Prevalence of extra-articular deformity (EAD) and tibia vara (TV) in patients undergoing total knee arthroplasty (TKA) in Indian population

Q2 Medicine

Journal of Clinical Orthopaedics and Trauma Pub Date : 2025-04-12 DOI:10.1016/j.jcot.2025.103015

Pathik Shah , Anjali Tiwari , Ishan Shah , Lokesh Naik , Aashiket Sable , Vaibhav Bagaria

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Abstract

Background

Varus deformity is the predominant knee deformity observed in osteoarthritic patients undergoing Total Knee Replacement (TKR). Extra-articular deformities (EADs) have been identified as one of the significant contributors to postoperative dissatisfaction and suboptimal functional outcomes.

Methods

This study analyzed 500 preoperative knee scannograms from 371 patients. Standing scannograms of both lower limbs were assessed by a trained orthopaedic surgeon to calculate several angular measurements: Hip-Knee-Ankle (HKA), Mechanical Lateral Distal Femoral Angle (mLDFA), Mechanical Medial Proximal Tibial Angle (mMPTA), Joint Line Congruence Angle (JLCA), Center Of Rotation of Angulation (CORA) for both femur and tibia, Epiphyseo-Diaphyseal Angle (EDA), and Tibia Vara Angle (TVA). An EAD was defined based on the CORA location being greater than 7 cm from the knee joint line for the tibia and greater than 3 cm for the femur.

Results

The mean age of patients was 66.58 ± 8.19 years, with a male-to-female ratio of 1:2.28. Varus deformities were present in the femur in 279 knees (55.80 %), in the tibia in 206 knees (41.20 %), and in both femur and tibia in 127 knees (25.40 %). Notably, 498 knees (99.60 %) demonstrated increased JLCA, indicating significant joint line alteration. EADs were identified in 51 patients (10.2 %), signifying that approximately 1 in 10 patients operated on for TKA exhibited significant extra-articular deformities.

Conclusions

This study establishes that 10.20 % of knees in an Indian cohort displayed significant EADs. Varus deformities were primarily associated with alterations in LDFA, MPTA, and JCLA measurements. The almost universal alteration of joint lines among patients scheduled for TKR underscores the importance of precise preoperative planning. Embracing advanced technologies such as robotics and enhancing our understanding of varus deformity could facilitate a more tailored approach to deformity correction, potentially elevating surgical outcomes.

Abstract Image

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印度人群中接受全膝关节置换术（TKA）患者的关节外畸形（EAD）和胫骨畸形（TV）发病率

背景：在接受全膝关节置换术（TKR）的骨关节炎患者中，内翻畸形是主要的膝关节畸形。关节外畸形（EADs）已被确定为术后不满意和次优功能预后的重要因素之一。方法分析371例患者术前500张膝关节扫描图。由训练有素的骨科医生评估双下肢站立扫描图，计算几个角度测量值：髋关节-膝关节-踝关节（HKA）、机械股骨外侧远端角（mLDFA）、机械胫骨内侧近端角（mMPTA）、关节线一致性角（JLCA）、股骨和胫骨的成角旋转中心（CORA）、骨骺-骨干角（EDA）和胫骨内翻角（TVA）。根据CORA位置距胫骨膝关节线大于7cm，距股骨关节线大于3cm来定义EAD。结果患者平均年龄66.58±8.19岁，男女比例为1:2.28。279例膝关节出现股骨内翻畸形（55.80%），206例膝关节出现胫骨内翻畸形（41.20%），127例膝关节出现股骨和胫骨内翻畸形（25.40%）。值得注意的是，498个膝关节（99.60%）显示JLCA增加，表明明显的关节线改变。51例（10.2%）患者中发现了EADs，这表明大约1 / 10的TKA手术患者表现出明显的关节外畸形。结论：本研究确定，10.20%的印度人群的膝盖表现出明显的EADs。内翻畸形主要与LDFA、MPTA和JCLA测量值的改变有关。在TKR患者中，几乎普遍的关节线改变强调了精确术前计划的重要性。采用先进的技术，如机器人技术和增强我们对内翻畸形的理解，可以促进更有针对性的畸形矫正方法，潜在地提高手术效果。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of Clinical Orthopaedics and Trauma Medicine-Orthopedics and Sports Medicine

CiteScore

4.30

自引率

0.00%

发文量

181

审稿时长

92 days

期刊介绍： Journal of Clinical Orthopaedics and Trauma (JCOT) aims to provide its readers with the latest clinical and basic research, and informed opinions that shape today''s orthopedic practice, thereby providing an opportunity to practice evidence-based medicine. With contributions from leading clinicians and researchers around the world, we aim to be the premier journal providing an international perspective advancing knowledge of the musculoskeletal system. JCOT publishes content of value to both general orthopedic practitioners and specialists on all aspects of musculoskeletal research, diagnoses, and treatment. We accept following types of articles: • Original articles focusing on current clinical issues. • Review articles with learning value for professionals as well as students. • Research articles providing the latest in basic biological or engineering research on musculoskeletal diseases. • Regular columns by experts discussing issues affecting the field of orthopedics. • "Symposia" devoted to a single topic offering the general reader an overview of a field, but providing the specialist current in-depth information. • Video of any orthopedic surgery which is innovative and adds to present concepts. • Articles emphasizing or demonstrating a new clinical sign in the art of patient examination is also considered for publication. Contributions from anywhere in the world are welcome and considered on their merits.