Gender-based differences exist in the functional knee phenotypes classification of the osteoarthritic knee.
coronal alignment
gender differences
knee phenotypes
total knee arthroplasty
Journal
Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA
ISSN: 1433-7347
Titre abrégé: Knee Surg Sports Traumatol Arthrosc
Pays: Germany
ID NLM: 9314730
Informations de publication
Date de publication:
28 Feb 2024
28 Feb 2024
Historique:
revised:
11
12
2023
received:
06
10
2023
accepted:
05
02
2024
medline:
28
2
2024
pubmed:
28
2
2024
entrez:
28
2
2024
Statut:
aheadofprint
Résumé
To identify gender differences in (1) the coronal alignment of functional knee phenotypes and (2) the JLCA (joint line convergence angle) in relation to the phenotype classification. This study is a retrospective data analysis, including 12,099 osteoarthritic knee computed tomography (5025 male, 7074 female) analysed by Medacta software for hip-knee-ankle angle (HKA), femoral mechanical angle (FMA), tibial mechanical angle (TMA) and JLCA. The data were grouped into genders and combined according to the Functional Knee Phenotypes Classification. Out of 127 phenotypes for males and 131 for females, 17 common phenotypes were reported. The commonest four were similar for both genders with VARHKA177° NEUFMA93° NEUTMA87° (9.8% males, 9.50% females), followed by VARHKA174° NEUFMA93°VARTMA84° (7.1%) and VARHKA174°VARFMA90° NEUTMA87° (7.0%) for males and VARHKA174° NEUFMA93° NEUTMA87° (6.1%), VARHKA174° NEUFMA93°VARTMA84° (5.1%) for females. The commonest FMA and TMA (91.5° to 94.5° and 85.5° to 88.5°, respectively) were the same for both genders, however, the rest of the male population observed greater femoral varus than the female population (p < 0.001). JLCA values ranged from -28.4° to 8.2° in the overall study population. Males and females had a mean JLCA of -2.96° (±2.6° SD) and -2.66° (±2.8°7 SD), respectively, p < 0.001. Gender differences exist within the osteoarthritic knee phenotype. The male varus phenotype is influenced by FMA, while TMA values are similar across genders. JLCA variations show similarities to both TMA and FMA, suggesting JLCA is influenced by bone morphology more than by gender. These differences inform surgical decision-making for the personalised approach to the primary TKA. Level III.
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Subventions
Organisme : Kantonsspital Baselland
Organisme : Department of Clinical Research from University Basel "DKF Knee"
Informations de copyright
© 2024 The Authors. Knee Surgery, Sports Traumatology, Arthroscopy published by John Wiley & Sons Ltd on behalf of European Society of Sports Traumatology, Knee Surgery and Arthroscopy.
Références
Beckers L, Colyn W, Bellemans J, Victor J, Vandekerckhove P-J. The contralateral limb is no reliable reference to restore coronal alignment in TKA. Knee Surg Sports Traumatol Arthrosc. 2022;30(2):477-487. https://doi.org/10.1007/s00167-020-06152-9
Behrendt P, Akoto R, Bartels I, Thürig G, Fahlbusch H, Korthaus A, et al. Preoperative joint line convergence angle correction is a key factor in optimising accuracy in varus knee correction osteotomy. Knee Surg Sports Traumatol Arthrosc. 2023;31(4):1583-1592. https://doi.org/10.1007/s00167-022-07092-2
Cherian JJ, Kapadia BH, Banerjee S, Jauregui JJ, Issa K, Mont MA. Mechanical, anatomical, and kinematic axis in TKA: concepts and practical applications. Curr Rev Musculoskelet Med. 2014;7(2):89-95. https://doi.org/10.1007/s12178-014-9218-y
