Seven phenotypes of varus osteoarthritic knees can be identified in the coronal plane
Purpose Recommendations for resecting distal femur and proximal tibia in mechanical and anatomical alignment techniques are standardized. Kinematic alignment propagates individualizing resection planes. Whether significant variation exists, to warrant departure from standardized resection planes, ha...
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| Vydané v: | Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA Ročník 30; číslo 8; s. 2793 - 2805 |
|---|---|
| Hlavní autori: | , , , , , |
| Médium: | Journal Article |
| Jazyk: | English |
| Vydavateľské údaje: |
Berlin/Heidelberg
Springer Berlin Heidelberg
01.08.2022
John Wiley & Sons, Inc |
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| ISSN: | 0942-2056, 1433-7347, 1433-7347 |
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| Abstract | Purpose
Recommendations for resecting distal femur and proximal tibia in mechanical and anatomical alignment techniques are standardized. Kinematic alignment propagates individualizing resection planes. Whether significant variation exists, to warrant departure from standardized resection planes, has not been shown thus far in a large cohort of knees and with a wide range of varus deformity. The null hypothesis of this study was that there was no phenotypic variation in varus osteoarthritic knees. The aim of this paper was to determine whether distinct phenotypes could be identified, based on variations in coronal femoral and tibial morphology, which could aid in surgical planning and categorizing varus knees for future studies.
Methods
2129 full-leg weightbearing radiographs were analyzed (1704 preoperative; 425 of contralateral arthritic knee). Measurements made were of HKA (hip-knee-ankle angle), VCA (valgus correction angle), mLDFA (lateral mechanical distal femoral angle), aLDFA (lateral anatomical distal femoral angle), MPTA (medial proximal tibial angle), MNSA (medial neck shaft angle), TAMA (angle between tibial mechanical and anatomical axes), and TPDR (percentage length of tibia proximal to extra-articular deformity).
Results
Seven distinct types were identified covering 2021 knees, reducible to 4 broad phenotypes: 11% were Type 1 ‘Neutral’ knees showing values close to reported normal knees (mean VCA 5.5°, mLDFA 87°, aLDFA 81°). 38% were Type 2 ‘Intra-articular varus’ with medial intra-articular bone loss (mean mLDFA 90.9°, MPTA 85.4°, VCA of 5.7°). 41% were Type 3 ‘Extra-articular varus’ with extra-articular deformity (EAD). Type 3a had proximal tibial EAD; Type 3b had tibial diaphyseal EAD; Type 3c had femoral EAD (mean VCA 8.7°, HKA 166°), and severe medial bone loss (mean mLDFA 92°, MPTA 83°). 9% were Type 4 ‘Valgoid type’ with features of valgus knees: Type 4a had medial femoral bowing (mean VCA 2.9°); Type 4b had significant distal femoral valgus (mean mLDFA 85.3°, aLDFA 78.6°).
Conclusions
The null hypothesis that there was no phenotypic variation in varus osteoarthritic knees was rejected as considerable variation was found in coronal morphology of femur and tibia. Four broad phenotypic groups could be identified. Plane of the knee joint articular surface was quite variable. This has relevance to planning and performance of corrective osteotomies, unicompartmental and total knee arthroplasty.
Level of Evidence
III, retrospective cohort study. |
|---|---|
| AbstractList | Recommendations for resecting distal femur and proximal tibia in mechanical and anatomical alignment techniques are standardized. Kinematic alignment propagates individualizing resection planes. Whether significant variation exists, to warrant departure from standardized resection planes, has not been shown thus far in a large cohort of knees and with a wide range of varus deformity. The null hypothesis of this study was that there was no phenotypic variation in varus osteoarthritic knees. The aim of this paper was to determine whether distinct phenotypes could be identified, based on variations in coronal femoral and tibial morphology, which could aid in surgical planning and categorizing varus knees for future studies.PURPOSERecommendations for resecting distal femur and proximal tibia in mechanical and anatomical alignment techniques are standardized. Kinematic alignment propagates individualizing resection planes. Whether significant variation exists, to warrant departure from standardized resection planes, has not been shown thus far in a large cohort of knees and with a wide range of varus deformity. The null hypothesis of this study was