Natural Distribution of the Femoral Mechanical Anatomical Angle in a Portuguese Population with Advanced Knee Osteoarthritis and it’s Implication in Total Knee Arthroplasty Surgical Planning

Authors

Keywords:

Arthroplasty, Replacement, Knee, Biomechanical Phenomena, Knee Joint/surgery, Osteoarthritis, Knee

Abstract

Introduction: Total knee arthroplasty is one of the most successful interventions in medicine. Mechanical alignment remains the gold standard in obtaining a proper coronal prosthetic alignment. There is controversy regarding the use of a fixed cutting angle of the distal femur, with a value between 4o‐7° of valgus that is frequently used intraoperatively. The aim of this study was to describe the distribution of the valgus cut angle in the Portuguese population and to assess the safety of using a fixed valgus cut angle.
Methods: From 13.3.2021 to 14.12.2021, 100 pangonograms of patients on the waiting list to undergo total knee arthroplasty, with advanced gonarthrosis, refractory to conservative treatment, were analysed retrospectively and consecutively.
Results: The preoperative full length weight bearing radiography of one hundred patients submitted total knee replacement were evaluated, with a mean valgus cut angle of 7.0o± 1.3o (range 3.7o‐10.3o).
Conclusion: The use of a fixed resection angle results in a percentage of mechanical axis deviation greater than acceptable (± 3o) in 8%‐68% of cases, as such we conclude that, in order to obtain a proper mechanical alignment, pre‐operative full length weight bearing evaluation is required for proper valgus cut angle measurement.

Downloads

Download data is not yet available.

References

Bumpass DB, Nunley RM. Assessing the value of a total joint replacement. Curr Rev Musculoskelet Med. 2012;5:274‐82. doi: 10.1007/ s12178‐012‐9139‐6.

Gunaratne R, Pratt DN, Banda J, Fick DP, Khan RJK, Robertson BW. Patient Dissatisfaction Following Total Knee Arthroplasty: A Systematic Review of the Literature. J Arthroplasty. 2017;32:3854‐60. doi: 10.1016/j.arth.2017.07.021.

Novak EJ, Silverstein MD, Bozic KJ. The cost‐effectiveness of computer‐assisted navigation in total knee arthroplasty. J Bone Joint Surg Am. 2007;89:2389‐97. doi: 10.2106/JBJS.F.01109.

Abdel MP, Oussedik S, Parratte S, Lustig S, Haddad FS. Coronal alignment in total knee replacement: historical review, contemporary analysis, and future direction. Bone Joint J. 2014;96‐B:857‐62. doi: 10.1302/0301‐620X.96B7.33946.

Meric G, Gracitelli GC, Aram LJ, Swank ML, Bugbee WD. Variability in distal femoral anatomy in patients undergoing total knee arthroplasty: measurements on 13,546 computed tomography scans. J Arthroplasty. 2015;30:1835‐8. doi: 10.1016/j.arth.2015.04.024.

Guggenberger R, Pfirrmann CW, Koch PP, Buck FM. Assessment of lower limb length and alignment by biplanar linear radiography: comparison with supine CT and upright full‐length radiography. AJR Am J Roentgenol. 2014;202:W161‐7. doi: 10.2214/AJR.13.10782.

Liu HX, Shang P, Ying XZ, Zhang Y. Shorter survival rate in varus‐aligned knees after total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc. 2016;24:2663‐71. doi: 10.1007/s00167‐015‐3781‐7.

Parratte S, Pagnano MW, Trousdale RT, Berry DJ. Effect of postoperative mechanical axis alignment on the fifteen‐year survival of modern, cemented total knee replacements. J Bone Joint Surg Am. 2010;92:2143‐9. doi: 10.2106/JBJS.I.01398.

Abdel MP, Ollivier M, Parratte S, Trousdale RT, Berry DJ, Pagnano MW. Effect of postoperative mechanical axis alignment on survival and functional outcomes of modern total knee arthroplasties with cement: a concise follow‐up at 20 years. J Bone Joint Surg Am. 2018;100:472‐ ‐8. doi: 10.2106/JBJS.16.01587.

Tan H, Wang Y, Long T, Nie B, Mao Z, Yue B. How to accurately determine the distal femoral valgus cut angle in the valgus knee arthroplasty. Int Orthop. 2018;42:537‐42. doi: 10.1007/s00264‐018‐3778‐1.

Parisi TJ, Jennings JM, Dennis DA. Coronal alignment in TKA: traditional principles versus new concepts. Reconstr Rev. 2018;8. doi: 10.15438/rr.8.2.213.

Cooke TD, Hietpas J, Lynch J, Nevitt M. Varus and valgus alignment and incident and progressive knee osteoarthritis. Ann Rheum Dis. 2010;69:1940‐5. doi: 10.1136/ard.2010.129742.

Moisio K, Chang A, Eckstein F, Chmiel JS, Wirth W, Almagor O, et al. Varus‐valgus alignment: reduced risk of subsequent cartilage loss in the less loaded compartment. Arthritis Rheum. 2011;63:1002‐9. doi: 10.1002/art.30216.

