Skip to main content

The alignment of the knee joint in relationship to age and osteoarthritis

The Copenhagen Osteoarthritis Study

Skeletal Radiology volume 42, pages 531–540 (2013)Cite this article

Abstract

Introduction

The aim of the present study was to describe the changes in the axis of the knee joint in both radiologically osteoarthritic and non-osteoarthritic knees, on the basis of angles measurable in standardized clinical short knee radiographs, in a cross sectional study of an epidemiological cohort.

Design

From the third inclusion of the Copenhagen City Heart Study, 4,151 subjects were selected for standardized radiography of the knees. After censuring the inclusion, the resulting cohort was comprised of 3,488 individuals. Images were analyzed for radiological knee joint osteoarthritis (OA) and the anatomical femorotibial axis of the knee joint was measured.

Results

The prevalence of knee joint OA in males was 27.9 % and 27.5 %, for the left and right knees respectively. In females this was 32.8 % and 36.4 %. The mean knee joint angles were 4.11° in males; and 5.45° in females. A difference of 1.3° was found between the genders. In non-osteoarthritic knees the increase in valgus orientation in relationship to increasing age was found to be 0.03° and 0.04° per year, respectively, for males and females. Likewise, Kellgren and Lawrence found that OA was seen to influence a shift towards varus of 0.55°–0.76° per level of OA.

Conclusion

Stratification in accordance with morphological severity of OA documented a clear tendency for the axis of the diseased knees to depart from the mean, primarily in the direction of varus. In knees exhibiting no signs of radiographic osteoarthritis we found a significant relationship between increasing age and a shift in the anatomical axis in the direction of valgus.

This is a preview of subscription content, access via your institution.

Access options

Buy single article

Instant access to the full article PDF.

43,34 €

Price includes VAT (Finland)
Tax calculation will be finalised during checkout.

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5

References

  1. Hunter DJ, Niu J, Felson DT, et al. Knee alignment does not predict incident osteoarthritis: the Framingham osteoarthritis study. Arthritis Rheum. 2007;56(4):1212–8.

    PubMed  Article  Google Scholar 

  2. Brouwer GM, van Tol AW, Bergink AP, et al. Association between valgus and varus alignment and the development and progression of radiographic osteoarthritis of the knee. Arthritis Rheum. 2007;56(4):1204–11.

    PubMed  Article  CAS  Google Scholar 

  3. Khan FA, Koff MF, Noiseux NO, et al. Effect of local alignment on compartmental patterns of knee osteoarthritis. J Bone Joint Surg Am. 2008;90(9):1961–9.

    PubMed  Article  Google Scholar 

  4. Sharma L, Song J, Felson DT, Cahue S, Shamiyeh E, Dunlop DD. The role of knee alignment in disease progression and functional decline in knee osteoarthritis. JAMA. 2001;286(2):188–95.

    PubMed  Article  CAS  Google Scholar 

  5. Hsu RW, Himeno S, Coventry MB, Chao EY. Normal axial alignment of the lower extremity and load-bearing distribution at the knee. Clin Orthop Relat Res. 1990;255:215–27.

    PubMed  Google Scholar 

  6. Moreland JR, Bassett LW, Hanker GJ. Radiographic analysis of the axial alignment of the lower extremity. J Bone Joint Surg Am. 1987;69(5):745–9.

    PubMed  CAS  Google Scholar 

  7. Hinman RS, May RL, Crossley KM. Is there an alternative to the full-leg radiograph for determining knee joint alignment in osteoarthritis? Arthritis Rheum. 2006;55(2):306–13.

    PubMed  Article  Google Scholar 

  8. Kraus VB, Vail TP, Worrell T, McDaniel G. A comparative assessment of alignment angle of the knee by radiographic and physical examination methods. Arthritis Rheum. 2005;52(6):1730–5.

    PubMed  Article  Google Scholar 

  9. van Raaij TM, Brouwer RW, Reijman M, Bierma-Zeinstra SM, Verhaar JA. Conventional knee films hamper accurate knee alignment determination in patients with varus osteoarthritis of the knee. Knee. 2009;16(2):109–11.

    PubMed  Article  Google Scholar 

  10. McDaniel G, Mitchell KL, Charles C, et al. A comparison of five approaches to measurement of anatomic knee alignment from radiographs. Osteoarthr Cartil. 2010;18(2):273–7.

