Prevalence of extra-articular tibia valga morphology in valgus knees and its implications for primary total knee arthroplasty

Journal of Orthopaedic Surgery and Research

Research Article

Michael Finsterwald¹  Salar Sobhi¹  Daniel P. Fick²  Riaz J. K. Khan³ 

[1] Hollywood Medical Centre, The Joint Studio, 85 Monash Avenue, 6009, Nedlands, WA, Australia;Hollywood Medical Centre, The Joint Studio, 85 Monash Avenue, 6009, Nedlands, WA, Australia;Hollywood Private Hospital, Monash Avenue, 6009, Nedlands, WA, Australia;Faculty of Science and Engineering, Curtin University, Kent Street, 6102, Bentley, WA, Australia;Hollywood Medical Centre, The Joint Studio, 85 Monash Avenue, 6009, Nedlands, WA, Australia;Hollywood Private Hospital, Monash Avenue, 6009, Nedlands, WA, Australia;Faculty of Science and Engineering, Curtin University, Kent Street, 6102, Bentley, WA, Australia;School of Medicine, University of Notre Dame, 9 Mouat Street, 6959, Fremantle, WA, Australia;

关键词: Tibia valga;    Pre-operative planning;    Total knee arthroplasty;    Total knee replacement;    Tibial component placement;   

DOI  :  10.1186/s13018-022-03418-5

 received in 2022-09-28, accepted in 2022-11-22,  发布年份 2022

来源: Springer

【 摘 要 】

IntroductionTibia valga, an extra-articular valgus deformity of the tibia, is common in valgus knees and can result in component misplacement and early total knee arthroplasty (TKA) failure. However, the prevalence and importance of tibia valga in TKA have been seldom reported. This study aims to describe the prevalence and characteristics of tibia valga morphology in valgus knees and describe implications for surgical planning in primary TKA.MethodsWe prospectively examined pre-operative weightbearing whole-body EOS digital radiographs of patients with knee osteoarthritis listed for TKA between December 2018 and December 2020. Hip–knee–ankle angle (HKA), mechanical lateral distal femoral angle (mLDFA), mechanical medial proximal tibial angle (mMPTA), joint line convergence angle (JLCA) and tibial morphology with centre of rotation of angulation of tibia (CORA-tibia) were measured and analysed.ResultsIn 830 knees, 253 (30%) and 577 (70%) were classified as valgus and varus, respectively. In valgus knees, 89 knees (35%) had tibia valga. Median CORA-tibia was 2.8° (range 0.2°–10.9°). Tibia valga knees had no difference in mLDFA, higher HKA (5.0o versus 3.0°, p = 0.002) and mMPTA (89.6° versus 88.1°, p < 0.01), and lower JLCA (2.1° versus 2.3°, p < 0.01) compared to non-tibia valga knees. Tibia valga deformity was weakly positively correlated with valgus HKA (ρ = 0.23, p < 0.001) and mMPTA (ρ = 0.38, p < 0.001). In varus knees, there were 52 cases of tibia valga (9%) with median CORA-tibia of 3.0° (range 0.5°–5.5°). Tibia valga knees had higher mMPTA (87.0° versus 85.2°, p < 0.05) and no difference in HKA, mLDFA and JLCA. CORA-tibia was weakly positively correlated with mMPTA.ConclusionsValgus knees may have an extra-articular deformity of the tibia which might be the primary contributor of the overall valgus HKA deformity rather than the distal femoral anatomy. To detect the deformity, full leg-length radiographs should be acquired pre-operatively. Intramedullary instrumentation should be used cautiously in knees with tibia valga when performing TKA.

【 授权许可】

CC BY   
© The Author(s) 2022

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