Summary: Hip-knee-ankle angle affects medial and lateral tibiofemoral compressive forces more significantly than joint line obliquity in patients post total knee arthroplasty

Introduction

Restoration of constitutional lower-limb coronal alignment (or hip-knee-ankle angle, HKA) is believed to improve reported patient satisfaction after total knee arthroplasty (TKA) (Howell et al. 2014). Long-term implant data suggests that deviation from neutral HKA would incur increased risk of prosthesis failure (van Hamersveld et al. 2019; Vanderkerckhove et al. 2017). Knee phenotype is a function of HKA and joint line obliquity (JLO). Sappey-Marinier et al. (2022) recently demonstrated study that JLO may not significantly affect clinical outcomes post TKA. Little is known about the independent effects of HKA versus JLO on bicompartmental knee loads during gait of TKA patients. We hypothesized that varus HKA concomitant with apex distal JLO would result in increased compressive medial knee loads. We also hypothesized that JLO would affect medial compressive load, independent of HKA effect.

Methods

Nine TKA patients were recruited and underwent gait analysis around 2 years post TKA Kinematics, force-plate and muscle electromyography data were recorded simultaneously for each walking trial during the stance phase of gait involving the TKA limb. Calculation of lower-limb muscle forces was based on musculoskeletal model which incorporated subject-specific implant contacts and alignment information (Lerner et al. 2015). Lower-limb muscle forces were determined using inverse dynamics and static optimization. Joint reaction analysis was used to determine the resultant contact forces and moments at each compartment (Steele et al. 2012).

Results

The 9 patients had HKA and JLO of 1.6±2.1° and 177.6±2.6°, respectively. These two variables were independent of each other (r=0.069, p>0.05). The patients walked at a walking speed 1.09±0.1 m/s. Computational pipeline investigated the individual contribution of HKA and JLO on the compressive joint load within the medial and lateral knee compartments. Varus HKA loaded the medial compartment more than apex distal JLO during the early stance (HKA, ? = 0.19BW/deg, r=0.86, p<0.05; JLO, ? = 0.13BW/deg, r=0.73, p<0.05). Varus HKA unloaded the lateral compartment more than apex distal JLO during the both halves of stance (Early stance: HKA, ? =-0.16BW/deg, r=0.79, p<0.05; JLO, ? = -0.075BW/deg, r=0.59, p<0.05. Late stance: HKA, ? =-0.15BW/deg, r=0.67, p<0.05; JLO, ? = -0.074BW/deg, r=0.49, p<0.05).

Discussion

Varus HKA concomitant with apex distal JLO resulted in highest compressive medial knee loads given achieved combinations of HKA and JLOs. Both HKA and JLO could individually and differently affect the medial and lateral compartments of the tibiofemoral joint. HKA had approximately twice the effect of JLO on affecting the two compartments within the tibiofemoral joint during gait. These findings may contribute data to the ongoing literature debate on long-term component wear risk with kinematic versus mechanical alignment, and inform future knee arthroplasty component placement (Parker, 2019; Parker, 2019b; Riviere C et al. 2019).

