Anatomic variations should be considered in total knee arthroplasty

Nagamine, Ryuji; Miura, Hiromasa; Bravo, Cristian V.; Urabe, Ken; Matsuda, Shuichi; Miyanishi, Keita; Hirata, Go; Iwamoto, Yukihide

doi:10.1007/s007760050157

Cited by 142 publications

(105 citation statements)

References 12 publications

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“…However, it is not feasible to compare our findings directly with those of previous studies because of differences in age and sex compositions of populations studied, the types of parameters measured, and the types of variables reported [11,16,26,29,30,36,38,40]. Nonetheless, it appears that like the Korean female patients in this study, Asian (Chinese, Indian, and Japanese) patients undergoing TKA for medial osteoarthritis commonly exhibit lateral femoral bowing and varus condylar orientation and a larger tibial plateau inclination than healthy Western subjects (Table 7) [11,26,29,30,36,40]. A high prevalence of lateral femoral bowing has been reported in China [40], India [29], and Japan [30], and a varus femoral condylar orientation tendency has been reported in India [29].…”

Section: Discussionmentioning

confidence: 88%

“…Second, we used only one conventional instrumentation system (Genesis II) and only one navigation system (Orthopilot), and different systems of standard instrument or navigation may produce different findings. Third, we used standing whole-limb AP radiographs for radiographic measurements, and although this radiographic view is known to have satisfactory accuracy and reliability [5,35] and have been frequently used in previous studies with similar purposes [11,26,29,30,36,40], it may be affected by several factors such as degree of rotation. To maintain the quality of radiographic images, we used a specially designed template to control rotation.…”

Section: Discussionmentioning

confidence: 99%

“…This 3°of varus inclination of the tibial plateau and approximately the same degree of valgus orientation of the distal femoral condyle have been viewed as basic in past anatomical studies [11,26] and as the norm to achieve proper coronal alignment using most TKA instrumentation systems. However, several authors have reported considerable variations in normal alignment between ethnicities [16,29,30,36,40]. Furthermore, several Asian studies have found femoral lateral bowing and obliquity of the proximal tibial joint surface in knees with advanced osteoarthritis can present with more severe varus inclination ([ 3°) [16,29,30,36,40].…”

Section: Introductionmentioning

confidence: 99%

“…However, several authors have reported considerable variations in normal alignment between ethnicities [16,29,30,36,40]. Furthermore, several Asian studies have found femoral lateral bowing and obliquity of the proximal tibial joint surface in knees with advanced osteoarthritis can present with more severe varus inclination ([ 3°) [16,29,30,36,40]. In addition, we have observed the femora in these patients frequently have lateral bowing of the shaft and varus orientation at the condyles and the tibiae exhibit a much larger varus inclination at the plateaus in Koreans.…”

Section: Introductionmentioning

confidence: 99%

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Femoral Lateral Bowing and Varus Condylar Orientation Are Prevalent and Affect Axial Alignment of TKA in Koreans

Lasam

Lee

Chang

et al. 2013

Clinical Orthopaedics &Amp; Related Research

120

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Background Coronal alignment is considered key to the function and longevity of a TKA. However, most studies do not consider femoral and tibial anatomical features such as lateral femoral bowing and the effects of these features and subsequent alignment on function after TKA are unclear. Questions/purposes We therefore determined (1) the prevalence of lateral femoral bowing, varus femoral condylar orientation, and severe tibia plateau inclination in female Koreans undergoing TKA; (2) whether postoperative alignments are affected by these anatomical features and improved by the use of navigation; and (3) whether postoperative coronal alignments are associated with function.Methods We measured alignment in 367 knees that underwent TKA and 60 sex-and age-matched normal knees (control group). We determined patterns and degrees of femoral bowing angle, femoral condylar orientation, and tibial plateau inclination on preoperative full-limb radiographs. Postoperatively, coronal alignment of limbs and of femoral and tibial components was measured. We compared American Knee Society scores, WOMAC scores, and SF-36 scores in aligned knees and outliers (beyond ± 3°o r ± 2°) at 1 year. Results The prevalence of lateral femoral bowing was 88% in the TKA group and 77% in the control group. Mean femoral condylar orientation angle was varus 2.6°in the TKA group and valgus 1.1°in the control group, and mean tibial plateau inclination was varus 8.3°in the TKA group and varus 5.4°in the control group. Femoral lateral bowing and varus femoral condylar orientation were associated with postoperative alignments. Several clinical outcome scales were inferior in the outliers in mechanical tibiofemoral angle, anatomical tibiofemoral angle, and tibial coronal alignment but not in femoral coronal alignment outliers. Conclusions Lateral femoral bowing, varus condylar orientation, and severe varus inclination of the tibia plateau should be considered when performing TKA in Korean patients or patients with otherwise similar anatomical features.

