Lucas Beckers1,2,3, William Colyn4, Johan Bellemans5,6,7, Jan Victor2,3,8, Pieter-Jan Vandekerckhove9,10,11. 1. Department of Orthopaedic Surgery and Traumatology, Sint-Jan Hospital, Ruddershove 10, 8000, Bruges, Belgium. 2. Department of Orthopaedic Surgery and Traumatology, Sint-Lucas Hospital, Sint-Lucaslaan 29, 8310, Bruges, Belgium. 3. Orthoclinic Orthopaedic Centre Bruges, Gistelsesteenweg 446, 8200, Sint-Andries, Belgium. 4. Department of Orthopaedic Surgery and Traumatology, General Hospital Turnhout, Steenweg op Merksplas 44, 2300, Turnhout, Belgium. 5. Department of Orthopaedic Surgery and Traumatology, Ziekenhuis Oost-Limburg, Schiepse Bos 6, 3600, Genk, Belgium. 6. Faculty of Medicine and Life Sciences, Hasselt University, Agoralaan D, 3500, Diepenbeek, Belgium. 7. GRIT Belgian Sports Clinic, Engels Plein 35, 3000, Leuven, Belgium. 8. Department of Orthopaedic Surgery, Ghent University Hospital, De Pintelaan 185, 9000, Ghent, Belgium. 9. Department of Orthopaedic Surgery and Traumatology, Sint-Jan Hospital, Ruddershove 10, 8000, Bruges, Belgium. pieterjanvandekerckhove@hotmail.com. 10. Department of Orthopaedic Surgery and Traumatology, Sint-Lucas Hospital, Sint-Lucaslaan 29, 8310, Bruges, Belgium. pieterjanvandekerckhove@hotmail.com. 11. Orthoclinic Orthopaedic Centre Bruges, Gistelsesteenweg 446, 8200, Sint-Andries, Belgium. pieterjanvandekerckhove@hotmail.com.
Abstract
PURPOSE: Implementation of morphometric reference data from the contralateral, unaffected lower limb is suggested when reconstructing the coronal plane alignment in TKA. Limited information, however, is available which confirms this left-to-right symmetry in coronal alignment based upon radiographs. The purpose of the study was, therefore, (1) to verify if a left-to-right symmetry is present and (2) to assess whether the contralateral lower limb would be a reliable reference for reconstructing the frontal plane alignment. METHODS: Full-leg standing radiographs of 250 volunteers (male, 125; female,125) were reviewed for three alignment parameters (Hip-Knee-Ankle angle (HKA), Femoral Mechanical Angle (FMA) and Tibial Mechanical Angle (TMA)). Evaluation of assumed left-to-right symmetry was performed according to two coronal alignment classifications (HKA subdivisions (HKA) and limb, femoral and tibial phenotypes (HKA, FMA and TMA)). Inter- and within-subject variability was calculated, along with correlations coefficients (r) and coefficients of determination (r2). Reliability of the contralateral limb as a personalized reference to reconstruct the constitutional alignment was investigated by intervals, expanding by 1° increments (0.5° increment both to varus and valgus) around the right knee alignment parameters. Subsequently, it was verified whether or not the left knee parameters fell within this interval. RESULTS: Symmetrical distribution in coronal alignment was found in 79% (HKA subdivision) and 59% (limb phenotype) of the cohort. Gender differences were present for the most common symmetric limb phenotypes (VARHKA3° (23.2%) in males and NEUHKA0° (38.4%) in females). Inter-subject variability was more prominent than the within-subject side differences for all parameters. Correlations analyses revealed mostly moderate correlations between the alignment measurements. Coefficients of determination showed overall weak left-to-right relationship, except for a moderate predictability for HKA (r2 = 0.538, p < 0.001) and FMA (r2 = 0.618, p < 0.001) in females. FMA and TMA marked weak predictive values for contralateral HKA. Only 60% of left knees were referenced within a 3° interval around the right knee. CONCLUSION: No strict left-to-right symmetry was observed in coronal alignment measurements. There is insufficient left-to-right agreement to consider the concept of the contralateral unaffected limb as an idealized reference for frontal plane alignment reconstruction based upon full-leg standing radiographs. LEVEL OF EVIDENCE: I.
