Oriol Pujol, Pedro Hinarejos, Albert Pons, Ernest Famada, Angela Zumel, Juan Erquicia, Joan Leal-Blanquet
{"title":"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。","authors":"Oriol Pujol, Pedro Hinarejos, Albert Pons, Ernest Famada, Angela Zumel, Juan Erquicia, Joan Leal-Blanquet","doi":"10.1002/ksa.12714","DOIUrl":null,"url":null,"abstract":"<div>\n \n \n <section>\n \n <h3> Purpose</h3>\n \n <p>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.</p>\n </section>\n \n <section>\n \n <h3> Methods</h3>\n \n <p>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.</p>\n </section>\n \n <section>\n \n <h3> Results</h3>\n \n <p>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.</p>\n </section>\n \n <section>\n \n <h3> Conclusions</h3>\n \n <p>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.</p>\n </section>\n \n <section>\n \n <h3> Level of Evidence</h3>\n \n <p>Level III.</p>\n </section>\n </div>","PeriodicalId":17880,"journal":{"name":"Knee Surgery, Sports Traumatology, Arthroscopy","volume":"33 10","pages":"3621-3628"},"PeriodicalIF":5.0000,"publicationDate":"2025-06-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"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\",\"authors\":\"Oriol Pujol, Pedro Hinarejos, Albert Pons, Ernest Famada, Angela Zumel, Juan Erquicia, Joan Leal-Blanquet\",\"doi\":\"10.1002/ksa.12714\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<div>\\n \\n \\n <section>\\n \\n <h3> Purpose</h3>\\n \\n <p>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.</p>\\n </section>\\n \\n <section>\\n \\n <h3> Methods</h3>\\n \\n <p>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.</p>\\n </section>\\n \\n <section>\\n \\n <h3> Results</h3>\\n \\n <p>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.</p>\\n </section>\\n \\n <section>\\n \\n <h3> Conclusions</h3>\\n \\n <p>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.</p>\\n </section>\\n \\n <section>\\n \\n <h3> Level of Evidence</h3>\\n \\n <p>Level III.</p>\\n </section>\\n </div>\",\"PeriodicalId\":17880,\"journal\":{\"name\":\"Knee Surgery, Sports Traumatology, Arthroscopy\",\"volume\":\"33 10\",\"pages\":\"3621-3628\"},\"PeriodicalIF\":5.0000,\"publicationDate\":\"2025-06-05\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Knee Surgery, Sports Traumatology, Arthroscopy\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://esskajournals.onlinelibrary.wiley.com/doi/10.1002/ksa.12714\",\"RegionNum\":2,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q1\",\"JCRName\":\"ORTHOPEDICS\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Knee Surgery, Sports Traumatology, Arthroscopy","FirstCategoryId":"3","ListUrlMain":"https://esskajournals.onlinelibrary.wiley.com/doi/10.1002/ksa.12714","RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"ORTHOPEDICS","Score":null,"Total":0}
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
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.
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).
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