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Section: Discussionmentioning

confidence: 88%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Femoral Lateral Bowing and Varus Condylar Orientation Are Prevalent and Affect Axial Alignment of TKA in Koreans

Lasam

Lee

Chang

et al. 2013

Clinical Orthopaedics &Amp; Related Research

120

View full text Add to dashboard Cite

show abstract

“…This axis is identifiable on most CT scans but is difficult for surgeons to identify manually during surgery. Several studies have shown using 3°of external rotation to the posterior condylar axis may accurately estimate the femoral flexion axis only 65% to 80% of the time [20,30,32]. Therefore, using a fixed 3°rotational alignment in the conventional group could have resulted in some of the differences found in this group.…”

Section: Discussionmentioning

confidence: 99%

Robotic-assisted TKA Reduces Postoperative Alignment Outliers and Improves Gap Balance Compared to Conventional TKA

Song

Seon

Yim

et al. 2013

Clinical Orthopaedics &Amp; Related Research

316

295

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Background Several studies have shown mechanical alignment influences the outcome of TKA. Robotic systems have been developed to improve the precision and accuracy of achieving component position and mechanical alignment. Questions/purposes We determined whether roboticassisted implantation for TKA (1) improved clinical outcome; (2) improved mechanical axis alignment and implant inclination in the coronal and sagittal planes; (3) improved the balance (flexion and extension gaps); and (4) reduced complications, postoperative drainage, and operative time when compared to conventionally implanted TKA over an intermediate-term (minimum 3-year) followup period. MethodsWe prospectively randomized 100 patients who underwent unilateral TKA into one of two groups: 50 using a robotic-assisted procedure and 50 using conventional manual techniques. Outcome variables considered were postoperative ROM, WOMAC scores, Hospital for Special Surgery (HSS) knee scores, mechanical axis alignment, flexion/extension gap balance, complications, postoperative drainage, and operative time. Minimum followup was 41 months (mean, 65 months; range, 41-81 months). Results There were no differences in postoperative ROM, WOMAC scores, and HSS knee scores. The roboticassisted group resulted in no mechanical axis outliers ([ ± 3°from neutral) compared to 24% in the conventional group. There were fewer robotic-assisted knees

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Constitutional varus knee due to tibial deformity is common and represents a good indication for high tibial osteotomy in Japanese population: Consideration of 1010 knees

Abe,

Goshima,

Morinaga

et al. 2024

Knee surg. sports traumatol. arthrosc.

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PurposeThis study aimed to elucidate the characteristics of varus knee deformities in the Japanese population, prevalence of various around knee osteotomy procedures and influence of femoral and tibial bowing.MethodsVarus knee deformity was defined as a weight‐bearing line ratio of <50%. A total of 1010 varus knees were selected from 1814 varus knees with weight‐bearing full‐length radiographs, obtained at two facilities, based on exclusion criteria. Various parameters were measured, and around knee osteotomy simulations based on the deformity centre were conducted using digital planning tools. Bowing of the femoral and tibial shafts was measured, with bowing defined as follows: ≤ −0.6° indicating lateral bowing and ≥ 0.6° indicating medial bowing. Statistical analysis was performed to investigate age‐related correlations and their impact on surgical techniques.ResultsThe study revealed that the proximal tibia was the centre of deformity in Japanese varus knees (42.8%), and high tibial osteotomy was frequently indicated (81.6%). Age demonstrated a mild correlation with femoral shaft bowing (r = −0.29), leading to an increase in the mechanical lateral distal femoral angle and to a decrease in the hip–knee–ankle angle and weight‐bearing line ratio (r = −0.29, 0.221, 0.219). The tibial shaft bowing was unaffected by age (r = −0.022).ConclusionA significant proportion of Japanese individuals with varus knees exhibit a deformity centre located in the proximal tibia, making them suitable candidates for high tibial osteotomy. No age‐related alterations were discerned in tibial morphology, indicating that the occurrence of constitutional varus knees is attributable to tibial deformities in the Japanese patient cohort.Level of EvidenceLevel IV.

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Anatomic variations should be considered in total knee arthroplasty

Cited by 142 publications

References 12 publications

Femoral Lateral Bowing and Varus Condylar Orientation Are Prevalent and Affect Axial Alignment of TKA in Koreans

Femoral Lateral Bowing and Varus Condylar Orientation Are Prevalent and Affect Axial Alignment of TKA in Koreans

Robotic-assisted TKA Reduces Postoperative Alignment Outliers and Improves Gap Balance Compared to Conventional TKA

Constitutional varus knee due to tibial deformity is common and represents a good indication for high tibial osteotomy in Japanese population: Consideration of 1010 knees

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