Skip to main content

Advertisement

SpringerLink
Log in

Changes in the femoral varus and rotational profiles are correlated in women with varus osteoarthritic lower limbs

  • Orthopaedic Surgery
  • Published:
Archives of Orthopaedic and Trauma Surgery Aims and scope Submit manuscript

Abstract

Introduction

Previous studies have reported the relationship between coronal alignment of the lower limbs and the rotational profile of the femur and tibia. However, the relationship between coronal alignment of the femur and tibia and their rotational profiles in patients with varus osteoarthritic knees is unclear.

Methods

One hundred women with varus osteoarthritic knees (varus OA group) and 50 women with neutrally aligned lower limbs without osteoarthritis (non-OA group) were evaluated retrospectively. The coronal alignment and rotational profile of the femur and tibia were evaluated, and the correlation between coronal alignment and rotational profile was analyzed, respectively.

Results

The femoral anteversion, posterior condylar angle of the distal femur, and tibial torsion were significantly smaller in the varus OA group than in the non-OA group. In the varus OA group, the femoral anteversion and rotational profile of the distal femur had significantly negative correlations with the degree of femoral varus, while tibial torsion was not related to the degree of tibial varus. In the non-OA group, there was no relationship between coronal alignment and rotational profiles of the femur and tibia in both the varus OA and non-OA groups.

Conclusion

Femoral anteversion and the rotational profile of the distal femur were negatively correlated with the degree of femoral varus in Asian women with varus osteoarthritic knees. This study enhanced the understanding of the relationship between changes in coronal alignment of the femur and tibia and their rotational profiles in patients with varus osteoarthritic lower limbs, although this study was limited by the small sample sizes and methodological quality.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Aglietti P, Sensi L, Cuomo P, Ciardullo A (2008) Rotational position of femoral and tibial components in TKA using the femoral transepicondylar axis. Clin Orthop Relat Res 466(11):2751–2755

  2. Arima J, Whiteside LA, McCarthy DS, White SE (1995) Femoral rotational alignment, based on the anteroposterior axis, in total knee arthroplasty in a valgus knee. A technical note. J Bone Jt Surg 77:1331–1334

    Article  CAS  Google Scholar 

  3. Barrack RL, Schrader T, Bertot AJ, Wolfe MW, Myers L (2001) Component rotation and anterior knee pain after total knee arthroplasty. Clin Orthop Relat Res Nov;(392):46–55

    Article  Google Scholar 

  4. Blagojevic M, Jinks C, Jeffery A, Jordan KP (2010) Risk factors for onset of osteoarthritis of the knee in older adults: a systematic review and meta-analysis. Osteoarthritis Cartilage 18:24–33

    Article  CAS  PubMed  Google Scholar 

  5. Chang CB, Seong SC, Lee S, You JH, Lee SH, Lee MC (2005) Anatomical assessment of distal femur for optimal femoral component rotational alignment in TKA. J Korean Orthop Assoc 40:882–888

    Article  Google Scholar 

  6. Chang MJ, Jeong HJ, Kang SB, Chang CB, Yoon C, Shin JY (2018) Relationship between coronal alignment and rotational profile of lower extremity in patients with knee osteoarthritis. J Arthroplasty 33:3773–3777

    Article  PubMed  Google Scholar 

  7. Eckhoff DG, Johnson KK (1994) Three-dimensional computed tomography reconstruction of tibial torsion. Clin Orthop Relat Res May;(302):42–46

    Article  Google Scholar 

  8. Eckhoff DG, Kramer RC, Alongi CA, VanGerven DP (1994) Femoral anteversion and arthritis of the knee. J Pediatr Orthop 14:608–610

    Article  CAS  PubMed  Google Scholar 

  9. El Ayoubi N, Chaaya M, Mahfoud Z, Habib RR, Uthman I, Slim ZN (2013) Risk factors for incident symptomatic knee osteoarthritis: a population-based case control study in Lebanon. Int J Rheum Dis 16:211–218

    Article  PubMed  Google Scholar 

  10. Georgiev T, Angelov AK (2019) Modifiable risk factors in knee osteoarthritis: treatment implications. Rheumatol Int 39:1145–1157

    Article  PubMed  Google Scholar 

  11. Griffin FM, Math K, Scuderi GR, Insall JN, Poilvache PL (2000) Anatomy of the epicondyles of the distal femur: MRI analysis of normal knees. J Arthroplasty 15:354–359

