Skip to main content

Advertisement

SpringerLink
Log in

Distal femoral valgus cut angle in degenerative varus knees of an Arabic population

  • Original Paper
  • Published:
International Orthopaedics Aims and scope Submit manuscript

Abstract

Purpose

This study aimed to determine the natural distribution of the distal femoral valgus cut angle (VCA) among an Arabic population; the percentage of patients whose VCA fell within the range of 5–6°; and whether demographic variables, severity of the pre-operative varus, and morphological femoral parameters would correlate with the VCA. To our knowledge, VCA measurement of degenerative varus knees among an Arabic population has not been reported previously in the literature.

Methods

A total of 492 knees (246 patients) were included. The VCA was measured on pre-operative hip-to-ankle radiographs according to a standard protocol. Patient characteristics and radiographic parameters were recorded.

Results

The mean VCA was 6.03 ± 1.69°, with 230 knees (46.7%) falling within the (5–6°) range. The VCA significantly differed according to the patient’s age (p = 0.02), sex (p = 0.009), height (p = 0.03), degree of varus (p < 0.001), hip offset (p = 0.013), and the presence of excessive lateral coronal bowing of the femur (p = 0.01). Among these, the degree of varus was the only significant factor on the multivariable regression analysis (p = 0.005).

Conclusion

The mean VCA in our population was 6.03°; however, the wide distribution of the VCA in our patients does not support the use of a fixed value. The severity of the pre-operative varus seems to be an independent factor with a positive correlation to the VCA and may also provide a clue to the ideal VCA if measurement of this angle is not available.

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

    Article  Google Scholar 

  2. Ritter MA, Davis KE, Meding JB et al (2011) The effect of alignment and BMI on failure of total knee replacement. J Bone Joint Surg Am 93:1588–1596

    Article  Google Scholar 

  3. Hsu RW, Himeno S, Coventry MB, Chao EY (1990) Normal axial alignment of the lower extremity and load-bearing distribution at the knee. Clin Orthop Relat Res 255:215–227

    Google Scholar 

  4. Drexler M, Dwyer T, Chakravertty R et al (2013) Assuring the happy total knee arthroplasty patient. Bone Joint J 95-B:120–123

    Article  CAS  Google Scholar 

  5. Yoshioka Y, Siu D, Cooke TD (1987) The anatomy and functional axes of the femur. J Bone Joint Surg Am 69:873–880

    Article  CAS  Google Scholar 

  6. Kharwadkar N, Kent RE, Sharara KH, Naique S (2006) 5°to 6°of distal femoral cut for uncomplicated primary total knee arthroplasty: is it safe? Knee 13:57–60

    Article  CAS  Google Scholar 

  7. Andrews SN, Beeler DM, Parke EA, Nakasone CK, Stickley CD (2019) Fixed distal femoral cut of 6° valgus in total knee arthroplasty: a radiographic review of 788 consecutive cases. J Arthroplast 34:755–759

    Article  Google Scholar 

  8. Bardakos N, Cil A, Thompson B, Stocks G (2007) Mechanical axis cannot be restored in total knee arthroplasty with a fixed valgus resection angle: a radiographic study. J Arthroplast 22:85–89

    Article  Google Scholar 

  9. Deakin AH, Basanagoudar PL, Nunag P, Johnston AT, Sarungi M (2012) Natural distribution of the femoral mechanical-anatomical angle in an osteoarthritic population and its relevance to total knee arthroplasty. Knee 19:120–123

    Article  Google Scholar 

  10. Nam D, Maher PA, Robles A, McLawhorn AS, Mayman DJ (2013) Variability in the relationship between the distal femoral mechanical and anatomical axes in patients undergoing primary total knee arthroplasty. J Arthroplast 28:798–801

    Article  Google Scholar 

  11. Abu-Rajab RB, Deakin AH, Kandasami M, McGlynn J, Picard F, Kinninmonth AW (2015) Hip-knee-ankle radiographs are more appropriate for assessment of post-operative mechanical alignment of total knee arthroplasties than standard AP knee radiographs. J Arthroplast 30:695–700

