The relationship between constitutional alignment and varus osteoarthritis of the knee

Purpose The role of neutral alignment in total knee arthroplasty (TKA) on short- and long-term outcomes has become controversial. Based on the concept of constitutional varus, it has been suggested that under-correction in TKA in a varus osteoarthritis (OA) population might lead to better clinical o...

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Veröffentlicht in:	Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA Jg. 25; H. 9; S. 2873 - 2879
Hauptverfasser:	Vandekerckhove, Pieter-Jan T. K., Matlovich, Nicholas, Teeter, Matthew G., MacDonald, Steven J., Howard, James L., Lanting, Brent A.
Format:	Journal Article
Sprache:	Englisch
Veröffentlicht:	Berlin/Heidelberg Springer Berlin Heidelberg 01.09.2017 John Wiley & Sons, Inc
Schlagworte:	Aged Alignment Arthritis Arthroplasty (knee) Arthroplasty, Replacement, Knee Biocompatibility Bone Malalignment - diagnostic imaging Deformation Female Humans Joint surgery Knee Knee Joint - diagnostic imaging Knee Joint - physiopathology Knee Joint - surgery Male Males Medicine Medicine & Public Health Men Middle Aged Orthopedics Osteoarthritis Osteoarthritis, Knee - surgery Radiographs Radiography Surgical implants Knee Constitutional varus Coronal plane alignment Varus Osteoarthritis
ISSN:	0942-2056, 1433-7347
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Abstract	Purpose The role of neutral alignment in total knee arthroplasty (TKA) on short- and long-term outcomes has become controversial. Based on the concept of constitutional varus, it has been suggested that under-correction in TKA in a varus osteoarthritis (OA) population might lead to better clinical outcomes. However, it is still unknown what the relationship between constitutional varus and the development of end-stage OA is. The goal of this study was to analyse the contribution of constitutional varus in a medial OA population and to define a correlation between the constitutional alignment and end-stage varus OA. Methods Based on full-length radiographs, corrected for the intra-articular deformity of the knee, of 315 patients with unilateral end-stage medial OA of the knee (Charnley type A), a correlation in the coronal plane was made between medial end-stage OA and the contralateral non-arthritic side. Results With increasing varus alignment in the arthritic limb, the physiologic limb alignment also became more varus. The proportion of constitutional varus rose with increasing overall alignment and was found to be continuous for males. Constitutional varus was three times higher in men when the overall arthritic alignment was greater more than 6° varus. Conclusion Constitutional varus significantly contributes to varus osteoarthritis and was found to be higher than in the general population. Level of evidence III.
AbstractList	Purpose The role of neutral alignment in total knee arthroplasty (TKA) on short- and long-term outcomes has become controversial. Based on the concept of constitutional varus, it has been suggested that under-correction in TKA in a varus osteoarthritis (OA) population might lead to better clinical outcomes. However, it is still unknown what the relationship between constitutional varus and the development of end-stage OA is. The goal of this study was to analyse the contribution of constitutional varus in a medial OA population and to define a correlation between the constitutional alignment and end-stage varus OA. Methods Based on full-length radiographs, corrected for the intra-articular deformity of the knee, of 315 patients with unilateral end-stage medial OA of the knee (Charnley type A), a correlation in the coronal plane was made between medial end-stage OA and the contralateral non-arthritic side. Results With increasing varus alignment in the arthritic limb, the physiologic limb alignment also became more varus. The proportion of constitutional varus rose with increasing overall alignment and was found to be continuous for males. Constitutional varus was three times higher in men when the overall arthritic alignment was greater more than 6° varus. Conclusion Constitutional varus significantly contributes to varus osteoarthritis and was found to be higher than in the general population. Level of evidence III. Purpose The role of neutral alignment in total knee arthroplasty (TKA) on short- and long-term outcomes has become controversial. Based on the concept of constitutional varus, it has been suggested that under-correction