Graichen H, Luderer V, Strauch M, Hirschmann MT, Scior W. Navigated, gap-balanced, adjusted mechanical alignment achieves alignment and balancing goals in a very high percentage but with partially non-anatomical resections. Knee Surg Sports Traumatol Arthrosc. 2023;31(3):768-776. https://doi.org/10.1007/s00167-022-07014-2
Hess S, Moser LB, Amsler F, Behrend H, Hirschmann MT. Highly variable coronal tibial and femoral alignment in osteoarthritic knees: a systematic review. Knee Surg Sports Traumatol Arthrosc. 2019;27(5):1368-1377. https://doi.org/10.1007/s00167-019-05506-2
Hirschmann MT, Moser LB, Amsler F, Behrend H, Leclercq V, Hess S. Phenotyping the knee in young non-osteoarthritic knees shows a wide distribution of femoral and tibial coronal alignment. Knee Surg Sports Traumatol Arthrosc. 2019;27(5):1385-1393. https://doi.org/10.1007/s00167-019-05508-0
Hirschmann MT, Moser LB, Amsler F, Behrend H, Leclerq V, Hess S. Functional knee phenotypes: a novel classification for phenotyping the coronal lower limb alignment based on the native alignment in young non-osteoarthritic patients. Knee Surg Sports Traumatol Arthrosc. 2019;27(5):1394-1402. https://doi.org/10.1007/s00167-019-05509-z
Howell SM, Howell SJ, Kuznik KT, Cohen J, Hull ML. Does a kinematically aligned total knee arthroplasty restore function without failure regardless of alignment category. Clin Orthop Relat Res. 2013;471(3):1000-1007. https://doi.org/10.1007/s11999-012-2613-z
Hsu CE, Chen CP, Wang SP, Huang JT, Tong KM, Huang KC. Validation and modification of the Coronal Plane Alignment of the Knee classification in the Asian population. Bone Joint Open. 2022;3(3):211-217. https://doi.org/10.1302/2633-1462.33.BJO-2022-0001.R1
Hsu CE, Huang JT, Tong KM, Huang KC. Total knee arthroplasty according to the original knee phenotypes with kinematic alignment surgical technique-early clinical and functional outcomes. BMC Musculoskelet Disord. 2020;21(1):839. https://doi.org/10.1186/s12891-020-03862-6.
Huber S, Mitterer JA, Vallant SM, Simon S, Hanak-Hammerl F, Schwarz GM, et al. Gender-specific distribution of knee morphology according to CPAK and functional phenotype classification: analysis of 8739 osteoarthritic knees prior to total knee arthroplasty using artificial intelligence. Knee Surg Sports Traumatol Arthrosc. 2023;31(10):4220-4230. https://doi.org/10.1007/s00167-023-07459-z
Jenny JY, Baldairon F, Hirschmann MT. Functional knee phenotypes of OA patients undergoing total knee arthroplasty are significantly more varus or valgus than in a non-OA control group. Knee Surg Sports Traumatol Arthrosc. 2022;30(8):2609-2616. https://doi.org/10.1007/s00167-021-06687-5
Kim JM, Kim SB, Kim JM, Lee DH, Lee BS, Bin SI. Results of gender-specific total knee arthroplasty: comparative study with traditional implant in female patients. Knee Surg Relat Res. 2015;27(1):17-23. https://doi.org/10.5792/ksrr.2015.27.1.17
Kim MS, Son JM, Koh IJ, Bahk JH, In Y. Intraoperative adjustment of alignment under valgus stress reduces outliers in patients undergoing medial opening-wedge high tibial osteotomy. Arch Orthop Trauma Surg. 2017;137(8):1035-1045. https://doi.org/10.1007/s00402-017-2729-4
Lin YH, Chang FS, Chen KH, Huang KC, Su KC. Mismatch between femur and tibia coronal alignment in the knee joint: classification of five lower limb types according to femoral and tibial mechanical alignment. BMC Musculoskelet Disord. 2018;19(1):411. https://doi.org/10.1186/s12891-018-2335-9.
