BACKGROUND In an era leaning toward a personalized alignment of total knee arthroplasty,coronal plane alignment of the knee(CPAK)phenotypes for each population are studied;furthermore,other possible variables affectin...BACKGROUND In an era leaning toward a personalized alignment of total knee arthroplasty,coronal plane alignment of the knee(CPAK)phenotypes for each population are studied;furthermore,other possible variables affecting the alignment,such as ankle joint alignment,should be considered.AIM To determine CPAK distribution in the North African(Egyptian)population with knee osteoarthritis and to assess ankle joint line orientation(AJLO)adaptations across different CPAK types.METHODS A cross-sectional study was conducted on patients with primary knee osteoarthritis and normal ankle joints.Radiographic parameters included the mechanical lateral distal femoral angle,medial proximal tibial angle,and the derived calculations of joint line obliquity(JLO)and arithmetic hip-knee-ankle angle(aHKA).The tibial plafond horizontal angle(TPHA)was used for AJLO assessment,where 0°is neutral(type N),<0°is varus(type A),and>0°is valgus(type B).The nine CPAK types were further divided into 27 subtypes after incorporating the three AJLO types.RESULTS A total of 527 patients(1054 knees)were included for CPAK classification,and 435 patients(870 knees and ankles)for AJLO assessment.The mean age was 57.2±7.8 years,with 79.5%females.Most knees(76.4%)demonstrated varus alignment(mean aHKA was-5.51°±4.84°)and apex distal JLO(55.3%)(mean JLO was 176.43°±4.53°).CPAK types I(44.3%),IV(28.6%),and II(10%)were the most common.Regarding AJLO,70.2%of ankles exhibited varus orientation(mean TPHA was-5.21°±6.45°).The most frequent combined subtypes were CPAK type I-A(33.7%),IV-A(21.5%),and I-N(6.9%).A significant positive correlation was found between the TPHA and aHKA(r=0.40,P<0.001).CONCLUSION In this North African cohort,varus knee alignment with apex distal JLO and varus AJLO predominated.CPAK types I,IV,and II were the most common types,while subtypes I-A,IV-A,and I-N were commonly occurring after incorporating AJLO types;furthermore,the AJLO was significantly correlated to aHKA.展开更多
Background：A good postoperative alignment in total knee arthroplasty （TKA） is the key to achieving satisfactory results.We assessed the effect of femoral and tibial resection on the overall alignment after conventi...Background：A good postoperative alignment in total knee arthroplasty （TKA） is the key to achieving satisfactory results.We assessed the effect of femoral and tibial resection on the overall alignment after conventional TKA.Methods：We conducted a retrospective analysis of 212 primary TKAs in 188 patients.Intramedullary （IM）-guided resection was applied on the femoral side while extramedullary （EM）-guided resection was used on the tibial side.Using full-length X-ray,the preoperative femoral valgus angle and lower extremity alignment,as well as 2-week postoperative femoral and tibial prosthetic coronal alignment and overall lower extremity alignment,were measured.Results：Postoperatively,good prosthetic alignment was achieved in 191 cases （90.1%） on the tibial side and in 144 cases （67.9%） on the femoral side （χ^2 =5.441,P =0.02）.Multiple linear regression analysis was used to assess the effect of different alignment sides on the overall alignment in the coronal plane.Data were divided into five subgroups based on the valgus or varus status of the prostheses.The standardized regression coefficients of the femoral and tibial prosthetic alignment on the overall alignment were 0.666 and 0.414,respectively;in varus on both sides were 0.658 and 0.377,respectively;in valgus,0.555 and 0.030;femoral side varus and tibial side valgus,0.702 and 0.211;femoral side valgus and tibial side varus,-0.416 and 0.287.The study showed that the overall low extremity alignment was statistically influenced by the prosthetic alignment,except for the tibial prosthetic alignment when femoral prosthesis was in valgus （P =0.153）.Conclusions：In conventional TKA,tibial side EM-guided resection may offer satisfactory postoperative alignment,and femoral resection relying on IM guide may lead to more undesirable results.Postoperative coronal alignment is mainly affected by the femoral resection.Therefore,femoral side operation should receive adequate attention from the surgeons.展开更多
基金approved by Institutional Review Board of Faculty of Medicine in Assiut University,No.04-2024-300470.
