The language of knee alignment

MacDessi, Samuel J.; Oussedik, Sam; Abdel, Matthew P.; Victor, Jan; Pagnano, Mark W.; Haddad, Fares S.

doi:10.1302/0301-620x.105b2.bjj-2022-1345

Cited by 29 publications

(27 citation statements)

References 91 publications

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“…Consequently, when aiming for neutral alignment by using mechanical alignment approaches in TKA, the native joint orientation is inevitably modiied in many patients [2]. The results indicate the need in individualized alignment paradigms that adjust for variations in individual knee morphology, such as kinematic alignment or personalized alignment approaches [13,22,33,36,37]. BMI is another major factor in TKA failure, and even though we were able to identify a signiicant interaction between knee alignment and a high BMI, the efect was extremely small.…”

Section: Discussionmentioning

confidence: 82%

Gender‐specific distribution of knee morphology according to CPAK and functional phenotype classification: analysis of 8739 osteoarthritic knees prior to total knee arthroplasty using artificial intelligence

Huber,

Mitterer,

Vallant

et al. 2023

Knee surg. sports traumatol. arthrosc.

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Purpose Osteoarthritis of the knee is commonly associated with malalignment of the lower limb. Recent classiications, as the Coronal Plane Alignment of the Knee (CPAK) and Functional Phenotype classiication, describe the bony knee morphology in addition to the overall limb alignment. Data on distribution of these classiications is not suicient in large populations. The aim of this study was to analyse the preoperative knee morphology with regard to the aforementioned classiications in long leg radiographs prior to total knee arthroplasty surgery using Artiicial Intelligence. Methods The cohort comprised 8739 preoperative long leg radiographs of 7456 patients of all total knee arthroplasty surgeries between 2009 and 2021 from our institutional database. The automated measurements were performed with the validated Artiicial Intelligence software LAMA (ImageBiopsy Lab, Vienna) and included standardized axes and angles [hip-knee-ankle angle (HKA), mechanical lateral distal femur angle (mLDFA), mechanical medial proximal tibia angle (mMPTA), mechanical axis deviation (MAD), anatomic mechanic axis deviation (AMA) and joint line convergence angle (JLCA)]. CPAK and functional phenotype classiications were performed and all measurements were analysed for gender, age, and body mass index (BMI) within these subgroups.

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Section: Discussionmentioning

confidence: 82%

Gender‐specific distribution of knee morphology according to CPAK and functional phenotype classification: analysis of 8739 osteoarthritic knees prior to total knee arthroplasty using artificial intelligence

Huber,

Mitterer,

Vallant

et al. 2023

Knee surg. sports traumatol. arthrosc.

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“…Therefore, a further limitation is that our indings may not be generalizable to global populations. Regardless of these limitations, the study's indings lend support to the rationale behind contemporary alignment strategies, which emphasise the importance of joint line obliquity [25]. The clinical relevance for surgeons applying these strategies is that imaging modality needs to be considered when setting surgical targets.…”

Section: Discussionmentioning

confidence: 72%

Long leg radiographs underestimate the degree of constitutional varus limb alignment and joint line obliquity in comparison with computed tomography: a radiographic study

Tarassoli,

Corban,

Wood

et al. 2023

Knee surg. sports traumatol. arthrosc.

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Purpose The purpose of this study was to understand if diferences exist between computed tomography (CT) and long leg radiographs (LLR) when deining coronal plane alignment of the lower limb in total knee arthroplasty (TKA). It aimed to identify any such diferences between the two imaging modalities by quantifying constitutional limb alignment (arithmetic hip-knee-ankle angle (aHKA), joint line obliquity (JLO) and Coronal Plane Alignment of the Knee (CPAK) type within the same population. Methods A retrospective radiographic study compared pre-operative LLR and CT measurements in patients undergoing robotic-assisted TKA. The aHKA, JLO and CPAK types were calculated after measuring the medial proximal tibial angle (MPTA) and lateral distal femoral angle (LDFA). The primary outcomes were the mean diferences in aHKA (MPTA− LDFA), JLO (MPTA + LDFA) and proportions of CPAK types between LLR and CT groups. The secondary outcomes were the diferences in CT-derived MPTA values based on four diferent tibial sagittal landmarks. Results After exclusions, 465 imaging sets were analysed in 394 patients. There was a statistically signiicant mean diference between LLR and CT, respectively, for both MPTA (87.5° vs. 86.2°; p < 0.01) and LDFA (88.7° vs. 87.3°; p < 0.01). There were also statistically signiicant diferences for aHKA (− 0.2° vs. − 1.1°) and JLO (175.1° vs. 173.4°) for LLR and CT, respectively (both p < 0.01). CT increased the proportion of patients with CPAK Type I (constitutional varus aHKA, apex distal JLO) and CPAK Type II (neutral aHKA, apex distal JLO), and decreased numbers of CPAK Types III-VI. There were signiicant mean diferences in the MPTA using varying sagittal landmarks. Conclusion Alignment determined by LLRs underestimates the magnitude of both constitutional varus alignment and joint line obliquity compared to CT, diferences that notably increase the proportions of patients included in CPAK Types I and II. These distinctions are primarily due to underestimation of proximal tibial varus when measured on LLRs compared to CT, which more speciically deines articular weight-bearing points. Level of evidence III.

