total knee arthroplasty |
| title_full_unstemmed | Varus morphology and its surgical implication in osteoarthritic knee and total knee arthroplasty |
| title_short | Varus morphology and its surgical implication in osteoarthritic knee and total knee arthroplasty |
| title_sort | varus morphology and its surgical implication in osteoarthritic knee and total knee arthroplasty |
| topic | Varus knee Total knee arthroplasty Lower limb alignment Medial proximal tibial angle |
| url | https://doi.org/10.1186/s13018-022-03184-4 |
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