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The contralateral limb is no reliable reference to restore coronal alignment in TKA.

Authors :
Beckers L
Colyn W
Bellemans J
Victor J
Vandekerckhove PJ
Source :
Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA [Knee Surg Sports Traumatol Arthrosc] 2022 Feb; Vol. 30 (2), pp. 477-487. Date of Electronic Publication: 2020 Jul 21.
Publication Year :
2022

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.<br />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 (r <superscript>2</superscript> ). 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.<br />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 (VAR <subscript>HKA</subscript> 3° (23.2%) in males and NEU <subscript>HKA</subscript> 0° (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 (r <superscript>2</superscript>  = 0.538, p < 0.001) and FMA (r <superscript>2</superscript>  = 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.<br />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.<br />Level of Evidence: I.<br /> (© 2020. European Society of Sports Traumatology, Knee Surgery, Arthroscopy (ESSKA).)

Details

Language :
English
ISSN :
1433-7347
Volume :
30
Issue :
2
Database :
MEDLINE
Journal :
Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA
Publication Type :
Academic Journal
Accession number :
32696089
Full Text :
https://doi.org/10.1007/s00167-020-06152-9