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Dynamic deformation of femur during medial compartment knee osteoarthritis.

ABSTRACT: OBJECTIVES:The aim of this study was to evaluate the morphological changes of the femur in the coronal plane in progressing varus gonarthrosis and to explore the interrelation of each component. PATIENTS AND METHODS:From January to July 2017, radiographic images of 1538 knees of 883 consecutive patients were collected and analyzed. We drew the alignments and measured the orientation angles of the lower extremities and compared the results among age groups for each sex. Correlation and regression tests were used to analyze the measurements. RESULTS:There were significant differences in the neck-shaft angle (NSA), femoral bowing angle (FBA) and anatomic medial distal femoral angle (aMDFA) by age group in females, whereas the differences were not significant in males. In females, a positive correlation was found between age and the FBA and aMDFA (r = 0.253, 0.141, p<0.01), and a negative correlation was found between age and the NSA while the FBA was controlled (r = -0.065, p<0.05). The FBA was positively correlated with the NSA (r = 0.312, p<0.01) and aMDFA (r = 0.233, p<0.01). The NSA, FBA, and aMDFA together affected 72.2% of the mechanical medial distal femoral angle (mMDFA) (? = 0.071, -0.528, 0.803, p<0.01). CONCLUSION:As knee osteoarthritis (KOA) progressed, dynamic deformation of the femur was found in females, while no obvious changes were found in males. Femoral mechanical axis varus (mMDFA decrease) was the result of changes in the NSA, FBA and aMDFA. The deformation was throughout the femur rather than in a local area, as femur bowing can lead to corresponding changes in both ends of the femur. We provided a theoretical basis for TKA and knee-salvage treatment, and more attention should be paid to aging patients, especially females, in the preoperative protocol for orthomorphia.

SUBMITTER: Lu Y

PROVIDER: S-EPMC6924647 | biostudies-literature | 2019

REPOSITORIES: biostudies-literature

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Project description:BackgroundOsteoarthritis of knee is one of the important causes of knee pain in elderly patients and is a debilitating disease. It often leads to varus deformity of knee. Many treatment options are available for this progressive knee joint disorder. Proximal fibular osteotomy (PFO) is a novel yet simple procedure used to alleviate the symptoms of medial compartment knee osteoarthritis. The present study was undertaken to evaluate whether this procedure improves the symptoms, functions and limb alignment in patients with medial compartment knee osteoarthritis.MethodsFollowing approval by the Institutional Review Board, this prospective study included 42 cases (56 knees) with Kellgren-Lawrence grade II and III medial compartment knee osteoarthritis and underwent proximal fibular osteotomy. Clinical assessment was done by visual analogue scale (VAS) score and The Western Ontario and McMaster universities osteoarthritis Index (WOMAC) score pre-operatively and at 3, 6 and 12 months follow-up for pain and functional improvement. Radiological assessment was done by measuring femoro-tibial angles (FTA) pre-operatively and at 1 year follow-up.ResultsThe mean age was 58.30 years. There were 30 females and 12 males. The preoperative mean WOMAC score was 87.3, at 3 months follow-up it was 29.4 this was significantly better (p < 0.05) but the improvement was not significant at subsequent follow-up visits. Similarly the VAS scores also showed significant improvement at 3 months, but not at 6 and 12 months follow-up. There was no significant improvement in the femoro-tibial angle (FTA) at 1 year follow-up.ConclusionThe study highlights that both the VAS scores and WOMAC scores were significantly better at 3 months after surgery. However these did not show any significant improvement at 6 and 12 months. It does not change the alignment of knee at one year follow-up. The authors conclude that proximal fibular osteotomy provides only short-term relief in patients of medial compartment knee osteo-arthritis.