in TKA in a varus osteoarthritis (OA) population might lead to better clinical outcomes. However, it is still unknown what the relationship between constitutional varus and the development of end-stage OA is. The goal of this study was to analyse the contribution of constitutional varus in a medial OA population and to define a correlation between the constitutional alignment and end-stage varus OA. Methods Based on full-length radiographs, corrected for the intra-articular deformity of the knee, of 315 patients with unilateral end-stage medial OA of the knee (Charnley type A), a correlation in the coronal plane was made between medial end-stage OA and the contralateral non-arthritic side. Results With increasing varus alignment in the arthritic limb, the physiologic limb alignment also became more varus. The proportion of constitutional varus rose with increasing overall alignment and was found to be continuous for males. Constitutional varus was three times higher in men when the overall arthritic alignment was greater more than 6° varus. Conclusion Constitutional varus significantly contributes to varus osteoarthritis and was found to be higher than in the general population. Level of evidence III. The role of neutral alignment in total knee arthroplasty (TKA) on short- and long-term outcomes has become controversial. Based on the concept of constitutional varus, it has been suggested that under-correction in TKA in a varus osteoarthritis (OA) population might lead to better clinical outcomes. However, it is still unknown what the relationship between constitutional varus and the development of end-stage OA is. The goal of this study was to analyse the contribution of constitutional varus in a medial OA population and to define a correlation between the constitutional alignment and end-stage varus OA. Based on full-length radiographs, corrected for the intra-articular deformity of the knee, of 315 patients with unilateral end-stage medial OA of the knee (Charnley type A), a correlation in the coronal plane was made between medial end-stage OA and the contralateral non-arthritic side. With increasing varus alignment in the arthritic limb, the physiologic limb alignment also became more varus. The proportion of constitutional varus rose with increasing overall alignment and was found to be continuous for males. Constitutional varus was three times higher in men when the overall arthritic alignment was greater more than 6° varus. Constitutional varus significantly contributes to varus osteoarthritis and was found to be higher than in the general population. III. PURPOSEThe role of neutral alignment in total knee arthroplasty (TKA) on short- and long-term outcomes has become controversial. Based on the concept of constitutional varus, it has been suggested that under-correction in TKA in a varus osteoarthritis (OA) population might lead to better clinical outcomes. However, it is still unknown what the relationship between constitutional varus and the development of end-stage OA is. The goal of this study was to analyse the contribution of constitutional varus in a medial OA population and to define a correlation between the constitutional alignment and end-stage varus OA.METHODSBased on full-length radiographs, corrected for the intra-articular deformity of the knee, of 315 patients with unilateral end-stage medial OA of the knee (Charnley type A), a correlation in the coronal plane was made between medial end-stage OA and the contralateral non-arthritic side.RESULTSWith increasing varus alignment in the arthritic limb, the physiologic limb alignment also became more varus. The proportion of constitutional varus rose with increasing overall alignment and was found to be continuous for males. Constitutional varus was three times higher in men when the overall arthritic alignment was greater more than 6° varus.CONCLUSIONConstitutional varus significantly contributes to varus osteoarthritis and was found to be higher than in the general population.LEVEL OF EVIDENCEIII.
Author	Vandekerckhove, Pieter-Jan T. K. MacDonald, Steven J. Matlovich, Nicholas Teeter, Matthew G. Lanting, Brent A. Howard, James L.
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BackLink	https://www.ncbi.nlm.nih.gov/pubmed/26831863$$D View this record in MEDLINE/PubMed
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Copyright	European Society of Sports Traumatology, Knee Surgery, Arthroscopy (ESSKA) 2016 Knee Surgery, Sports Traumatology, Arthroscopy is a copyright of Springer, 2017.