    Article  Google Scholar 

  12. Lampart M, Behrend H, Moser LB, Hirschmann MT (2019) Due to great variability fixed HKS angle for alignment of the distal cut leads to a significant error in coronal TKA orientation. Knee Surg Sports Traumatol Arthrosc 27:1434–1441

    Article  Google Scholar 

  13. Mullaji AB, Marawar SV, Mittal VA (2009) Comparison of coronal plane axial femoral relationships in Asian patients with varus osteoarthritic knees and healthy knees. J Arthroplast 24:861–867

    Article  Google Scholar 

  14. Jingjit W, Poomcharoen P, Limmahakhun S, Klunklin K, Leerapun T, Rojanasthien S (2014) Femoral mechanical-anatomical angle of osteoarthritic knees. J Med Assoc Thail 97:1314–1318

    Google Scholar 

  15. Costa MA, Mozella Ade P, Cobra HA (2015) Distal femoral cut in total knee arthroplasty in a Brazilian population. Rev Bras Ortop 50:295–299

    Article  Google Scholar 

  16. Drexler M, Abolghasemian M, Barbuto R et al (2017) Patient’s height and hip medial offset are the main determinants of the valgus cut angle during total knee arthroplasty. J Arthroplast 32:1496–1501

    Article  Google Scholar 

  17. Swanson KE, Stocks GW, Warren PD, Hazel M (2000) Does axial limb rotation affect the alignment measurements in deformed limbs? Clin Orthop 371:246–252

    Article  Google Scholar 

  18. Oswald MH, Jakob RP, Schneider E, Hoogewoud HM (1993) Radiological analysis of normal axial alignment of femur and tibia in view of total knee arthroplasty. J Arthroplast 8:419–426

    Article  CAS  Google Scholar 

  19. Desme D, Galand-Desme S, Besse JL, Henner J, Moyen B, Leart JL (2006) Analyse segmentaire de la deformation frontale dans les gonarthroses femoro-tibiales lateralisees. Rev Chir Orthop 92:673–679 (in French)

  20. Lee CY, Huang TW, Peng KT, Lee MS, Hsu RW, Shen WJ (2015) Variability of distal femoral valgus resection angle in patients with end-stage osteoarthritis and genu varum deformity: radiographic study in an ethnic Asian population. Biom J 38:350–355

    Google Scholar 

  21. Palanisami D, Iyyampillai G, Shanmugam S, Natesan R, S R (2016) Individualised distal femoral cut improves femoral component placement and limb alignment during total knee replacement in knees with moderate and severe varus deformity. Int Orthop 40:2049–2054

    Article  Google Scholar 

  22. Parratte S, Pagnano MW, Trousdale RT, Berry DJ (2010) Effect of postoperative mechanical axis alignment on the fifteen-year survival of modern, cemented total knee replacements. J Bone Joint Surg Am 92:2143–2149

    Article  Google Scholar 

  23. Bellemans J, Colyn W, Vandenneucker H, Victor J (2012) The Chitranjan Ranawat award: is neutral mechanical alignment normal for all patients? The concept of constitutional varus. Clin Orthop Relat Res 470:45–53

    Article  Google Scholar 

  24. Hafez MA, Sheikhedrees SM, Saweeres ES (2016) Anthropometry of Arabian arthritic knees: comparison to other ethnic groups and implant dimensions. J Arthroplast 31:1109–1116

    Article  Google Scholar 

  25. Koshino T, Takeyama M, Jiang LS, Yoshida T, Saito T (2002) Underestimation of varus angulation in knees with flexion deformity. Knee 9:275–279

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Orthopedic Surgery, King Saud University, Riyadh, Saudi Arabia

    Abdulrahman D. Algarni

Authors
  1. Abdulrahman D. Algarni
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Abdulrahman D. Algarni.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Additional information

Publisher’s note

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

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Algarni, A.D. Distal femoral valgus cut angle in degenerative varus knees of an Arabic population. International Orthopaedics (SICOT) 44, 2627–2633 (2020). https://doi.org/10.1007/s00264-020-04748-x

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00264-020-04748-x

Keywords

Search

Navigation