Weight-bearing radiography depends on limb loading
The mechanical axis of the lower limb has shown to vary between different weight-bearing conditions and change after total knee arthroplasty (TKA). The purpose of this study was to investigate the correlation between mechanical axis alignment in standing long-leg radiographs and limb loading after TKA.
Mechanical axis of the lower limb and limb loading have been prospectively evaluated in 115 patients 10 days and 3 months after TKA. By the moment of standing long-leg radiography for analysis of the mechanical leg axis, two digital scales separately captured the load of each limb.
Mechanical axis changed from an initial − 1° ± 2° valgus alignment to a varus axis of + 1° ± 2° (p < 0.01). This change in alignment was associated with an increase of limb loading from 89.9 ± 10.7 to 93.0 ± 7.0% (p < 0.01). The mechanical axis strongly correlated with relative limb loading at the first and second measurements (r = 0.804, p < 0.001, respectively, r = 0.562, p < 0.001). A significant change in the rate of outliers was registered within the observation period. These alterations and distinctions were much more pronounced in patients with postoperative incomplete extension (n = 15).
The postoperative mechanical axis correlates with limb loading. A clinical relevant change in frontal alignment of the lower limb is associated with increased limb loading after TKA. The actual mechanical axis can only be assessed at physiological limb loading in long-leg radiographs with complete extension at full weight bearing.
Level of evidence
Diagnostic study, Level II.
KeywordsTotal knee arthroplasty Total knee replacement Mechanical axis Limb loading Standing long-leg radiographs
Body mass index
Total knee arthroplasty
Numerical rating scale
No funding hase been received for this study.
Compliance with ethical standards
Conflict of interest
The authors have no conflicts of interest.
This study was approved by the competent ethical committee (AS 17 (bB)/2015).
A written informed consent was obtained from all patients.
- 39.Schoenmakers DAL, Feczko PZ, Boonen B, Schotanus MGM, Kort NP, Emans PJ (2017) Measurement of lower limb alignment: there are within-person differences between weight-bearing and non-weight-bearing measurement modalities. Knee Surg Sports Traumatol Arthrosc 25:3569–3575CrossRefPubMedPubMedCentralGoogle Scholar
- 40.Schroter S, Ateschrang A, Lowe W, Nakayama H, Stockle U, Ihle C (2017) Early full weight-bearing versus 6-week partial weight-bearing after open wedge high tibial osteotomy leads to earlier improvement of the clinical results: a prospective, randomised evaluation. Knee Surg Sports Traumatol Arthrosc 25:325–332CrossRefPubMedGoogle Scholar
- 42.Shelton TJ, Nedopil AJ, Howell SM, Hull ML (2017) Do varus or valgus outliers have higher forces in the medial or lateral compartments than those which are in-range after a kinematically aligned total knee arthroplasty? limb and joint line alignment after kinematically aligned total knee arthroplasty. Bone Joint J 99-B:1319–1328CrossRefPubMedGoogle Scholar
- 46.Slevin O, Hirschmann A, Schiapparelli FF, Amsler F, Huegli RW, Hirschmann MT (2017) Neutral alignment leads to higher knee society scores after total knee arthroplasty in preoperatively non-varus patients: a prospective clinical study using 3D-CT. Knee Surg Sports Traumatol Arthrosc. https://doi.org/10.1007/s00167-017-4744-y CrossRefPubMedGoogle Scholar