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Knee Surgery, Sports Traumatology, Arthroscopy

Published in:

11-10-2023 | Osteoarthrosis | KNEE

Distribution of coronal plane alignment of the knee classification does not change as knee osteoarthritis progresses: a longitudinal study from the Toei study

Authors: Kazuki Nomoto, Mitsuru Hanada, Kensuke Hotta, Yukihiro Matsuyama

Published in: Knee Surgery, Sports Traumatology, Arthroscopy | Issue 12/2023

Abstract

Purpose

The purpose of this study was to investigate the coronal plane alignment of the knee (CPAK) phenotypes of individuals with knee osteoarthritis (OA) progression. We hypothesized that distributions of CPAK phenotypes would be similar throughout OA progression, despite arithmetic hip–knee–ankle angle (aHKA) and joint line obliquity (JLO) changing.

Methods

A total of 248 patients (79 men and 169 women) participated in the first study in 2012 and the fifth study in 2020. Patients with progression of knee OA for eight years were included. Knee OA progression was defined as advancement from KL grade 0–2 to KL grade 3 or 4. Alignment parameters, including the aHKA, JLO, hip–knee–ankle angle (HKA), lateral distal femur angle (LDFA), medial proximal tibial angle (MPTA), and joint line convergence angle (JLCA), were measured. Changes in distribution of CPAK classifications and alignment parameters were investigated. Alignment parameters were compared using a paired t-test. Statistical significance was defined as p < 0.05.

Results

The study included 48 patients (60 knees). The distributions of all CPAK phenotypes were similar between 2012 and 2020. MPTA (83.7° ± 2.8° vs. 82.3° ± 4.8°, p < 0.01), aHKA (− 3.6° ± 3.8° vs. − 4.9° ± 6.2°, p = 0.01), and JLO (171.1° ± 4.6° vs. 169.5° ± 5.1°, p < 0.01) decreased significantly, and JLCA (1.17° ± 2.2° vs. 3.1° ± 4.7°, p < 0.01) and HKA (4.8° ± 3.9° vs. 8.0° ± 5.4°, p < 0.01) increased significantly. In contrast, LDFA (87.4° ± 3.2° vs. 87.2° ± 3.1°, p = n.s.) did not change significantly.

Conclusions

The CPAK classification system can predict constitutional alignment, even with knee OA progression, and enables surgeons to perform individualized preoperative alignment planning according to knee phenotypes.

Bellemans J, Colyn W, Vandenneucker H, Victor J (2012) The Chitranjan Ranawat award: is neutral mechanical alignment normal for all patients? The concept of constitutional varus. Clin Orthop Relat Res 470:45–53CrossRefPubMed

Boonen B, Kerens B, Schotanus MG, Emans P, Jong B, Kort NP (2016) Inter-observer reliability of measurements performed on digital long-leg standing radiographs and assessment of validity compared to 3D CT-scan. Knee 23:20–24CrossRefPubMed

Colyn W, Bruckers L, Scheys L, Truijen J, Smeets K, Bellemans J (2023) Changes in coronal knee-alignment parameters during the osteoarthritis process in the varus knee. J ISAKOS 8:68–73CrossRefPubMed

Cooke D, Scudamore A, Li J, Wyss U, Bryant T, Costigan P (1997) Axial lower-limb alignment: comparison of knee geometry in normal volunteers and osteoarthritis patients. Osteoarthr Cartil 5:39–47CrossRef

Cooke TD, Harrison L, Khan B, Scudamore A, Chaudhary MA (2002) Analysis of limb alignment in the pathogenesis of osteoarthritis: a comparison of Saudi Arabian and Canadian cases. Rheumatol Int 22:160–164CrossRefPubMed

Cooke TDV, Scudamore A, Greer W (2003) Varus knee osteoarthritis: whence the varus? J Rheumatol 30:2521–2523PubMed

Gbejuade HO, White P, Hassaballa M, Porteous AJ, Robinson JR, Murray JR (2014) Do long leg supine CT scanograms correlate with weight-bearing full-length radiographs to measure lower limb coronal alignment? Knee 21:549–552CrossRefPubMed

Griffiths-Jones W, Chen DB, Harris IA, Bellemans J, MacDessi SJ (2021) Arithmetic hip-knee-ankle angle (aHKA): an algorithm for estimating constitutional lower limb alignment in the arthritic patient population. Bone Jt Open 2:351–358CrossRefPubMedPubMedCentral

Hess S, Moser LB, Robertson EL, Behrend H, Amsler F, Iordache E, Leclercq V, Hirschmann MT (2022) Osteoarthritic and non-osteoarthritic patients show comparable coronal knee joint line orientations in a cross-sectional study based on 3D reconstructed CT images. Knee Surg Sports Traumatol Arthrosc 30:407–418CrossRefPubMed

10.