    Article  CAS  PubMed  Google Scholar 

  12. Gustilo T, Comadoll JL, Gustilo RB (1996) Long-term results of 56 revision total knee replacements. Orthopedics 19:99–103

    Article  CAS  PubMed  Google Scholar 

  13. Khan MS, Seon JK, Song EK (2012) Rotational profile of lower limb and axis for tibial component alignment in varus osteoarthritic knees. J Arthroplasty 27:797–802

    Article  PubMed  Google Scholar 

  14. Ko DO, Lee S, Kim JH, Hwang IC, Jang SJ, Jung J (2021) The influence of femoral internal rotation on patellar tracking in total knee arthroplasty using gap technique. Clin Orthop Surg 13:e62

  15. Lim HC, Bae JH, Kim SJ (2013) Postoperative femoral component rotation and femoral anteversion after total knee arthroplasty in patients with distal femoral deformity. J Arthroplasty 28:1084–1088

    Article  PubMed  Google Scholar 

  16. Luyckx T, Zambianchi F, Catani F, Bellemans J, Victor J (2013) Coronal alignment is a predictor of the rotational geometry of the distal femur in the osteo-arthritic knee. Knee Surg Sports Traumatol Arthrosc 21:2331–2337

    Article  CAS  PubMed  Google Scholar 

  17. Matsuda S, Matsuda H, Miyagi T, Sasaki K, Iwamoto Y, Miura H (1998) Femoral condyle geometry in the normal and varus knee. Clin Orthop Relat Res Apr;(349):183–188

    Article  Google Scholar 

  18. Matsuda S, Miura H, Nagamine R, Mawatari T, Tokunaga M, Nabeyama R, Iwamoto Y (2004) Anatomical analysis of the femoral condyle in normal and osteoarthritic knees. J Orthop Res 22:104–109

    Article  PubMed  Google Scholar 

  19. Matsuda S, Miura H, Nagamine R, Urabe K, Mawatari T, Iwamoto Y (2003) A comparison of rotational landmarks in the distal femur and the tibial shaft. Clin Orthop Relat Res Sep;(414):183–188

    Article  Google Scholar 

  20. Mochizuki T, Tanifuji O, Koga Y, Hata R, Mori T, Nishino K, Sato T, Kobayashi K, Omori G, Sakamoto M, Tanabe Y, Endo N (2017) External torsion in a proximal tibia and internal torsion in a distal tibia occur independently in varus osteoarthritic knees compared to healthy knees. J Orthop Sci 22:501–505

    Article  PubMed  Google Scholar 

  21. Moussa M (1994) Rotational malalignment and femoral torsion in osteoarthritic knees with patellofemoral joint involvement. A CT scan study. Clin Orthop Relat Res Jul;(304):176–183

  22. Nagamine R, Miura H, Inoue Y, Urabe K, Matsuda S, Okamoto Y, Nishizawa M, Iwamoto Y (1998) Reliability of the anteroposterior axis and the posterior condylar axis for determining rotational alignment of the femoral component in total knee arthroplasty. J Orthop Sci 3:194–198

    Article  CAS  PubMed  Google Scholar 

  23. Nagamine R, Miyanishi K, Miura H, Urabe K, Matsuda S, Iwamoto Y (2003) Medial torsion of the tibia in Japanese patients with osteoarthritis of the knee. Clin Orthop Relat Res Mar;(408):218–224

  24. Nicoll DR, Rowley DI (2010) Internal rotational error of the tibial component is a major cause of pain after total knee replacement. J Bone Jt Surg Br 92:1238–1244

    Article  CAS  Google Scholar 

  25. Oh S-M, Bin S-I, Kim J-Y, Lee B-S, Kim J-M (2020) Short knee radiographs can be inadequate for estimating TKA alignment in knees with bowing. Knee Surg Relat Res 32:9

    Article  PubMed  PubMed Central  Google Scholar 

  26. Park IS, Ong A, Nam CH, Ahn NK, Ahn HS, Lee SC, Jung KA (2014) Transepicondylar axes for femoral component rotation might produce flexion asymmetry during total knee arthroplasty in knees with proximal tibia vara. Knee 21:369–373

    Article  PubMed  Google Scholar 

  27. Poilvache PL, Insall JN, Scuderi GR, Font-Rodriguez DE (1996) Rotational landmarks and sizing of the distal femur in total knee arthroplasty. Clin Orthop Relat Res Oct;(331):35–46