Lu Y, Zheng Z, Lv J, Hao R, Yang Y, Zhang Y. Relationships between morphological changes of lower limbs and gender during medial compartment knee osteoarthritis. Orthop Surg. 2019;11(5):835-844. https://doi.org/10.1111/os.12529
Luderer V, Strauch M, Hirschmann MT, Graichen H. Independent of the preoperative coronal deformity, adjusted mechanical alignment leads in a high percentage to non-anatomical tibial and femoral bone cuts. Knee Surg Sports Traumatol Arthrosc. 2023;31(9):3784-3791. https://doi.org/10.1007/s00167-023-07337-8
MacDessi SJ, Griffiths-Jones W, Harris IA, Bellemans J, Chen DB. Coronal Plane Alignment of the Knee (CPAK) classification: a new system for describing knee phenotypes. Bone Joint J. 2021;103-B(2):329-337. https://doi.org/10.1302/0301-620X.103B2.BJJ-2020-1050.R1
Merchant AC, Arendt EA, Dye SF, Fredericson M, Grelsamer RP, Leadbetter WB, et al. The female knee: anatomic variations and the female-specific total knee design. Clin Orthop Relat Res. 2008;466(12):3059-3065. https://doi.org/10.1007/s11999-008-0536-5
Micicoi G, Khakha R, Kley K, Wilson A, Cerciello S, Ollivier M. Managing intra-articular deformity in high Tibial osteotomy: a narrative review. J Exp Orthop. 2020;7(1):65. https://doi.org/10.1186/s40634-020-00283-1
Moser LB, Hess S, Amsler F, Behrend H, Hirschmann MT. Native non-osteoarthritic knees have a highly variable coronal alignment: a systematic review. Knee Surg Sports Traumatol Arthrosc. 2019;27(5):1359-1367. https://doi.org/10.1007/s00167-019-05417-2
Mullaji A, Shah R, Bhoskar R, Singh A, Haidermota M, Thakur H. Seven phenotypes of varus osteoarthritic knees can be identified in the coronal plane. Knee Surg Sports Traumatol Arthrosc. 2022;30(8):2793-2805. https://doi.org/10.1007/s00167-021-06676-8
Nayak M, Kumar V, Yadav R, Maredupaka S, Srivastava DN, Malhotra R, et al. Coronal alignment of the lower extremity: a gender-based radio-graphic analysis in indian patients. Indian J Orthop. 2020;54(4):504-512. https://doi.org/10.1007/s43465-020-00050-5
Sappey-Marinier E, Pauvert A, Batailler C, Swan J, Cheze L, Servien E, et al. Kinematic versus mechanical alignment for primary total knee arthroplasty with minimum 2 years follow-up: a systematic review. SICOT J. 2020;6:18. https://doi.org/10.1051/sicotj/2020014.
Sappey-Marinier E, Swan J, Batailler C, Servien E, Lustig S. No clinical benefit from gender-specific total knee replacement implants: a systematic review. SICOT J. 2020;6:25. https://doi.org/10.1051/sicotj/2020023.
Schelker BL, Moret CS, Sava MP, von Eisenhart-Rothe R, Graichen H, Arnold MP, et al. The impact of different alignment strategies on bone cuts in total knee arthroplasty for varus knee phenotypes. Knee Surg Sports Traumatol Arthrosc. 2023;31(5):1840-1850. https://doi.org/10.1007/s00167-023-07351-w
Schelker BL, Moret CS, von Eisenhart-Rothe R, Graichen H, Arnold MP, Leclercq V, et al. The impact of different alignment strategies on bone cuts for neutral knee phenotypes in total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc. 2023;31(4):1267-1275. https://doi.org/10.1007/s00167-022-07209-7
Schelker BL, Nowakowski AM, Hirschmann MT. What is the “safe zone” for transition of coronal alignment from systematic to a more personalised one in total knee arthroplasty? A systematic review. Knee Surg Sports Traumatol Arthrosc. 2022;30(2):419-427. https://doi.org/10.1007/s00167-021-06811-5
Voleti PB, Stephenson JW, Lotke PA, Lee GC. No sex differences exist in posterior condylar offsets of the knee. Clin Orthop Relat Res. 2015;473(4):1425-1431. https://doi.org/10.1007/s11999-014-4066-z
Wise BL, Niu J, Yang M, Lane NE, Harvey W, Felson DT, et al. Patterns of compartment involvement in tibiofemoral osteoarthritis in men and women and in whites and African Americans. Arthritis Care Res. 2012;64(6):847-852. https://doi.org/10.1002/acr.21606
Wise BL, Niu J, Zhang Y, Liu F, Pang J, Lynch JA, et al. Patterns of change over time in knee bone shape are associated with sex. Clin Orthop Relat Res. 2020;478(7):1491-1502. https://doi.org/10.1097/CORR.0000000000001219
Yan M, Wang J, Wang Y, Zhang J, Yue B, Zeng Y. Gender-based differences in the dimensions of the femoral trochlea and condyles in the Chinese population: correlation to the risk of femoral component overhang. Knee. 2014;21(1):252-256. https://doi.org/10.1016/j.knee.2012.11.005
Zeng YM, Wang Y, Zhu ZA, Dai KR. Effects of sex and lower extremity alignment on orientation of the knee joint line in knee surgery. Chin Med J. 2012;125(12):2126-2131. https://doi.org/10.3760/cma.j.issn.0366-6999.2012.12.009