Costa MAV, Mozella AP, Cobra AA. Corte femoral distal na artroplastia total de joelho na população brasileira. Rev Bras Ortop. 2015;50:295‐ ‐9.

Rezende FC, de Castro Ferreira M, Debieux P, da Silveira Franciozi CE, Luzo MVM, Carneiro M. Is it safe the empirical distal femoral resection angle of 5° to 6° of valgus in the Brazilian geriatric population? Rev Bras Ortop. 2013;48:421‐6. doi: 10.1016/j.rboe.2012.08.009.

Kharwadkar N, Kent RE, Sharara KH, Naique S. 5 degrees to 6 degrees of distal femoral cut for uncomplicated primary total knee arthroplasty: is it safe? Knee. 2006;13:57‐60. doi: 10.1016/j.knee.2005.07.001.

Vaishya R, Vijay V, Edomwonyi EO, Agarwal AK. Fixed distal femoral valgus cutting angle is still justifiable in total knee replacement. J Clin Orthop Trauma. 2018;9:112‐5. doi: 10.1016/j.jcot.2017.02.007.

McGrory JE, Trousdale RT, Pagnano MW, Nigbur M. Preoperative hip to ankle radiographs in total knee arthroplasty. Clin Orthop Relat Res. 2002;404:196‐202. doi: 10.1097/00003086‐200211000‐00032 .

Zhou K, Zhou Z, Shi X, Shen B, Kang P, Yang J, Pei F. Effect of individual distal femoral valgus resection in total knee arthroplasty for patients with valgus knee: A retrospective cohort study. Int J Surg. 2018;52:309‐13. doi: 10.1016/j.ijsu.2018.02.048.

Andrews SN, Beeler DM, Parke EA, Nakasone CK, Stickley CD. Fixed Distal Femoral Cut of 6° Valgus in Total Knee Arthroplasty: A Radiographic Review of 788 Consecutive Cases. J Arthroplasty. 2019;34:755‐ ‐9. doi:10.1016/j.arth.2018.12.013.

Bardakos N, Cil A, Thompson B, Stocks G. Mechanical axis cannot be restored in total knee arthroplasty with a fixed valgus resection angle: a radiographic study. J Arthroplasty. 2007;22:85‐9. doi: 10.1016/j. arth.2007.04.018.

Deakin AH, Basanagoudar PL, Nunag P, Johnston AT, Sarungi M. Natural distribution of the femoral mechanical‐anatomical angle in an osteoarthritic population and its relevance to total knee arthroplasty. Knee. 2012;19:120‐3. doi: 10.1016/j.knee.2011.02.001.

Mullaji AB, Shetty GM, Kanna R, Vadapalli RC. The influence of preoperative deformity on valgus correction angle: an analysis of 503 total knee arthroplasties. J Arthroplasty. 2013;28:20‐7. doi: 10.1016/j. arth.2012.04.014.

Lee CY, Huang TW, Peng KT, Lee MS, Hsu RW, Shen WJ. Variability of distal femoral valgus resection angle in patients with end‐stage osteoarthritis and genu varum deformity: Radiographic study in an ethnic Asian population. Biomed J. 2015;38:350‐5. doi: 10.4103/2319‐ ‐4170.151030.

Jingjit W, Poomcharoen P, Limmahakhun S, Klunklin K, Leerapun T, Rojanasthien S. Femoral mechanical‐anatomical angle of osteoarthritic knees. J Med Assoc Thai. 2014;97:1314‐8.

Algarni AD. Distal femoral valgus cut angle in degenerative varus knees of an Arabic population. Int Orthop. 2020;44:2627‐33. doi: 10.1007/ s00264‐020‐04748‐x.

Maderbacher G, Schaumburger J, Baier C, Zeman F, Springorum HR, Dornia C, et al. Predicting knee rotation by the projection overlap of the proximal fibula and tibia in long‐leg radiographs. Knee Surg Sports Traumatol Arthrosc. 2014;22:2982‐8. doi: 10.1007/s00167‐014‐ ‐3327‐4.

Marques Luís N, Varatojo R. Radiological assessment of lower limb alignment. EFORT Open Rev. 2021;6:487‐94. doi: 10.1302/2058‐ ‐5241.6.210015.

Maderbacher G, Schaumburger J, Baier C, Zeman F, Springorum HR, Dornia C, et al. Predicting knee rotation by the projection overlap of the proximal fibula and tibia in long‐leg radiographs. Knee Surg Sports Traumatol Arthrosc. 2014;22:2982‐8. doi: 10.1007/s00167‐014‐ ‐3327‐4.

Glasser J, Mariorenzi M, Blood T, O’Donnell S, Garcia D, Antoci V. Distal femoral valgus cut angles unreliable in total knee arthroplasty. J Orthop. 2021;24:29‐33. doi: 10.1016/j.jor.2021.02.010.

Published

2024-06-05

Issue

Section

Original Article

How to Cite

Natural Distribution of the Femoral Mechanical Anatomical Angle in a Portuguese Population with Advanced Knee Osteoarthritis and it’s Implication in Total Knee Arthroplasty Surgical Planning. (2024). Orthopaedic SPOT, 1(2), 73-79. https://orthopaedicspot.com/index.php/journal/article/view/26