Poor side-to-side symmetry limits the use of the contralateral limb as a reliable reference for guiding coronal positioning and alignment in total knee arthroplasty

IF 5 2区医学 Q1 ORTHOPEDICS

Knee Surgery, Sports Traumatology, Arthroscopy Pub Date : 2025-06-05 DOI:10.1002/ksa.12714

Oriol Pujol, Pedro Hinarejos, Albert Pons, Ernest Famada, Angela Zumel, Juan Erquicia, Joan Leal-Blanquet

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Abstract

Purpose

To assess the symmetry of coronal alignment in the lower limbs of patients with knee osteoarthritis to evaluate whether the contralateral lower limb can serve as a reliable reference for guiding coronal positioning and alignment in total knee arthroplasty (TKA) surgery.

Methods

This is a multicentric cross-sectional observational study. Preoperative full-leg weight-bearing radiographies from patients with knee osteoarthritis treated with a TKA between 2022 and 2024 were analyzed. Radiological parameters were measured in both lower limbs: medial proximal tibial angle, tibial mechanical angle (TMA), lateral distal femoral angle, femoral mechanical angle (FMA), hip–knee–ankle angle (HKA) and Kellgren–Lawrence. Lower limb coronal symmetry was assessed using the HKA, coronal plane alignment of the knee (CPAK) and phenotypes classifications. The relationship between concordance rates and osteoarthritis severity and symmetry was also analyzed.

Results

Seventy-six patients were included. The operated-to-contralateral concordance for the HKA classification was 57%. It was higher when the operated knee was neutral (81%), compared to varus (58%) or valgus (27%). The CPAK concordance was 38%; it was similar across different CPAK types. The phenotype classification concordance was only 11%; 30% for the HKA parameter, 39% for FMA and 34% for TMA. There was no relationship between osteoarthritis severity or symmetry and coronal concordance rates.

Conclusions

Patients with knee osteoarthritis have poor side-to-side symmetry in lower limb coronal alignment. The concordance rate was 56% for the HKA classification, 39% for the CPAK classification and 11% for the phenotype classification. Therefore, the contralateral lower limb may not be a reliable reference for guiding coronal positioning and alignment in TKA surgery.

Level of Evidence

Level III.

Abstract Image

查看原文本刊更多论文

在全膝关节置换术中，对侧肢体作为指导冠状位定位和对齐的可靠参考，由于两侧对称性差，限制了对侧肢体的使用。

目的：评估膝关节骨性关节炎患者下肢冠状位对齐的对称性，以评价对侧下肢是否可以作为指导全膝关节置换术（TKA）中冠状位对齐的可靠参考。方法：这是一项多中心横断面观察性研究。分析了2022年至2024年间接受TKA治疗的膝关节骨性关节炎患者的术前全腿负重x线片。测量双下肢放射学参数：胫骨内侧近端角、胫骨机械角（TMA）、股骨外侧远端角、股骨机械角（FMA）、髋关节-膝关节-踝关节角（HKA）和Kellgren-Lawrence角。采用HKA、膝关节冠状面排列（CPAK）和表型分类评估下肢冠状面对称性。分析了一致性率与骨关节炎严重程度和对称性之间的关系。结果：纳入76例患者。手术-对侧HKA分类的一致性为57%。与内翻（58%）或外翻（27%）相比，手术膝关节中性时（81%）的发生率更高。CPAK的一致性为38%；在不同的CPAK类型中是相似的。表型分类一致性仅为11%；HKA参数占30%，FMA占39%，TMA占34%。骨关节炎的严重程度或对称性与冠状一致率之间没有关系。结论：膝关节骨性关节炎患者下肢冠状位侧对侧对称性较差。HKA分类的一致性率为56%，CPAK分类的一致性率为39%，表型分类的一致性率为11%。因此，在TKA手术中，对侧下肢可能不是指导冠状定位和对准的可靠参考。证据等级：三级。

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

Knee Surgery, Sports Traumatology, Arthroscopy 医学-外科

CiteScore

8.10

自引率

18.40%

发文量

418

审稿时长

2 months

期刊介绍： Few other areas of orthopedic surgery and traumatology have undergone such a dramatic evolution in the last 10 years as knee surgery, arthroscopy and sports traumatology. Ranked among the top 33% of journals in both Orthopedics and Sports Sciences, the goal of this European journal is to publish papers about innovative knee surgery, sports trauma surgery and arthroscopy. Each issue features a series of peer-reviewed articles that deal with diagnosis and management and with basic research. Each issue also contains at least one review article about an important clinical problem. Case presentations or short notes about technical innovations are also accepted for publication. The articles cover all aspects of knee surgery and all types of sports trauma; in addition, epidemiology, diagnosis, treatment and prevention, and all types of arthroscopy (not only the knee but also the shoulder, elbow, wrist, hip, ankle, etc.) are addressed. Articles on new diagnostic techniques such as MRI and ultrasound and high-quality articles about the biomechanics of joints, muscles and tendons are included. Although this is largely a clinical journal, it is also open to basic research with clinical relevance. Because the journal is supported by a distinguished European Editorial Board, assisted by an international Advisory Board, you can be assured that the journal maintains the highest standards. Official Clinical Journal of the European Society of Sports Traumatology, Knee Surgery and Arthroscopy (ESSKA).