  28. Puthumanapully PK, Harris SJ, Leong A, Cobb JP, Amis AA, Jeffers J (2014) A morphometric study of normal and varus knees. Knee Surg Sports Traumatol Arthrosc 22:2891–2899

    Article  PubMed  PubMed Central  Google Scholar 

  29. Sharkey PF, Hozack WJ, Rothman RH, Shastri S, Jacoby SM (2002) Why are total knee arthroplasties failing today? Clin Orthop Relat Res Nov;(404):7–13

  30. Takagawa S, Mitsugi N, Mochida Y, Taki N, Harigane K, Yukizawa Y, Sasaki Y, Tsuji M, Sahara K, Inaba Y (2020) In Asian women undergoing total knee arthroplasty, lower leg morphology in those with rheumatoid arthritis differed from those with osteoarthritis. Mod Rheumatol 30:489–494

    Article  PubMed  Google Scholar 

  31. Takahashi A, Aizawa T, Aki T, Kashiwaba M, Kamimura M, Hitachi S, Itoi E (2012) Effect of medial tibial torsion on the sagittal alignment of lower legs in patients with medial knee osteoarthritis. Surg Radiol Anat 35:205–210

    Article  PubMed  Google Scholar 

  32. van Tunen JAC, Dell’Isola A, Juhl C, Dekker J, Steultjens M, Thorlund JB, Lund H (2018) Association of malalignment, muscular dysfunction, proprioception, laxity and abnormal joint loading with tibiofemoral knee osteoarthritis—a systematic review and meta-analysis. BMC Musculoskelet Disord 19:273

    Article  PubMed  PubMed Central  Google Scholar 

  33. Victor J (2009) Rotational alignment of the distal femur: a literature review. Orthop Traumatol Surg Res 95:365–372

    Article  CAS  PubMed  Google Scholar 

  34. Xie K, Jiang X, Han X, Ai S, Qu X, Yan M (2018) Association between knee malalignment and ankle degeneration in patients with end-stage knee osteoarthritis. J Arthroplasty 33(12):3694–3698

    Article  PubMed  Google Scholar 

  35. Yagi T, Sasaki T (1986) Tibial torsion in patients with medial-type osteoarthritic knee. Clin Orthop Relat Res Dec;(212):177–182

  36. Yip DK, Zhu YH, Chiu KY, Ng TP (2004) Distal rotational alignment of the Chinese femur and its relevance in total knee arthroplasty. J Arthroplasty 19:613–619

    Article  PubMed  Google Scholar 

  37. Yoo JJ, Kim DH, Kim HA (2018) Risk factors for progression of radiographic knee osteoarthritis in elderly community residents in Korea. BMC Musculoskelet Disord 19:80

    Article  PubMed  PubMed Central  Google Scholar 

  38. Yoon JR, Lee JK, Ryu J, Um R, Yang JH (2021) Increased external rotation of the osteoarthritic knee joint according to the genu varum deformity. Knee Surg Sports Traumatol Arthrosc 29(4):1098–1105

  39. Zhao Z, Wang W, Wang S, Jiang L, Zhang S, Zhao Y (2015) Femoral rotation influences dynamic alignment of the lower extremity in total knee arthroplasty. Int Orthop 39:55–60

    Article  PubMed  Google Scholar 

Download references

Funding

Not applicable.

Author information

Authors and Affiliations

  1. Department of Orthopedic Surgery, Eulji University School of Medicine, Uijeongbu-si, Republic of Korea

    O-Sung Lee

  2. Department of Orthopedic Surgery, National Medical Center, Seoul, Republic of Korea

    Jangyun Lee

  3. Department of Orthopedic Surgery, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 110-744, Republic of Korea

    Myung Chul Lee & Hyuk-Soo Han

Authors
  1. O-Sung Lee
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Jangyun Lee
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Myung Chul Lee
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Hyuk-Soo Han
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Hyuk-Soo Han.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

This study was approved by Seoul National University College of Medicine/Seoul National University Hospital Institutional Review Board (IRB no.: H-1306-086-498).

Informed consent

Not applicable.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Supplementary Information

Below is the link to the electronic supplementary material.

Supplementary file1 (JPG 103 KB)

Supplementary file2 (DOCX 50 KB)

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Lee, OS., Lee, J., Lee, M.C. et al. Changes in the femoral varus and rotational profiles are correlated in women with varus osteoarthritic lower limbs. Arch Orthop Trauma Surg 143, 583–590 (2023). https://doi.org/10.1007/s00402-021-04094-6

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00402-021-04094-6

Keywords

Search

Navigation