that there was no phenotypic variation in varus osteoarthritic knees. The aim of this paper was to determine whether distinct phenotypes could be identified, based on variations in coronal femoral and tibial morphology, which could aid in surgical planning and categorizing varus knees for future studies.2129 full-leg weightbearing radiographs were analyzed (1704 preoperative; 425 of contralateral arthritic knee). Measurements made were of HKA (hip-knee-ankle angle), VCA (valgus correction angle), mLDFA (lateral mechanical distal femoral angle), aLDFA (lateral anatomical distal femoral angle), MPTA (medial proximal tibial angle), MNSA (medial neck shaft angle), TAMA (angle between tibial mechanical and anatomical axes), and TPDR (percentage length of tibia proximal to extra-articular deformity).METHODS2129 full-leg weightbearing radiographs were analyzed (1704 preoperative; 425 of contralateral arthritic knee). Measurements made were of HKA (hip-knee-ankle angle), VCA (valgus correction angle), mLDFA (lateral mechanical distal femoral angle), aLDFA (lateral anatomical distal femoral angle), MPTA (medial proximal tibial angle), MNSA (medial neck shaft angle), TAMA (angle between tibial mechanical and anatomical axes), and TPDR (percentage length of tibia proximal to extra-articular deformity).Seven distinct types were identified covering 2021 knees, reducible to 4 broad phenotypes: 11% were Type 1 'Neutral' knees showing values close to reported normal knees (mean VCA 5.5°, mLDFA 87°, aLDFA 81°). 38% were Type 2 'Intra-articular varus' with medial intra-articular bone loss (mean mLDFA 90.9°, MPTA 85.4°, VCA of 5.7°). 41% were Type 3 'Extra-articular varus' with extra-articular deformity (EAD). Type 3a had proximal tibial EAD; Type 3b had tibial diaphyseal EAD; Type 3c had femoral EAD (mean VCA 8.7°, HKA 166°), and severe medial bone loss (mean mLDFA 92°, MPTA 83°). 9% were Type 4 'Valgoid type' with features of valgus knees: Type 4a had medial femoral bowing (mean VCA 2.9°); Type 4b had significant distal femoral valgus (mean mLDFA 85.3°, aLDFA 78.6°).RESULTSSeven distinct types were identified covering 2021 knees, reducible to 4 broad phenotypes: 11% were Type 1 'Neutral' knees showing values close to reported normal knees (mean VCA 5.5°, mLDFA 87°, aLDFA 81°). 38% were Type 2 'Intra-articular varus' with medial intra-articular bone loss (mean mLDFA 90.9°, MPTA 85.4°, VCA of 5.7°). 41% were Type 3 'Extra-articular varus' with extra-articular deformity (EAD). Type 3a had proximal tibial EAD; Type 3b had tibial diaphyseal EAD; Type 3c had femoral EAD (mean VCA 8.7°, HKA 166°), and severe medial bone loss (mean mLDFA 92°, MPTA 83°). 9% were Type 4 'Valgoid type' with features of valgus knees: Type 4a had medial femoral bowing (mean VCA 2.9°); Type 4b had significant distal femoral valgus (mean mLDFA 85.3°, aLDFA 78.6°).The null hypothesis that there was no phenotypic variation in varus osteoarthritic knees was rejected as considerable variation was found in coronal morphology of femur and tibia. Four broad phenotypic groups could be identified. Plane of the knee joint articular surface was quite variable. This has relevance to planning and performance of corrective osteotomies, unicompartmental and total knee arthroplasty.CONCLUSIONSThe null hypothesis that there was no phenotypic variation in varus osteoarthritic knees was rejected as considerable variation was found in coronal morphology of femur and tibia. Four broad phenotypic groups could be identified. Plane of the knee joint articular surface was quite variable. This has relevance to planning and performance of corrective osteotomies, unicompartmental and total knee arthroplasty.III, retrospective cohort study.LEVEL OF EVIDENCEIII, retrospective cohort study. PurposeRecommendations for resecting distal femur and proximal tibia in mechanical and anatomical alignment techniques are standardized. Kinematic alignment propagates individualizing resection planes. Whether significant variation exists, to warrant departure from standardized resection planes, has not been shown thus far in a large cohort of knees and with a wide range of varus deformity. The null hypothesis of this study was that there was no phenotypic variation in varus osteoarthritic knees. The aim of this paper was to determine whether distinct phenotypes could be identified, based on variations in coronal femoral and tibial morphology, which could aid in surgical planning and categorizing varus knees for future studies.Methods2129 full-leg weightbearing radiographs were analyzed (1704 preoperative; 425 of contralateral arthritic knee). Measurements made were of HKA (hip-knee-ankle angle), VCA (valgus correction angle), mLDFA (lateral mechanical distal femoral angle), aLDFA (lateral anatomical distal femoral angle), MPTA (medial proximal tibial angle), MNSA (medial neck shaft angle), TAMA (angle between tibial mechanical and anatomical axes), and TPDR (percentage length of tibia proximal to extra-articular deformity).ResultsSeven distinct types were identified covering 2021 knees, reducible to 4 broad phenotypes: 11% were Type 1 ‘Neutral’ knees showing values close to reported normal knees (mean VCA 5.5°, mLDFA 87°, aLDFA 81°). 