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Keywords	Knee Constitutional varus Coronal plane alignment Varus Osteoarthritis
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publication-title: J Bone Joint Surg Br doi: 10.1302/0301-620X.67B4.4030849 – reference: 19760472 - Clin Orthop Relat Res. 2010 Feb;468(2):542-6 – reference: 12478515 - J Arthroplasty. 2002 Dec;17(8):1033-9 – reference: 24906519 - J Arthroplasty. 2014 Sep;29(9):1795-802 – reference: 4030849 - J Bone Joint Surg Br. 1985 Aug;67(4):551-6 – reference: 21911533 - J Bone Joint Surg Br. 2011 Sep;93(9):1217-22 – reference: 16265702 - J Rheumatol. 2005 Nov;32(11):2192-9 – reference: 8028882 - Orthop Clin North Am. 1994 Jul;25(3):387-93 – reference: 18841432 - Clin Orthop Relat Res. 2009 Feb;467(2):504-9 – reference: 20844155 - J Bone Joint Surg Am. 2010 Sep 15;92(12):2143-9 – reference: 15534515 - Clin Orthop Relat Res. 2004 Nov;(428):26-34 – reference: 11716373 - Clin Orthop Relat Res. 2001 Nov;(392):124-30 – reference: 19553073 - J Arthroplasty. 2009 Sep;24(6 Suppl):39-43 – reference: 25823516 - Int Orthop. 2015 Nov;39(11):2117-24 – reference: 23184086 - Knee Surg Sports Traumatol Arthrosc. 2013 Oct;21(10 ):2331-7 – reference: 21656315 - Clin Orthop Relat Res. 2012 Jan;470(1):45-53 – reference: 20165859 - Arch Orthop Trauma Surg. 2010 Dec;130(12 ):1487-91 – reference: 6490696 - J Bone Joint Surg Am. 1984 Oct;66(8):1211-8 – reference: 6825330 - Clin Orthop Relat Res. 1983 Mar;(173):178-83 – reference: 21732057 - Knee Surg Sports Traumatol Arthrosc. 2012 Jul;20(7):1307-22 – reference: 11716388 - Clin Orthop Relat Res. 2001 Nov;(392):232-8 – reference: 21915573 - J Bone Joint Surg Am. 2011 Sep 7;93(17):1588-96 – reference: 24820681 - J Orthop Res. 2014 Aug;32(8):1068-74 – reference: 23809707 - J Arthroplasty. 2014 Feb;29(2):365-8 – reference: 2805471 - Clin Orthop Relat Res. 1989 Nov;(248):135-44 – reference: 17787049 - J Rheumatol. 2007 Sep;34(9):1796-801 – reference: 21789710 - Clin Orthop Relat Res. 2011 Dec;469(12):3443-50 – reference: 23733590 - Clin Orthop Relat Res. 2014 Jan;472(1):98-104 – reference: 3597474 - J Bone Joint Surg Am. 1987 Jun;69(5):745-9 – reference: 11832264 - Clin Biomech (Bristol, Avon). 2002 Feb;17(2):140-6 – reference: 23552665 - Knee Surg Sports Traumatol Arthrosc. 2013 Oct;21(10 ):2325-30 – reference: 22206820 - Knee. 2012 Oct;19(5):560-3 – reference: 23743581 - Knee Surg Sports Traumatol Arthrosc. 2013 Sep;21(9):2040-7 – reference: 2347155 - Clin Orthop Relat Res. 1990 Jun;(255 ):215-27 – reference: 8028881 - Orthop Clin North Am. 1994 Jul;25(3):379-86 – reference: 18790641 - Knee. 2009 Jan;16(1):42-5 – reference: 24051507 - Knee Surg Sports Traumatol Arthrosc. 2014 Mar;22(3):674-9 – reference: 10192260 - Orthopedics. 1999 Mar;22(3):303-7
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Snippet	Purpose The role of neutral alignment in total knee arthroplasty (TKA) on short- and long-term outcomes has become controversial. Based on the concept of... The role of neutral alignment in total knee arthroplasty (TKA) on short- and long-term outcomes has become controversial. Based on the concept of... Purpose The role of neutral alignment in total knee arthroplasty (TKA) on short- and long-term outcomes has become controversial. Based on the concept of... PURPOSEThe role of neutral alignment in total knee arthroplasty (TKA) on short- and long-term outcomes has become controversial. Based on the concept of...
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SubjectTerms	Aged Alignment Arthritis Arthroplasty (knee) Arthroplasty, Replacement, Knee Biocompatibility Bone Malalignment - diagnostic imaging Deformation Female Humans Joint surgery Knee Knee Joint - diagnostic imaging Knee Joint - physiopathology Knee Joint - surgery Male Males Medicine Medicine & Public Health Men Middle Aged Orthopedics Osteoarthritis Osteoarthritis, Knee - surgery Radiographs Radiography Surgical implants
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Title	The relationship between constitutional alignment and varus osteoarthritis of the knee
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