Comparison of Lower-Limb Alignment in Patients with Advanced Knee Osteoarthritis: EOS Biplanar Stereoradiography versus Conventional Scanography

Abstract

Background Accurate measurement of the lower limb alignment is one of the most crucial factors in advanced knee osteoarthritis patients scheduled for surgery. Recently, EOS biplanar stereoradiography with three-dimensional reconstruction was developed. The purpose of this study was to compare radiographic parameters between conventional scanography and EOS in patients with advanced knee osteoarthritis who need surgical treatment. Methods A total of 52 consecutive patients (104 knees) with bilateral knee osteoarthritis of advanced stage (Kellgren-Lawrence [KL] grade 3 or 4) were retrospectively reviewed. We measured the hip-knee-ankle angle (HKA) on conventional scanograms. In EOS, we measured HKA, hip-knee-shaft angle, mechanical lateral distal femoral angle, and mechanical medial proximal tibial angle. To evaluate sagittal and axial plane alignment, knee flexion angle (KFA), and knee joint rotation (KJR) were also measured. Results Ninety knees were KL grade 4, and 14 knees were grade 3. The average HKA was 10.14° ± 6.16° on conventional scanograms and 11.26° ± 6.21° in EOS. HKA was greater in EOS than on conventional scanograms, and the difference (1.12°; range, −1.07° to 3.22°) was statistically significant ( p < 0.001). Significant correlations were observed on the difference in HKA and mechanical medial proximal tibial angle ( r = –0.198, p = 0.044), KFA ( r = 0.193, p = 0.049), and KJR ( r = 0.290, p = 0.003). In multivariable linear regression analysis, the difference in HKA had significant relationship with KFA (β = 0.286, p = 0.003) and KJR (β = 0.363, p < 0.001). Conclusions HKA measured on conventional scanograms and in EOS differed significantly and the difference had a significant correlations with KFA, KJR, and medial proximal tibial angle. Surgeons can consider these results before orthopedic surgery in patients who have advanced knee osteoarthritis.

Central Sensitization and Neuropathic Pain Cumulatively Affect Patients Reporting Inferior Outcomes Following Total Knee Arthroplasty

“…First, most of the patients in each group were women (88% overall; 279 of 316). The reason for this is unknown, but female predominance has been reported in the Korean population undergoing TKA [50][51][52][53][54] . It is also known that the prevalences of central sensitization and neuropathic pain are higher in women 14,55 .…”

Preoperative joint line obliquity, a newly identified factor for overcorrection, can be incorporated into a novel preoperative planning method to optimise alignment in high tibial osteotomy

“…Preoperative radiographic evaluations were performed for each patient using several radiographic modalities. Preoperative MPTA, mechanical lateral distal femoral angle, hip-knee-ankle (HKA) angle [4], weight-bearing line (WBL) ratio [20], JLCA (pre-JLCA std ) [21], tibial plafond inclination (TPI) [22], and joint line obliquity (preJLO) [23] were measured on standing whole lower extremity anteroposterior radiographs. The JLCA was also evaluated on supine whole lower extremity anteroposterior radiographs (preJLCA sup ).…”

Factor affecting the discrepancy in the coronal alignment of the lower limb between the standing and supine radiographs

“…Radiographic variables included the hip-knee-ankle (HKA) angle, medial proximal tibial angle, lateral distal femoral angle, and joint line convergence angle (Fig. 2A) [24][25][26][27]. The discrepancy in the coronal alignment of the lower limb between the standing and supine radiographs was defined as the absolute value of the difference in the HKA angle between the two radiographs and represented the ΔHKA angle (Fig.…”