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No Difference In Sports Participation And Patient-Reported Functional Outcomes Between Total Knee Arthroplasty And Unicompartmental Knee Arthroplasty At Minimum 2-Year Follow-Up In A Matched Control Study ePoster Presentation Amit Meena, MBBS, MS, DNB, INDIA Elisabeth Abermann, MD, AUSTRIA Christian Hoser, MD, AUSTRIA Luca Farinelli, MD, ITALY Caroline Hepperger, PhD, AUSTRIA Akshya Raj, MBBS,MS, INDIA Mohit Kumar Patralekh, MBBS, MS(Orthopaedics), DNB(Orthopaedics), MNAMS, INDIA Christian Fink, MD, Prof., AUSTRIA
Same Complication Rate After Day-Case Procedure Or Fast-Track Procedure After Total Hip And Knee Arthroplasty. A Prospective, Propensity Score-Matched Case-Control Study ePoster Presentation Jean-Yves Jenny, Prof., FRANCE Vincent Gisonni, MD, FRANCE
High Cure Rate In Hematogenous TKA PJI At A Long-Term Follow-Up By Means Of Dair Procedure ePoster Presentation Daniel Pérez-Prieto, MD, SPAIN Albert Fontanellas, MD, SPAIN Raúl Torres-Claramunt, PhD, SPAIN Juan Francisco Sanchez-Soler, MD, PhD, SPAIN Joan Carles Monllau, MD, PhD, Prof., SPAIN Pedro Hinarejos, MD, PhD, SPAIN
Patellofemoral Arthroplasty In Community Programs: Case Series of 425 Patients ePoster Presentation Alexander P. Sah, MD, UNITED STATES
Tibia Placement Difference Between The Supine And Prone Position After Total Knee Arthroplasty: The Comparison Of The BCS and PS-TKA ePoster Presentation Takanori Iriuchishima, MD, PhD, JAPAN Keinosuke Ryu, Prof., JAPAN Eiji Cho, MD, JAPAN
Intraoperative Surgeon-Performed vs. Conventional Anesthesiologist-Performed Continuous Adductor Canal Block In Total Knee Arthroplasty: A Randomized Controlled Trial ePoster Presentation Chayut Chaiperm, MD, THAILAND Srihatach Ngarmukos, MD, THAILAND Aree Tanavalee, MD, THAILAND Chotetawan Tanavalee, MD, THAILAND Wirinaree Kampitak, MD, THAILAND
The Functional Outcome of Zimmer Biomet’s Nexgen Total Knee Arthroplasty as Compared with Healthy Older Adults ePoster Presentation Gwenllian F. Tawy, PhD, MRes, BSc(Hons), UNITED KINGDOM Michael J. McNicholas, BSc, MD, FRCS Tr & Orth, UNITED KINGDOM Leela C. Biant, MS, MFSTEd, FRCSEd(Tr&Orth), UNITED KINGDOM
Comparison of Outcomes between Fungal and Non-fungal Periprosthetic Joint Infections in Total Knee Arthroplasty: A Propensity Score-Matched Analysis ePoster Presentation Hong Yeol Yang, MD, PhD, KOREA, REPUBLIC OF Jong-Keun Seon, MD, PhD, Prof, KOREA, REPUBLIC OF
Evaluation of The Safety And Efficacy of The Fully Automated Active Robotic System In Robotic Assisted Total Knee Arthroplasty ePoster Presentation Sanjay B. Londhe, MS, FRCS, FRCSI, MCh, INDIA Santosh Chandrashekar Shetty, MS, INDIA Ashit Hasmukhbhai Shah, FRCS Orth, M ChOrth, M S Orth, D N B Orth, INDIA Niraj Vora, MS,MRCS, INDIA Vijay Shetty, MD, MSc, FRCSC, INDIA Rakesh Nair, MS, INDIA Clevio Joao Baptista Desouza, MD, INDIA Farheen Khan, B.Tech, INDIA
Participation of Physical Activity Following Knee Arthroplasty: A Meta-Analysis ePoster Presentation Ahmed A Magan, BM BSc (Hons) MRCS (Eng) FRCS (Eng) Trauma & Orth, UNITED KINGDOM Babar Kayani, BSc (HONS), MBBS, MRCS (Eng), UNITED KINGDOM Warran Wignadasan, MBBS, BSc (Hons), MRCS, UNITED KINGDOM Dia Eldean Giebaly, MBChB, MSc, FRCS, EMBA, UNITED KINGDOM Flaminia Ronca, PHD, UNITED KINGDOM Fares S. Haddad, MCh(Orth), BSc, FRCS(Orth), UNITED KINGDOM
Impact of Femur Correction on the Mechanical Alignment of the Total Knee Prosthesis ePoster Presentation Israel Alejandro Alejandro González Rizo, MD, MEXICO Fidel G Dobarganes, Prof, MEXICO Jorge Negrete Corona, MD, MEXICO Alberto Guevara-Alvarez, MD, MEXICO Franco Garcini Munguia, MD, MEXICO

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Hip-Knee-Ankle Angle Affects Medial and Lateral Tibiofemoral Compressive Forces More Significantly than Joint Line Obliquity in Patients Post Total Knee Arthroplasty

Hip-Knee-Ankle Angle Affects Medial and Lateral Tibiofemoral Compressive Forces More Significantly than Joint Line Obliquity in Patients Post Total Knee Arthroplasty

Introduction

Methods

Results

Discussion

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Hip-Knee-Ankle Angle Affects Medial and Lateral Tibiofemoral Compressive Forces More Significantly than Joint Line Obliquity in Patients Post Total Knee Arthroplasty

Hip-Knee-Ankle Angle Affects Medial and Lateral Tibiofemoral Compressive Forces More Significantly than Joint Line Obliquity in Patients Post Total Knee Arthroplasty

Introduction

Methods

Results

Discussion

More 2023 ISAKOS Congress Content