Higano Y, Hayami T, Omori G, Koga Y, Endo K, Endo N (2016) The varus alignment and morphologic alterations of proximal tibia affect the onset of medial knee osteoarthritis in rural Japanese women: case control study from the longitudinal evaluation of Matsudai Knee osteoarthritis Survey. J Orthop Sci 21:166–171CrossRefPubMed

11.

Hirschmann MT, Moser LB, Amsler F, Behrend H, Leclerq V, Hess S (2019) Functional knee phenotypes: a novel classification for phenotyping the coronal lower limb alignment based on the native alignment in young non-osteoarthritic patients. Knee Surg Sports Traumatol Arthrosc 27:1394–1402CrossRefPubMed

12.

Howell SM, Howell SJ, Kuznik KT, Cohen J, Hull ML (2013) Does a kinematically aligned total knee arthroplasty restore function without failure regardless of alignment category? Clin Orthop Relat Res 471:1000–1007CrossRefPubMed

13.

Howell SM, Papadopoulos S, Kuznik KT, Hull ML (2013) Accurate alignment and high function after kinematically aligned TKA performed with generic instruments. Knee Surg Sports Traumatol Arthrosc 21:2271–2280CrossRefPubMed

14.

Howell SM, Shelton TJ, Hull ML (2018) Implant survival and function ten years after kinematically aligned total knee arthroplasty. J Arthroplasty 33:3678–3684CrossRefPubMed

15.

Kellgren JH, Lawrence JS (1957) Radiological assessment of osteo-arthrosis. Ann Rheum Dis 16:494–502CrossRefPubMedPubMedCentral

16.

Lazennec JY, Chometon Q, Folinais D, Robbins CB, Pour AE (2017) Are advanced three-dimensional imaging studies always needed to measure the coronal knee alignment of the lower extremity? Int Orthop 41:917–924CrossRefPubMed

17.

MacDessi SJ, Griffiths-Jones W, Harris IA, Bellemans J, Chen DB (2021) Coronal plane alignment of the knee (CPAK) classification. Bone Joint J 103:329–337.

18.

Mulpur P, Desai KB, Mahajan A, Masilamani ABS, Hippalgaonkar K, Reddy AVG (2022) Radiological Evaluation of the phenotype of Indian Osteoarthritic Knees based on the Coronal Plane Alignment of the Knee Classification (CPAK). Indian J Orthop 56:2066–2076CrossRefPubMedPubMedCentral

19.

Thienpont E, Schwab PE, Cornu O, Bellemans J, Victor J (2017) Bone morphotypes of the varus and valgus knee. Arch Orthop Trauma Surg 137:393–400CrossRefPubMed

20.

Toyooka S, Osaki Y, Masuda H, Arai N, Miyamoto W, Ando S, Kawano H, Nakagawa T (2023) Distribution of coronal plane alignment of the knee classification in patients with knee osteoarthritis in Japan. J Knee Surg 36:738–743CrossRefPubMed

Title: Distribution of coronal plane alignment of the knee classification does not change as knee osteoarthritis progresses: a longitudinal study from the Toei study
Authors: Kazuki Nomoto
Mitsuru Hanada
Kensuke Hotta
Yukihiro Matsuyama
Publication date: 11-10-2023
Publisher: Springer Berlin Heidelberg
Keywords: Osteoarthrosis
Osteoarthrosis
Knee Osteoarthritis
Knee Osteoarthritis
Published in: Knee Surgery, Sports Traumatology, Arthroscopy / Issue 12/2023
Print ISSN: 0942-2056
Electronic ISSN: 1433-7347
DOI: https://doi.org/10.1007/s00167-023-07604-8

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Distribution of coronal plane alignment of the knee classification does not change as knee osteoarthritis progresses: a longitudinal study from the Toei study

Abstract

Purpose

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusions

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