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Archives of Orthopaedic and Trauma Surgery

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10-12-2022 | Osteoarthrosis | Knee Arthroplasty

The pre-diseased coronal alignment can be predicted from conventional radiographs taken of the varus arthritic knee

Authors: William Colyn, A. Cleymans, L. Bruckers, J. Truijen, K. Smeets, J. Bellemans

Published in: Archives of Orthopaedic and Trauma Surgery | Issue 7/2023

Abstract

Introduction

The concept of restoring the constitutional, pre-diseased alignment has gained lots of interest among knee surgeons. Previous attempts to use the contralateral limb to bridge the gap between the arthritic and the constitutional alignment were unsuccessful. We investigated the usability of a mathematical formula to predict the constitutional (pre-diseased) coronal alignment once arthritis has occurred. It is our hypothesis that by using the KL grade, CPAK classification and four radiographic measurements of the arthritic knee, the pre-diseased coronal alignment could be predicted.

Material and methods

Hundred arthritic patients with consecutive X-rays were used to determine a mathematical formula. Five alignment parameters were determined on full-length X-rays: HKA angle, mechanical lateral distal femoral angle (mLDFA), medial proximal tibial angle (MPTA), joint line convergence angle (JLCA) and the tibial joint line angle (TJLA). A refinement of the algorithm was implemented based on a reference cohort, consisted of 250 young adults aged between 20 and 27 years. Moreover, all knees were subdivided based on their CPAK-phenotype and the Kellgren–Lawrence scale (KL scale). An independent arthritic cohort of 289 patients scheduled for primary total knee arthroplasty was included to verify the accuracy of the predicted HKAs (HKA_PRED).

Results

In CPAK type 1, the HKA_PRED was 3.86° varus (STD 1.39) and the HKA_YHA was 4.0° varus. In CPAK type 2, the HKA_PRED was 1.68° varus (STD 1.95) compared to a HKA_YHA of 1.34° (STD 0.81). The average constitutional HKA is not different in both CPAK 1 (p = 0.61) and CPAK 2 (p = 0.25), and the difference in the mean is estimated to be equal to – 0.14 (95CI – 0.68 to 0.40) in CPAK 1 and 0.35 (95CI – 0.06 to 0.75) in CPAK 2.

Conclusion

Using the KL grade, CPAK classification and four radiographic measurements of the arthritic knee, the pre-diseased coronal alignment can be predicted in 80% of the varus knees with an accuracy of ≤ 0.5°. The predicted HKA (HKA_PRED) can be very useful in the current and future clinical practice.

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Title: The pre-diseased coronal alignment can be predicted from conventional radiographs taken of the varus arthritic knee
Authors: William Colyn
A. Cleymans
L. Bruckers
J. Truijen
K. Smeets
J. Bellemans
Publication date: 10-12-2022
Publisher: Springer Berlin Heidelberg
Keywords: Osteoarthrosis
Osteoarthrosis
Published in: Archives of Orthopaedic and Trauma Surgery / Issue 7/2023
Print ISSN: 0936-8051
Electronic ISSN: 1434-3916
DOI: https://doi.org/10.1007/s00402-022-04709-6

Keynote webinar | Spotlight on medication adherence

Springer Medicine

The pre-diseased coronal alignment can be predicted from conventional radiographs taken of the varus arthritic knee

Abstract

Introduction

Material and methods

Results

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Introduction

Material and methods

Results

Conclusion

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