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Femoral Lateral Bowing and Varus Condylar Orientation Are Prevalent and Affect Axial Alignment of TKA in Koreans

  • Symposium: Special Considerations for TKA in Asian Patients
  • Published:
Clinical Orthopaedics and Related Research®

Abstract

Background

Coronal alignment is considered key to the function and longevity of a TKA. However, most studies do not consider femoral and tibial anatomical features such as lateral femoral bowing and the effects of these features and subsequent alignment on function after TKA are unclear.

Questions/purposes

We therefore determined (1) the prevalence of lateral femoral bowing, varus femoral condylar orientation, and severe tibia plateau inclination in female Koreans undergoing TKA; (2) whether postoperative alignments are affected by these anatomical features and improved by the use of navigation; and (3) whether postoperative coronal alignments are associated with function.

Methods

We measured alignment in 367 knees that underwent TKA and 60 sex- and age-matched normal knees (control group). We determined patterns and degrees of femoral bowing angle, femoral condylar orientation, and tibial plateau inclination on preoperative full-limb radiographs. Postoperatively, coronal alignment of limbs and of femoral and tibial components was measured. We compared American Knee Society scores, WOMAC scores, and SF-36 scores in aligned knees and outliers (beyond ± 3° or ± 2°) at 1 year.

Results

The prevalence of lateral femoral bowing was 88% in the TKA group and 77% in the control group. Mean femoral condylar orientation angle was varus 2.6° in the TKA group and valgus 1.1° in the control group, and mean tibial plateau inclination was varus 8.3° in the TKA group and varus 5.4° in the control group. Femoral lateral bowing and varus femoral condylar orientation were associated with postoperative alignments. Several clinical outcome scales were inferior in the outliers in mechanical tibiofemoral angle, anatomical tibiofemoral angle, and tibial coronal alignment but not in femoral coronal alignment outliers.

Conclusions

Lateral femoral bowing, varus condylar orientation, and severe varus inclination of the tibia plateau should be considered when performing TKA in Korean patients or patients with otherwise similar anatomical features.

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Fig. 2A–D

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Acknowledgments

We thank Moon Jong Chang, MD (Department of Orthopaedic Surgery, Seoul National University Bundang Hospital), for his scientific debate and manuscript review and Sung Ju Kim, MS, PhD candidate (Department of Orthopaedic Surgery, Korea University), for his help with statistical analyses.

Author information

Authors and Affiliations

  1. Department of Orthopaedics, Cagayan Valley Medical Center, Tuguegarao City, Cagayan, Philippines

    Marco Paolo G. Lasam MD

  2. Joint Reconstruction Center, Seoul National University Bundang Hospital, 166 Gumiro, Bundangu, Seongnam-si, Gyunggido, 463-707, Korea

    Kil Jae Lee MD, Chong Bum Chang MD, PhD, Yeon Gwi Kang MS & Tae Kyun Kim MD, PhD

Authors
  1. Marco Paolo G. Lasam MD
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  2. Kil Jae Lee MD
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  3. Chong Bum Chang MD, PhD
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  4. Yeon Gwi Kang MS
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  5. Tae Kyun Kim MD, PhD
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Corresponding author

Correspondence to Tae Kyun Kim MD, PhD.

Additional information

One or more of the authors (TKK) have received funding from the Korean Human Technology Research Foundation and a clinical research fund of Seoul National University Bundang Hospital, Bundang, Korea.

All ICMJE Conflict of Interest Forms for authors and Clinical Orthopaedics and Related Research editors and board members are on file with the publication and can be viewed on request.

Each author certifies that his or her institution has approved the human protocol for this investigation in that all investigations were conducted in conformity with ethical principles of research and that informed consent was obtained.

This work was performed at the Joint Reconstruction Center, Seoul National University Bundang Hospital, Bundang, Korea.

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Lasam, M.P.G., Lee, K.J., Chang, C.B. et al. Femoral Lateral Bowing and Varus Condylar Orientation Are Prevalent and Affect Axial Alignment of TKA in Koreans. Clin Orthop Relat Res 471, 1472–1483 (2013). https://doi.org/10.1007/s11999-012-2618-7

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  • DOI: https://doi.org/10.1007/s11999-012-2618-7

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