文摘BACKGROUND In an era leaning toward a personalized alignment of total knee arthroplasty,coronal plane alignment of the knee(CPAK)phenotypes for each population are studied;furthermore,other possible variables affecting the alignment,such as ankle joint alignment,should be considered.AIM To determine CPAK distribution in the North African(Egyptian)population with knee osteoarthritis and to assess ankle joint line orientation(AJLO)adaptations across different CPAK types.METHODS A cross-sectional study was conducted on patients with primary knee osteoarthritis and normal ankle joints.Radiographic parameters included the mechanical lateral distal femoral angle,medial proximal tibial angle,and the derived calculations of joint line obliquity(JLO)and arithmetic hip-knee-ankle angle(aHKA).The tibial plafond horizontal angle(TPHA)was used for AJLO assessment,where 0°is neutral(type N),<0°is varus(type A),and>0°is valgus(type B).The nine CPAK types were further divided into 27 subtypes after incorporating the three AJLO types.RESULTS A total of 527 patients(1054 knees)were included for CPAK classification,and 435 patients(870 knees and ankles)for AJLO assessment.The mean age was 57.2±7.8 years,with 79.5%females.Most knees(76.4%)demonstrated varus alignment(mean aHKA was-5.51°±4.84°)and apex distal JLO(55.3%)(mean JLO was 176.43°±4.53°).CPAK types I(44.3%),IV(28.6%),and II(10%)were the most common.Regarding AJLO,70.2%of ankles exhibited varus orientation(mean TPHA was-5.21°±6.45°).The most frequent combined subtypes were CPAK type I-A(33.7%),IV-A(21.5%),and I-N(6.9%).A significant positive correlation was found between the TPHA and aHKA(r=0.40,P<0.001).CONCLUSION In this North African cohort,varus knee alignment with apex distal JLO and varus AJLO predominated.CPAK types I,IV,and II were the most common types,while subtypes I-A,IV-A,and I-N were commonly occurring after incorporating AJLO types;furthermore,the AJLO was significantly correlated to aHKA.
文摘Background：A good postoperative alignment in total knee arthroplasty （TKA） is the key to achieving satisfactory results.We assessed the effect of femoral and tibial resection on the overall alignment after conventional TKA.Methods：We conducted a retrospective analysis of 212 primary TKAs in 188 patients.Intramedullary （IM）-guided resection was applied on the femoral side while extramedullary （EM）-guided resection was used on the tibial side.Using full-length X-ray,the preoperative femoral valgus angle and lower extremity alignment,as well as 2-week postoperative femoral and tibial prosthetic coronal alignment and overall lower extremity alignment,were measured.Results：Postoperatively,good prosthetic alignment was achieved in 191 cases （90.1%） on the tibial side and in 144 cases （67.9%） on the femoral side （χ^2 =5.441,P =0.02）.Multiple linear regression analysis was used to assess the effect of different alignment sides on the overall alignment in the coronal plane.Data were divided into five subgroups based on the valgus or varus status of the prostheses.The standardized regression coefficients of the femoral and tibial prosthetic alignment on the overall alignment were 0.666 and 0.414,respectively;in varus on both sides were 0.658 and 0.377,respectively;in valgus,0.555 and 0.030;femoral side varus and tibial side valgus,0.702 and 0.211;femoral side valgus and tibial side varus,-0.416 and 0.287.The study showed that the overall low extremity alignment was statistically influenced by the prosthetic alignment,except for the tibial prosthetic alignment when femoral prosthesis was in valgus （P =0.153）.Conclusions：In conventional TKA,tibial side EM-guided resection may offer satisfactory postoperative alignment,and femoral resection relying on IM guide may lead to more undesirable results.Postoperative coronal alignment is mainly affected by the femoral resection.Therefore,femoral side operation should receive adequate attention from the surgeons.