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“…Individualized alignment strategies include four distinct approaches: adjusted mechanical alignment, unrestricted and restricted kinematic alignments, and functional alignment, aiming for native soft-tissue tension and prioritizing constitutional alignment. Among these approaches, there are four of them commonly used and accepted in literature for the varus knee phenotype: functional alignment, unrestricted kinematic alignment, mechanical alignment, and adjusted mechanical alignment [31].…”

Section: Discussionmentioning

confidence: 99%

Mid-Term Clinical and Radiological Results at a Tertiary Care Hospital in Türkiye: Is Residual Varus Really Important After Mechanically-Aligned Total Knee Arthroplasty?

Aydın¹,

Gürsu²,

Yapıcı³

et al. 2023

Cureus

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Introduction: Traditionally, in total knee arthroplasty (TKA), it is aimed to keep the mechanical axis of the lower extremity neutral (mechanical alignment: 3° varus-valgus in the coronal plane) to improve long-term outcomes. This study aimed to assess the mid-term radiological and clinical results of patients with postoperative residual varus (more than 3° of varus) after mechanically-aligned TKA.Methods: A total of 616 individuals who had undergone TKA for primary knee osteoarthritis between 2008 and 2013 in our tertiary care hospital were retrospectively examined. All TKAs were performed with the mechanical alignment strategy. For radiological evaluation, hip-knee-ankle (HKA) angle, knee alignment angle (KAA), mechanical medial proximal tibial angle (mMPTA), knee inclination (KI), joint line orientation angle relative to ground (JLOA-G), posterior tibial slope (PS), joint line convergence angle (JLCA) were measured. Besides, patients' latest radiographs were screened for any clue of aseptic loosening or mechanical failure. Knee Society Score (KSS) (knee and functional subgroups), and Lysholm, Oxford, and Tegner scores were used for clinical evaluation. In addition, knee flexion and extension limitations were assessed.Results: After applying the exclusion criteria, a minimum of five-year follow-up result of 110 patients was demonstrated. There were 101 females (92%) and nine males (8%). The mean follow-up time was 65.8 ± 6.3 months (range: 60.8-75.8 years). The mean age was 65.9 ± 7.7 years (range: 39 to 89 years). The preoperative mean mechanical axis angle of the lower extremity was 17.3° ± 7.8° (range: 13.4-43.9°), whereas it was 8.3° ± 3.6° (range: 3.2-19.8°) postoperatively. The preoperative mean flexion angle was 90.7° ± 23.8° (range: 40-130°), and the extension limitation was -2.5° ± 7.4° (range: -40-0°), whereas, postoperatively, they were 102.8° ± 15.4° (range from 40° to 150°) and -3.7° ± 7.5° (range from -40° to 0°), respectively. The latest follow-up's mean KSS knee subgroup was 67 ± 18.4 (range: 12-93), the mean KSS functional subgroup was 74 ± 23.6 (range: 20-100), the mean Lysholm score was 81.7 ± 15.7 (range:25-100), the mean Tegner score was 3.65 ± 0.99 (range: 1-5), the mean Oxford score was 37.4 ± 6.5 (range: 9-48). There was no patient with aseptic loosening or mechanical failure.Conclusions: In the mid-term follow-up of patients with residual varus after mechanically-aligned TKA, satisfactory clinical and radiological results were obtained without aseptic loosening or implant failure.

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The language of knee alignment

Cited by 29 publications

References 91 publications

Gender‐specific distribution of knee morphology according to CPAK and functional phenotype classification: analysis of 8739 osteoarthritic knees prior to total knee arthroplasty using artificial intelligence

Gender‐specific distribution of knee morphology according to CPAK and functional phenotype classification: analysis of 8739 osteoarthritic knees prior to total knee arthroplasty using artificial intelligence

Long leg radiographs underestimate the degree of constitutional varus limb alignment and joint line obliquity in comparison with computed tomography: a radiographic study

Mid-Term Clinical and Radiological Results at a Tertiary Care Hospital in Türkiye: Is Residual Varus Really Important After Mechanically-Aligned Total Knee Arthroplasty?

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