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Primary osteoarthritic knees have more varus coronal alignment of the femur compared to young non-arthritic knees in a large cohort study

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Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Purpose

Many surgeons are performing total knee arthroplasty (TKA) with an aim to reproducing native anatomical coronal alignment. Yet, it remains unclear if primary osteoarthritic and non-osteoarthritic populations have similar knee coronal alignment. This study aims to describe and compare the distribution of femoral and tibial coronal alignment in a large primary osteoarthritic cohort and a young non-osteoarthritic cohort.

Methods

This is a retrospective analysis of a monocentric prospectively gathered data, from 1990 to 2019, of 2859 consecutive primary osteoarthritic knees in 2279 patients. Patients underwent standardized long-leg radiographs. Femoral mechanical angle (FMA) and tibial mechanical angle (TMA) were digitally measured using software. Femoral, tibial and knee phenotypes were analyzed, and descriptive data were reported. Data were compared to a young non-osteoarthritic population previously described.

Results

In osteoarthritic knees, the mean FMA was 91° ± 2.9° (range 86°–100°) and the mean TMA was 87° ± 3.1° (range 80°–94°). No significant difference was observed for FMA and TMA between genders. The most common femoral and tibial phenotypes were varus (38.7%) and neutral (37.1%). The most frequent knee phenotype was a varus femoral phenotype with a neutral tibial phenotype (15.5%), which is different to the non-osteoarthritic population.

Conclusion

This study showed the wide distribution of knee phenotypes in a large osteoarthritic cohort. There was more varus distribution of the femoral coronal alignment compared to a non-osteoarthritic population, suggesting consideration and potential adaptation of the realignment strategy of the femoral component during TKA.

Level of evidence

III.

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Authors and Affiliations

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

    Elliot Sappey-Marinier, Cécile Batailler, John Swan, Matthieu Malatray, Elvire Servien & Sébastien Lustig

  2. Univ Lyon, Claude Bernard Lyon 1 University, IFSTTAR LBMC UMR-T9406, 69622, Lyon, France

    Laurence Cheze & Sébastien Lustig

  3. 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. Matthieu Malatray
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  5. Laurence Cheze
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  6. Elvire Servien
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  7. 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 and Maitrise Orthopédique. The other authors declare that they have no conflicts of interest.

Funding

No funding for this study.

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 #11681).

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Sappey-Marinier, E., Batailler, C., Swan, J. et al. Primary osteoarthritic knees have more varus coronal alignment of the femur compared to young non-arthritic knees in a large cohort study. Knee Surg Sports Traumatol Arthrosc 30, 428–436 (2022). https://doi.org/10.1007/s00167-020-06083-5

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