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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Preoperative Bone Marrow Edema Negatively Impacts Intermediate to Long-Term Outcomes after Unicompartmental Knee Arthroplasty ePoster Presentation Hong Yeol Yang, MD, PhD, KOREA, REPUBLIC OF Jong-Keun Seon, MD, PhD, Prof, KOREA, REPUBLIC OF
Short Term Outcome of Tibial Defect Reconstruction In Primary Total Knee Arthroplasty: A Retrospective Study ePoster Presentation Sanjib Kumar Behera, MS (Orth), DNB (Rehab), DPMR, INDIA Madhumita Pradhan, BDS, MPH, MHA , INDIA Vikram Choudhary, MD, UNITED STATES
Total Knee Arthroplasty Outcomes Following Anterior Cruciate Ligament Reconstruction ePoster Presentation Brian Rao, BS, UNITED STATES Alex C. Dibartola, MD, MPH, UNITED STATES Eric Milliron, BS, UNITED STATES Parker Cavendish, BS, UNITED STATES James C. Kirven, BS, UNITED STATES Spencer E. Talentino, MD, UNITED STATES Charles Qin, MD, UNITED STATES Ryan H. Barnes, MD, UNITED STATES Robert A. Duerr, MD, UNITED STATES Christopher C. Kaeding, MD, UNITED STATES Robert A Magnussen, MD, MPH, UNITED STATES David C. Flanigan, MD, UNITED STATES
Success of Debridement, Antibiotics, and Implant Retention vs Revision In Early And Late Prosthetic Joint Infections Following Primary TKA: A Prospective, Multicenter Study of 251 Cases ePoster Presentation Mark Zhu, MBChB, NEW ZEALAND Richard Rahardja, MBChB, BMedSc(Hons), NEW ZEALAND Laurens Manning, MBChB, AUSTRALIA Sarah Metcalf, MBChB, NEW ZEALAND Simon W. Young, MD, FRACS, NEW ZEALAND
"The Other Partial Knee"- Milling System Technique for Patellofemoral Arthroplasty in 250 Patients ePoster Presentation Alexander P. Sah, MD, UNITED STATES
Differences In Pain, Sleep Status And Functional Recovery Between TKA And UKA ePoster Presentation Takeo Mammoto, MD, JAPAN
Effect of Restricted Kinematic Alignment Total Knee Arthroplasty on Coronal Plane Alignment Of The Ankle Joint ePoster Presentation Bartosz Michał Maciąg, MD, POLAND Marcin Łapiński, MD, POLAND Tomasz Mrozek, MD, POLAND Adrian Góralczyk, MD, POLAND Maciej Swiercz, MD, POLAND Grzegorz Maciąg, POLAND Krystian Żarnovsky, POLAND Olga Adamska, POLAND Artur Stolarczyk, MD, PhD, POLAND
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, UNITED STATES Fumiyoshi Kawashima, MD, JAPAN Hiroshi Takagi, MD, PhD, JAPAN Koji Kanzaki, Prof., JAPAN
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
Phenotypic Differences In Coronal Alignment In Robot-Assisted Total Knee Arthroplasty Do Not Affect Patient-Reported Outcome Measurements In A Three-Dimensional Computed Tomography Analysis: A Single-Center Cohort Study ePoster Presentation Takao Kaneko, MD, PhD,, JAPAN Ayakane Yamamoto, MD, JAPAN Kazutaka Takada, MD, JAPAN Shu Yoshizawa, MD, JAPAN Hiroyasu Ikegami, MD, PhD, Prof., JAPAN
Does 1000 Mg Ferric Carboxylate Maltose Have an Additional Benefit on the Haemoglobin Recovery Post Total Knee Arthroplasty? - A Comparison with 500 Mg of Ferric Carboxymaltose ePoster Presentation Adit Maniar, MBBS, MS Orthopaedics, DNB Orthopaedics, CANADA Ashwini Khokhar, MS, INDIA Akshay Nayak, M.B.B.S, M.S , INDIA Naveen Chandar, MBBS, INDIA Abhinav Mishra, MS, DNB, INDIA Rajesh Maniar, INDIA

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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

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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