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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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
Three-Dimensional Evaluation of Distal Femoral Valgus Angle Using Whole Leg CT in Total Knee Arthroplasty ePoster Presentation Atsushi Sato, MD, PhD, JAPAN Jun Oike, MD, PhD, JAPAN Masataka Ota, MD, JAPAN Kanako Izukashi, MD, JAPAN Saki Yagura, MD, JAPAN Takayuki Okumo, MD, PhD, JAPAN Naoki Okuma, MD, JAPAN Takayuki Koya, MD, PhD, JAPAN Fumiyoshi Kawashima, MD, JAPAN Hiroshi Takagi, MD, PhD, JAPAN Koji Kanzaki, Prof., JAPAN
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
Combined Fixed-Bearing Unicompartmental Knee Arthroplasty and Anterior Cruciate Ligament Reconstruction ePoster Presentation Claudio Legnani, MD, ITALY Enrico Borgo, MD, ITALY Vittorio Macchi, MD, ITALY Alberto Ventura, MD, ITALY
Golfers Have Greater Preoperative and Equal Postoperative Function When Undergoing Total Knee Arthroplasty Compared to Non-Golfers ePoster Presentation Patrick G Robinson, MBChB, MRCS, MS, MBA, UNITED KINGDOM Robert Kay, MBChB, UNITED KINGDOM Deborah Macdonald, BA(Hons), UNITED KINGDOM Andrew Murray, MBChB, FFSEM, UNITED KINGDOM Nick David Clement, MBBS, MD, PhD, FRCS(Orth), UNITED KINGDOM
Patella in Total Knee Replacement: Patellar Resurfacing has Better Outcomes than Lateral Facetectomy at One Year Follow-Up ePoster Presentation Tomas Alfredo Esteves, MD, ARGENTINA Matias Novillo, MD, ARGENTINA Tomas Nicolino, MD, ARGENTINA Matias Costa-Paz, MD, PhD, ARGENTINA Lisandro Carbó, MD, ARGENTINA Julian Costantini, MD, ARGENTINA
Quality of Life Following Primary Total Knee Arthroplasty: Factors Predicting Satisfaction in Low-Income Population ePoster Presentation Mohamed Amine Gharbi , MD, TUNISIA Houssem Eddine Chahed, MD, TUNISIA Ahmed Zendeoui, MD, TUNISIA Moatassem Belleh Jelassi, MD, TUNISIA Anis Tebourbi, MD, TUNISIA Ramzi Bouzidi, PhD, TUNISIA Khelil Ezzaouia, PhD, TUNISIA Mouadh Nefiss, MD, TUNISIA
Palliative Arthroscopic Debridement with Continuous Irrigation for the Infection TKA of High Mortality Risk Patients ePoster Presentation Yoon Sang Jeon, MD, KOREA, REPUBLIC OF Sung-Sahn Lee, MD., PhD., KOREA, REPUBLIC OF Yoon Cheol Nam, MD, KOREA, REPUBLIC OF Dong Jin Ryu, MD, PhD., KOREA, REPUBLIC OF
Comparative Analysis Of Time Taken In Conventional vs. Robotic Assisted Total Knee Arthroplast 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
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
Novel Technique For Surgeon-Placed Nerve Block And Continuous Nerve Block In Total Knee Arthroplasty. A Cadaveric Study ePoster Presentation Daniel E Matthews, MD, FAAOS, UNITED STATES

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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

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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