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A single type of varus knee does not exist: morphotyping and gap analysis in varus OA

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Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Purpose

To achieve a higher level of satisfaction in patients having undergone Total Knee Arthroplasty (TKA), a more personalized approach has been discussed recently. It can be assumed that a more profound knowledge of bony morphology and ligamentous situation would be beneficial. While CT/MRI can give 3D information on bone morphology, the understanding of the ligamentous situation in different flexion angles is still incomplete. In this study, the dynamic gap widths of a large number of varus knees were assessed in various flexion angles, to find out whether all varus knees behave similar or have more individual soft tissue patterns. Additionally, it was investigated whether the amount of varus deformity or other patient factors have an effect on joint gap widths.

Methods

A series of 1000 consecutive TKA patients, including their CAS data and patient records were analyzed. Joint gap widths in multiple flexion angles (0°, 30°, 60°, 90°) were measured in mm and differences between the joint gaps were compared. A “standard” varus knee was defined as follows: (1) Lateral extension gap greater than medial, (2) lateral flexion gap greater than medial, and (3) flexion gap greater than extension gap. The percentage of fulfillment was tested for each and all criteria. To measure the influence of varus deformity on gap width difference, three subgroups were formed based on the deformity. Data were analyzed at 0°, 30°, 60° and 90° flexion. The effect of patient factors (gender, BMI, age) on gap sizes was tested by performing subgroup analyses.

Results

Only 444 of 680 (65%) patients met all three varus knee criteria. The lateral extension gap (4.1 mm) was significantly larger than the medial extension gap (0.6 mm) in 657 (97%) patients and the gap difference highly correlated with the amount of varus deformity (r2 = 0.62). In all flexion positions, however, no correlation between gap differences and varus deformity existed. Women had significantly larger extension and flexion gaps. Age and BMI showed no significant effect on gap widths.

Conclusion

Varus knees show a large inter-individual variability regarding gap widths and gap differences. The amount of varus deformity correlates highly with the medio-lateral gap difference in extension, but not in any flexion angle. As varus knees are not all alike, a uniform surgical technique will not treat all varus knees adequately and the individual gap sizes need to be analyzed and addressed accordingly with an individualized balancing technique. Which final balancing goal should be achieved needs to be analyzed in future studies.

Level of evidence

Level III.

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Funding

No grants or other funding were received for this study.

Author information

Authors and Affiliations

  1. Department for Arthroplasty, Sports-Traumatology and General Orthopaedics, Asklepios Orthopaedic Hospital Lindenlohe, Lindenlohe 18, 92421, Schwandorf, Germany

    Heiko Graichen, Kreangsak Lekkreusuwan, Kim Eller & Wolfgang Scior

  2. Phramongkutklao College of Medicine, 315 Ratchawithi Rd, Thung Phaya Thai District, Khet Ratchathewi, Bangkok, 10400, Thailand

    Kreangsak Lekkreusuwan

  3. Kopfzentrum, Acqua Clinics, Acqua Medical Group, Käthe Kollwitz Straße 64, 04109, Leipzig, Germany

    Thomas Grau

  4. Department of Orthopaedic Surgery and Traumatology, Kantonsspital Baselland, Mühlemattstrasse 26, 4410, Liestal, Switzerland

    Michael T. Hirschmann

Authors
  1. Heiko Graichen
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  2. Kreangsak Lekkreusuwan
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  3. Kim Eller
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  4. Thomas Grau
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  5. Michael T. Hirschmann
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  6. Wolfgang Scior
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Contributions

HG conceived and planned the study. HG and WS planned and performed operations. LK and KE contributed to the processing and analysis of the data. HG took the lead in writing the manuscript. KE and MH were responsible for corrections and revisions. All authors provided critical feedback and helped design the study, analyze the data, and write the manuscript.

Corresponding author

Correspondence to Heiko Graichen.

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Conflict of interest

Each author (Heiko Graichen, Kreangsak Lekkreusuwan, Kim Eller, Thomas Grau, Michael T. Hirschmann, Wolfgang Scior) confirms that he or she has no commercial affiliations that could constitute a conflict of interest in connection with the submitted article.

Ethical approval

All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1964 and its later amendments. Our evaluations were written exclusively in anonymized form and applicable data protection regulations were observed.

Informed consent

Written consent of all patients for data collection was obtained prior to Hospital entry.

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Graichen, H., Lekkreusuwan, K., Eller, K. et al. A single type of varus knee does not exist: morphotyping and gap analysis in varus OA. Knee Surg Sports Traumatol Arthrosc 30, 2600–2608 (2022). https://doi.org/10.1007/s00167-021-06688-4

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  • DOI: https://doi.org/10.1007/s00167-021-06688-4

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