38% were Type 2 ‘Intra-articular varus’ with medial intra-articular bone loss (mean mLDFA 90.9°, MPTA 85.4°, VCA of 5.7°). 41% were Type 3 ‘Extra-articular varus’ with extra-articular deformity (EAD). Type 3a had proximal tibial EAD; Type 3b had tibial diaphyseal EAD; Type 3c had femoral EAD (mean VCA 8.7°, HKA 166°), and severe medial bone loss (mean mLDFA 92°, MPTA 83°). 9% were Type 4 ‘Valgoid type’ with features of valgus knees: Type 4a had medial femoral bowing (mean VCA 2.9°); Type 4b had significant distal femoral valgus (mean mLDFA 85.3°, aLDFA 78.6°).ConclusionsThe null hypothesis that there was no phenotypic variation in varus osteoarthritic knees was rejected as considerable variation was found in coronal morphology of femur and tibia. Four broad phenotypic groups could be identified. Plane of the knee joint articular surface was quite variable. This has relevance to planning and performance of corrective osteotomies, unicompartmental and total knee arthroplasty.Level of EvidenceIII, retrospective cohort study. Purpose Recommendations for resecting distal femur and proximal tibia in mechanical and anatomical alignment techniques are standardized. Kinematic alignment propagates individualizing resection planes. Whether significant variation exists, to warrant departure from standardized resection planes, has not been shown thus far in a large cohort of knees and with a wide range of varus deformity. The null hypothesis of this study was that there was no phenotypic variation in varus osteoarthritic knees. The aim of this paper was to determine whether distinct phenotypes could be identified, based on variations in coronal femoral and tibial morphology, which could aid in surgical planning and categorizing varus knees for future studies. Methods 2129 full-leg weightbearing radiographs were analyzed (1704 preoperative; 425 of contralateral arthritic knee). Measurements made were of HKA (hip-knee-ankle angle), VCA (valgus correction angle), mLDFA (lateral mechanical distal femoral angle), aLDFA (lateral anatomical distal femoral angle), MPTA (medial proximal tibial angle), MNSA (medial neck shaft angle), TAMA (angle between tibial mechanical and anatomical axes), and TPDR (percentage length of tibia proximal to extra-articular deformity). Results Seven distinct types were identified covering 2021 knees, reducible to 4 broad phenotypes: 11% were Type 1 ‘Neutral’ knees showing values close to reported normal knees (mean VCA 5.5°, mLDFA 87°, aLDFA 81°). 38% were Type 2 ‘Intra-articular varus’ with medial intra-articular bone loss (mean mLDFA 90.9°, MPTA 85.4°, VCA of 5.7°). 41% were Type 3 ‘Extra-articular varus’ with extra-articular deformity (EAD). Type 3a had proximal tibial EAD; Type 3b had tibial diaphyseal EAD; Type 3c had femoral EAD (mean VCA 8.7°, HKA 166°), and severe medial bone loss (mean mLDFA 92°, MPTA 83°). 9% were Type 4 ‘Valgoid type’ with features of valgus knees: Type 4a had medial femoral bowing (mean VCA 2.9°); Type 4b had significant distal femoral valgus (mean mLDFA 85.3°, aLDFA 78.6°). Conclusions The null hypothesis that there was no phenotypic variation in varus osteoarthritic knees was rejected as considerable variation was found in coronal morphology of femur and tibia. Four broad phenotypic groups could be identified. Plane of the knee joint articular surface was quite variable. This has relevance to planning and performance of corrective osteotomies, unicompartmental and total knee arthroplasty. Level of Evidence III, retrospective cohort study. |
| Author | Bhoskar, Ritesh Shah, Rahul Singh, Abhimanyu Haidermota, Murtaza Thakur, Harshad Mullaji, Arun |