    PubMed  Article  CAS  Google Scholar 

  11. Cahuzac JP, Vardon D, de Sales GJ. Development of the clinical tibiofemoral angle in normal adolescents. A study of 427 normal subjects from 10 to 16 years of age. J Bone Joint Surg Br. 1995;77(5):729–32.

    PubMed  CAS  Google Scholar 

  12. Sabharwal S, Zhao C, Edgar M. Lower limb alignment in children: reference values based on a full-length standing radiograph. J Pediatr Orthop. 2008;28(7):740–6.

    PubMed  Article  Google Scholar 

  13. Schnohr P, Jensen JS, Scharling H, Nordestgaard BG. Coronary heart disease risk factors ranked by importance for the individual and community. A 21 year follow-up of 12 000 men and women from The Copenhagen City Heart Study. Eur Heart J. 2002;23(8):620–6.

    PubMed  Article  CAS  Google Scholar 

  14. Paley D. Principles of deformity correction. Springer; 2002.

  15. Paley D, Herzenberg JE, Tetsworth K, McKie J, Bhave A. Deformity planning for frontal and sagittal plane corrective osteotomies. Orthop Clin North Am. 1994;25(3):425–65.

    PubMed  CAS  Google Scholar 

  16. Kellgren JH, Lawrence JS. Radiological assessment of osteoarthrosis. Ann Rheum Dis. 1957;16(4):494–502.

    PubMed  Article  CAS  Google Scholar 

  17. Laxafoss E, Jacobsen S, Gosvig KK, Sonne-Holm S. Case definitions of knee osteoarthritis in 4,151 unselected subjects: relevance for epidemiological studies: the Copenhagen Osteoarthritis Study. Skelet Radiol. 2010;39(9):859–66.

    Article  Google Scholar 

  18. Wolfe F, Lane NE, Buckland-Wright C. Radiographic methods in knee osteoarthritis: a further comparison of semiflexed (MTP), schuss-tunnel, and weight-bearing anteroposterior views for joint space narrowing and osteophytes. J Rheumatol. 2002;29(12):2597–601.

    PubMed  Google Scholar 

  19. Vignon E, Piperno M, Le Graverand MP, et al. Measurement of radiographic joint space width in the tibiofemoral compartment of the osteoarthritic knee: comparison of standing anteroposterior and Lyon schuss views. Arthritis Rheum. 2003;48(2):378–84.

    PubMed  Article  Google Scholar 

  20. Andriacchi TP. Dynamics of knee malalignment. Orthop Clin North Am. 1994;25(3):395–403.

    PubMed  CAS  Google Scholar 

  21. Sharma L, Song J, Felson DT, et al. The role of knee alignment in disease progression and functional decline in knee osteoarthritis. JAMA. 2001;286(2):188–95.

    PubMed  Article  CAS  Google Scholar 

  22. Issa SN, Dunlop D, Chang A, et al. Full-limb and knee radiography assessments of varus-valgus alignment and their relationship to osteoarthritis disease features by magnetic resonance imaging. Arthritis Rheum. 2007;57(3):398–406.

    PubMed  Article  Google Scholar 

  23. Sharma L, Lou C, Felson DT, et al. Laxity in healthy and osteoarthritic knees. Arthritis Rheum. 1999;42(5):861–70.

    PubMed  Article  CAS  Google Scholar 

Download references

Conflict of interest

The authors declare that they have no conflict of interest.

Author information

Affiliations

  1. Department of Orthopaedic Surgery, Copenhagen University Hospital of Hvidovre, Kettegaards Allé 30, 2650, Hvidovre, Denmark

    Erling Laxafoss, Steffen Jacobsen & Stig Sonne-Holm

  2. Department of Radiology, Copenhagen University Hospital of Hvidovre, Kettegaards Allé 30, 2650, Hvidovre, Denmark

    Kasper K. Gosvig

Authors
  1. Erling Laxafoss
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Steffen Jacobsen
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Kasper K. Gosvig
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Stig Sonne-Holm
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Erling Laxafoss.

Rights and permissions

Reprints and Permissions

About this article

Cite this article

Laxafoss, E., Jacobsen, S., Gosvig, K.K. et al. The alignment of the knee joint in relationship to age and osteoarthritis. Skeletal Radiol 42, 531–540 (2013). https://doi.org/10.1007/s00256-012-1509-z

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00256-012-1509-z

Keywords

  • Knee joint anatomical axis
  • Osteoarthritis
  • OA
  • X-ray radiographs
  • Varus
  • Valgus
  • Age
  • Cross-sectional
  • Kellgren and Lawrence