Abstract
Purpose
Only few prognostic factors for progression of knee osteoarthritis are well established, including varus malalignment. The purpose of this study was to evaluate whether coronal tibiofemoral subluxation is a predictor for total knee arthroplasty.
Methods
Patients from the progression subcohort of the longitudinal database “Osteoarthritis Initiative” with moderate to severe osteoarthritis and varus malalignment of greater than 3 degrees were included. Patients who underwent total knee arthroplasty were matched with patients treated conservatively. Subluxation was measured on full limb length X-rays. Cox regression analysis was performed to retrospectively evaluate subluxation as a risk factor for total knee arthroplasty and check for a possible association between subluxation and pain at the beginning of the observation period in this study.
Results
A total of 215 patients were included. Cox regression demonstrated that varus malalignment increased the hazard to undergo surgery by 16% (HR 1.158, p = 0.008) while subluxation did not (HR 1.12, p = 0.11). Furthermore, subluxation was neither associated with poor WOMAC (OR 1.13, p = 0.194) nor KOOS (OR 1.11, p = 0.256) knee pain scores at the beginning of the observation period.
Conclusion
The results presented show that subluxation is neither an independent risk factor for total knee arthroplasty, nor for poor pain scores.
Level of evidence
III.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Guccione AA, Felson DT, Anderson JJ et al (1994) The effects of specific medical conditions on the functional limitations of elders in the Framingham Study. Am J Public Health 84(3):351–358
Silverwood V, Blagojevic-Bucknall M, Jinks C et al (2015) Current evidence on risk factors for knee osteoarthritis in older adults: a systematic review and meta-analysis. Osteoarthr Cartil 23(4):507–515. doi:10.1016/j.joca.2014.11.019
Bastick AN, Belo JN, Runhaar J et al (2015) What are the prognostic factors for radiographic progression of knee osteoarthritis? A meta-analysis. Clin Orthop Relat Res 473(9):2969–2989. doi:10.1007/s11999-015-4349-z
Brouwer GM, van Tol AW, Bergink AP et al (2007) Association between valgus and varus alignment and the development and progression of radiographic osteoarthritis of the knee. Arthritis Rheum 56(4):1204–1211. doi:10.1002/art.22515
Cerejo R, Dunlop DD, Cahue S et al (2002) The influence of alignment on risk of knee osteoarthritis progression according to baseline stage of disease. Arthritis Rheum 46(10):2632–2636. doi:10.1002/art.10530
Sharma L, Song J, Felson DT et al (2001) The role of knee alignment in disease progression and functional decline in knee osteoarthritis. JAMA 286(2):188–195
Chang CB, Koh IJ, Seo ES et al (2011) The radiographic predictors of symptom severity in advanced knee osteoarthritis with varus deformity. Knee 18(6):456–460. doi:10.1016/j.knee.2010.08.010
Khamaisy S, Nam D, Thein R et al (2015) Limb alignment, subluxation, and bone density relationship in the osteoarthritic varus knee. J Knee Surg 28(3):207–212. doi:10.1055/s-0034-1376327
Berger RA, Della Valle CJ (2010) Unicompartmental knee arthroplasty: indications, techniques, and results. Instr Course Lect 59:47–56
Scott RD, Santore RF (1981) Unicondylar unicompartmental replacement for osteoarthritis of the knee. J Bone Joint Surg Am 63(4):536–544
Khamaisy S, Zuiderbaan HA, Thein R et al (2016) Coronal tibiofemoral subluxation in knee osteoarthritis. Skelet Radiol 45(1):57–61. doi:10.1007/s00256-015-2244-z
Kellgren JH, Lawrence JS (1957) Radiological assessment of osteo-arthrosis. Ann Rheum Dis 16(4):494–502
Cooke TDV, Sled EA, Scudamore RA (2007) Frontal plane knee alignment: a call for standardized measurement. J Rheumatol 34(9):1796–1801
Sled EA, Sheehy LM, Felson DT et al (2011) Reliability of lower limb alignment measures using an established landmark-based method with a customized computer software program. Rheumatol Int 31(1):71–77. doi:10.1007/s00296-009-1236-5
Thienpont E, Schwab PE, Cornu O et al (2017) Bone morphotypes of the varus and valgus knee. Arch Orthop Trauma Surg 137(3):393–400. doi:10.1007/s00402-017-2626-x
Ogawa H, Matsumoto K, Ogawa T et al (2016) Preoperative varus laxity correlates with overcorrection in medial opening wedge high tibial osteotomy. Arch Orthop Trauma Surg 136(10):1337–1342. doi:10.1007/s00402-016-2521-x
Akamatsu Y, Kobayashi H, Kusayama Y et al (2016) Femoral shaft bowing in the coronal and sagittal planes on reconstructed computed tomography in women with medial compartment knee osteoarthritis: a comparison with radiograph and its predictive factors. Arch Orthop Trauma Surg 136(9):1227–1232. doi:10.1007/s00402-016-2519-4
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Ethical approval
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. For this type of study formal consent is not required.
Funding
This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.
Conflict of interest
Author Boettner has received royalties from Smith and Nephew and OrthoDevelopment. Authors Schadler, Kasparek, Sgroi and Faschingbauer declare that they have no conflict of interest.
Rights and permissions
About this article
Cite this article
Schadler, P., Kasparek, M., Boettner, F. et al. Coronal tibiofemoral subluxation is not an independent risk factor for total knee arthroplasty in patients with moderate to severe varus-osteoarthritis: data from the “Osteoarthritis Initiative”. Arch Orthop Trauma Surg 137, 1423–1428 (2017). https://doi.org/10.1007/s00402-017-2777-9
Received:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00402-017-2777-9