| Author_xml | – sequence: 1 givenname: Arun orcidid: 0000-0002-6622-7860 surname: Mullaji fullname: Mullaji, Arun email: arunmullaji@gmail.com organization: Consultant Orthopaedic Surgeon, Breach Candy Hospital, and Mullaji Knee Clinic – sequence: 2 givenname: Rahul surname: Shah fullname: Shah, Rahul organization: Associate Orthopaedic Surgeon, Mullaji Knee Clinic – sequence: 3 givenname: Ritesh surname: Bhoskar fullname: Bhoskar, Ritesh organization: Associate Orthopaedic Surgeon, Mullaji Knee Clinic – sequence: 4 givenname: Abhimanyu surname: Singh fullname: Singh, Abhimanyu organization: Associate Orthopaedic Surgeon, Mullaji Knee Clinic – sequence: 5 givenname: Murtaza surname: Haidermota fullname: Haidermota, Murtaza organization: Fellow in Arthroplasty, Breach Candy Hospital – sequence: 6 givenname: Harshad surname: Thakur fullname: Thakur, Harshad organization: Director, National Institute of Health and Family Welfare (NIHFW) |
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| CitedBy_id | crossref_primary_10_1002_ksa_12099 crossref_primary_10_1302_0301_620X_106B12_BJJ_2023_1269_R1 crossref_primary_10_1002_ksa_12141 crossref_primary_10_1002_ksa_12043 crossref_primary_10_1016_j_jor_2025_08_041 crossref_primary_10_1002_ksa_12168 crossref_primary_10_1002_ksa_12311 crossref_primary_10_1007_s00167_021_06796_1 crossref_primary_10_1002_ksa_12149 crossref_primary_10_3233_THC_231261 crossref_primary_10_3390_jcm14051679 crossref_primary_10_1186_s42836_024_00239_1 crossref_primary_10_1186_s13018_024_05126_8 crossref_primary_10_3390_medicina60111818 crossref_primary_10_1002_jeo2_12007 crossref_primary_10_1016_j_asmart_2025_08_006 crossref_primary_10_1016_j_medengphy_2024_104185 crossref_primary_10_1002_jeo2_70409 crossref_primary_10_1002_ksa_12095 crossref_primary_10_1002_ksa_12082 |
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| ContentType | Journal Article |
| Copyright | European Society of Sports Traumatology, Knee Surgery, Arthroscopy (ESSKA) 2021 European Society of Sports Traumatology, Knee Surgery, Arthroscopy (ESSKA) 2021. 2021. European Society of Sports Traumatology, Knee Surgery, Arthroscopy (ESSKA). |
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| DOI | 10.1007/s00167-021-06676-8 |
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| Issue | 8 |
| Keywords | Phenotypes Total knee arthroplasty Anatomic alignment Kinematic Alignment Extra-articular deformity Unicompartmental knee arthroplasty Corrective osteotomy Intra-articular deformity Mechanical alignment Varus osteoarthritis Coronal plane alignment |
| Language | English |
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| PublicationTitle | Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA |
| PublicationTitleAbbrev | Knee Surg Sports Traumatol Arthrosc |
| PublicationYear | 2022 |
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three-dimensional imaging studies always needed to measure the coronal knee alignment of the lower extremity? publication-title: Int Orthop Int Orthop doi: 10.1007/s00264-016-3340-y – ident: e_1_2_8_4_2 doi: 10.1007/s00296‐002‐0218‐7 – ident: e_1_2_8_34_2 doi: 10.1007/s00167‐017‐4570‐2 – volume: 9 start-page: 1 year: 2020 ident: e_1_2_8_18_2 article-title: The effect of knee joint rotation in the sagittal and axial plane on the measurement accuracy of coronal alignment of the lower limb publication-title: BMC Musculoskelet Disord – volume: 1 start-page: 44 year: 2014 ident: e_1_2_8_8_2 article-title: Kinematic alignment in total knee arthroplasty definition, history, principle, surgical technique, and results of an alignment option for TKA what is kinematic alignment in TKA? publication-title: Arthropaedia – ident: e_1_2_8_25_2 doi: 10.1016/j.knee.2019.05.010 – ident: e_1_2_8_16_2 doi: 10.1054/arth.2003.50002 – ident: e_1_2_8_19_2 doi: 10.1016/j.arth.2009.05.005 – ident: e_1_2_8_26_2 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Recommendations for resecting distal femur and proximal tibia in mechanical and anatomical alignment techniques are standardized. Kinematic alignment... PurposeRecommendations for resecting distal femur and proximal tibia in mechanical and anatomical alignment techniques are standardized. Kinematic alignment... Recommendations for resecting distal femur and proximal tibia in mechanical and anatomical alignment techniques are standardized. Kinematic alignment... |
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| SubjectTerms | Alignment Ankle Arthroplasty (knee) Biomedical materials Bone loss Bowing Femur Hypotheses Knee Medicine Medicine & Public Health Morphology Null hypothesis Orthopedics Osteoarthritis Phenotypes Phenotypic variations Sports Medicine Tibia |
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| Title | Seven phenotypes of varus osteoarthritic knees can be identified in the coronal plane |
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