PURPOSE: Implementation of morphometric reference data from the contralateral, unaffected lower limb is suggested when reconstructing the coronal plane alignment in TKA. Limited information, however, is available which confirms this left-to-right symmetry in coronal alignment based upon radiographs. The purpose of the study was, therefore, (1) to verify if a left-to-right symmetry is present and (2) to assess whether the contralateral lower limb would be a reliable reference for reconstructing the frontal plane alignment. METHODS: Full-leg standing radiographs of 250 volunteers (male, 125; female,125) were reviewed for three alignment parameters (Hip-Knee-Ankle angle (HKA), Femoral Mechanical Angle (FMA) and Tibial Mechanical Angle (TMA)). Evaluation of assumed left-to-right symmetry was performed according to two coronal alignment classifications (HKA subdivisions (HKA) and limb, femoral and tibial phenotypes (HKA, FMA and TMA)). Inter- and within-subject variability was calculated, along with correlations coefficients (r) and coefficients of determination (r2). Reliability of the contralateral limb as a personalized reference to reconstruct the constitutional alignment was investigated by intervals, expanding by 1° increments (0.5° increment both to varus and valgus) around the right knee alignment parameters. Subsequently, it was verified whether or not the left knee parameters fell within this interval. RESULTS: Symmetrical distribution in coronal alignment was found in 79% (HKA subdivision) and 59% (limb phenotype) of the cohort. Gender differences were present for the most common symmetric limb phenotypes (VARHKA3° (23.2%) in males and NEUHKA0° (38.4%) in females). Inter-subject variability was more prominent than the within-subject side differences for all parameters. Correlations analyses revealed mostly moderate correlations between the alignment measurements. Coefficients of determination showed overall weak left-to-right relationship, except for a moderate predictability for HKA (r2 = 0.538, p < 0.001) and FMA (r2 = 0.618, p < 0.001) in females. FMA and TMA marked weak predictive values for contralateral HKA. Only 60% of left knees were referenced within a 3° interval around the right knee. CONCLUSION: No strict left-to-right symmetry was observed in coronal alignment measurements. There is insufficient left-to-right agreement to consider the concept of the contralateral unaffected limb as an idealized reference for frontal plane alignment reconstruction based upon full-leg standing radiographs. LEVEL OF EVIDENCE: I.
Authors: Michael T Hirschmann; Silvan Hess; Henrik Behrend; Felix Amsler; Vincent Leclercq; Lukas B Moser Journal: Knee Surg Sports Traumatol Arthrosc Date: 2019-04-09 Impact factor: 4.342
Authors: Michael T Hirschmann; Lukas B Moser; Felix Amsler; Henrik Behrend; Vincent Leclercq; Silvan Hess Journal: Knee Surg Sports Traumatol Arthrosc Date: 2019-04-12 Impact factor: 4.342
Authors: Silvan Hess; Lukas B Moser; Felix Amsler; Henrik Behrend; Michael T Hirschmann Journal: Knee Surg Sports Traumatol Arthrosc Date: 2019-04-15 Impact factor: 4.342
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Authors: Silvan Hess; Lukas B Moser; Emma L Robertson; Henrik Behrend; Felix Amsler; Edna Iordache; Vincent Leclercq; Michael T Hirschmann Journal: Knee Surg Sports Traumatol Arthrosc Date: 2021-09-26 Impact factor: 4.114
Authors: Lukas B Moser; Silvan Hess; Jean-Baptiste de Villeneuve Bargemon; Ahmad Faizan; Sally LiArno; Felix Amsler; Michael T Hirschmann; Matthieu Ollivier Journal: J Pers Med Date: 2022-01-17