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Mechanical alignment for primary TKA may change both knee phenotype and joint line obliquity without influencing clinical outcomes: a study comparing restored and unrestored joint line obliquity

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Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Purpose

In total knee arthroplasty (TKA), knee phenotypes including joint line obliquity are of interest regarding surgical realignment strategies. The hypothesis of this study is that better clinical results, including decreased postoperative knee pain, will be observed for patients with a restored knee phenotype.

Methods

A retrospective analysis was performed on prospective data, including 1078 primary osteoarthritic knees in 936 patients. The male:female ratio was 780:298, mean age at surgery was 71.3 years ± 8.0. International Knee Society Scores and standardized long-leg radiographs (LLR) were collected preoperatively and at 2 years follow-up after TKA. Patients were categorized using the Coronal Plane Alignment of the Knee (CPAK) classification including the lateral distal femoral angle (LDFA) and medial proximal tibial angle (MPTA) measured on LLR by a single observer, allowing knee phenotypes to be categorized considering the arithmetic hip–knee–ankle (aHKA) angle (MPTA-LDFA) as measure of constitutional alignment, and joint line obliquity (JLO) (MPTA + LDFA). Clinical results were compared between patients with surgically restored preoperative constitutional knee phenotype to patients without restored constitutional knee phenotypes. Descriptive data analysis such as means, standard deviations and ranges were performed. T tests for independent samples were performed to compare group differences. Comparisons of categorical data were performed using the χ2 test. Significance was set at p < 0.05.

Results

A third of patients (33.4%) had constitutional knee varus with apex distal JLO. 63.5% of patients had preoperative apex distal JLO. Postoperatively, 57.8% of patients had a neutral HKA (− 2° to 2°) and a neutral JLO (− 3° and 3°), with only 18% of patients with restored constitutional knee phenotype. Of these patients, statistically less postoperative pain was observed in patients where apex distal JLO was restored compared to non-restored apex distal JLO (pain score 46.7 vs. 44.6; p = 0.02) without clinical relevance. Other categories of restored JLO or arithmetic HKA angle were not associated with improved outcomes.

Conclusion

This study showed that performing mechanical alignment for primary TKA resulted in most cases in a change of the preoperative knee phenotype. These results emphasize the relevance of considering joint line obliquity to better understand preoperative knee deformity and better restore knee phenotypes with a more personalized realignment strategy to potentially improve TKA postoperative results.

Level of evidence

III.

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Funding

No funding for this study

Author information

Authors and Affiliations

  1. Orthopaedics Surgery and Sports Medicine Department, FIFA Medical Center of Excellence, Croix-Rousse Hospital, Lyon University Hospital, 103 grande rue de la croix rousse, Hopital de La Croix Rousse, 69004, Lyon, France

    Elliot Sappey-Marinier, Cécile Batailler, John Swan, Axel Schmidt, Elvire Servien & Sébastien Lustig

  2. LBMC UMR_T9406, Univ Lyon, Claude Bernard Lyon 1 University, Gustave Eiffel University, 69622, Lyon, France

    Elliot Sappey-Marinier, Cécile Batailler, Laurence Cheze & Sébastien Lustig

  3. Sydney Knee Specialists, Kogarah, Australia

    Samuel J. MacDessi

  4. St George Hospital Clinical School, University of New South Wales, Sydney, Australia

    Samuel J. MacDessi

  5. LIBM–EA 7424, Interuniversity Laboratory of Biology of Mobility, Claude Bernard Lyon 1 University, Lyon, France

    Elvire Servien

Authors
  1. Elliot Sappey-Marinier
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  2. Cécile Batailler
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  3. John Swan
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  4. Axel Schmidt
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  5. Laurence Cheze
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  6. Samuel J. MacDessi
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  7. Elvire Servien
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  8. Sébastien Lustig
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Corresponding author

Correspondence to Elliot Sappey-Marinier.

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Conflict of interest

Prof. Sébastien Lustig has performed consultancy work for Medacta, Heraeus, Corin, Amplitude, Groupe Lépine, Depuy Synthes, Smith & Nephew, Stryker. Prof. Sébastien Lustig receives institutional research support from Corin and Amplitude. Prof. Sébastien Lustig is a board member of KSSTA, Maitrise Orthopédique and JBJS american. The other authors declare that they have no conflicts of interest.

Ethical approval

The French advisory committee on health research data processing (Comité Consultatif sur le Traitement de l’Information en matière de Recherche dans le domaine de la Santé [CCTIRS]) approved this study on the 24th January 2012 and then 9 March 2015 (approval #11-681). All procedures performed were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards.

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Sappey-Marinier, E., Batailler, C., Swan, J. et al. Mechanical alignment for primary TKA may change both knee phenotype and joint line obliquity without influencing clinical outcomes: a study comparing restored and unrestored joint line obliquity. Knee Surg Sports Traumatol Arthrosc 30, 2806–2814 (2022). https://doi.org/10.1007/s00167-021-06674-w

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