Project description:PurposeTo quantify intraoperative joint space widening afforded by the outside-in, percutaneous release of the medial collateral ligament (MCL) and to evaluate its impact on medial compartment width and functional outcomes at 6-week follow-up for patients undergoing a partial medial meniscectomy without postoperative bracing.MethodsPatients with posteromedial meniscus tears and no evidence of ipsilateral knee pathology, undergoing partial medial meniscectomy, were enrolled. Intraoperatively, medial compartment width was quantified with fluoroscopy before and after the percutaneous MCL release with an 18-gauge spinal needle proximal to the joint line. At 6-week follow-up, valgus stress radiographs re-evaluated medial compartment width. International Knee Documentation Committee (IKDC) and Patient-Reported Outcomes Measurement Information System (PROMIS) scores were completed preoperatively and at 6-week follow-up to evaluate functional outcomes. A paired sample t test performed at a 95% confidence interval (CI) was used to compare these variables.ResultsForty-two patients, mean (± standard deviation) age 55.3 ± 10.7 years, were available for analysis of intraoperative medial compartment widening. Medial compartment width increased from 5.95 ± 1.32 to 11.09 ± 1.74 mm intraoperatively after MCL release. At 6-week follow-up, radiographic assessment demonstrated a mean medial compartment width of 5.85 ± .99 mm, which represented an insignificant change compared with the preoperative value (CI -0.68 to .33, P = .474). PROMIS and IKDC scores significantly improved from baseline, with increases of 6.9 ± 12.4 (CI 2.0 to 11.8, P = .008) and 11.7 ± 17.8 (CI 4.7 to 18.8, P = .002), respectively.ConclusionsPercutaneous MCL release during knee arthroscopy improves visualization and facilitates instrumentation by providing an almost 2× wider working space within the medial tibiofemoral joint. In this study, the performance of percutaneous MCL release did not result in any complications. Radiographic and clinical resolution of iatrogenic laxity was demonstrated by 6-weeks postoperatively, without the use of postoperative bracing.Level of evidenceIV, therapeutic case series.

Project description:Background:Interest in bicompartmental knee arthroplasty (BKA) for the treatment of medial patellofemoral osteoarthritis (MPFOA) has grown in recent years because BKA offers a bone and ligament-preserving alternative to total knee arthroplasty (TKA). BKA only resurfaces the diseased compartments, while preserving proprioception and native knee kinematics. Therefore, the objective of this study is to assess knee function, perioperative morbidity, and implant survivability in patients undergoing BKA vs TKA for MPFOA. Methods:The databases MEDLINE, PUBMED, and EMBASE were systematically searched. Randomized controlled trials and nonrandomized comparative studies comparing BKA with TKA for the treatment of MPFOA were included for further analysis. The primary outcome of interest was knee function. Secondary outcomes included range of movement, operation length, intraoperative blood loss, hospital length of stay, postoperative complications, and rate of revision length. The quality of evidence was evaluated using the GRADE approach. Meta-analysis was performed by pooling the results of the selected studies when possible. Results:Six studies were selected for inclusion (4 prospective studies and 2 retrospective cohort studies). In total, 274 patients and 277 knees were included for analysis. There were no significant differences between the 2 groups at any time points in terms of knee function, length of stay, complication rate, or revision rate, when monolithic BKA designs were controlled for. BKA did result in significantly decreased intraoperative blood loss, at the expense of increased operative length compared with TKA. Conclusions:The use of modular BKA for MPFOA is comparable with TKA in terms of short-term function, complication rate, and revision rate. BKA reduces intraoperative blood losses, but it is also more technically demanding, resulting in increased operation length. The use of modular BKA has acceptable short-term outcomes, but more long-term data are needed before it can be recommended for routine use in the treatment of MPFOA. The selection of modular BKA should be determined on a patient-specific basis. Currently, there is no evidence to suggest the use of monolithic BKA designs because of their high revision and failure rate.

Project description:CONTEXT::Knee osteoarthritis affects 9.3 million adults over age 45 years in the United States. There is significant disability associated with this condition. Given the potential complications and the significant cost to the health care system with the dramatic increase in total knee arthroplasties performed for this condition, assessment of the efficacy of nonoperative modalities, such as offloading knee braces, is essential as part of optimizing nonoperative treatment for this condition. OBJECTIVE::To determine the effectiveness of valgus offloader braces in improving clinical outcomes for patients with medial compartment knee osteoarthritis. DATA SOURCES::Three databases (PubMed, MEDLINE, and EMBASE) were searched from database inception through July 28, 2017. STUDY SELECTION::Studies reporting outcomes of valgus offloader knee braces in the treatment of medial compartment knee osteoarthritis were included. STUDY DESIGN::Systematic review. LEVEL OF EVIDENCE::Level 4. DATA EXTRACTION::Data pertaining to demographics, descriptive statistics, and clinical outcomes were extracted from the included studies. The methodological quality of included studies was evaluated. RESULTS::A total of 31 studies were included, with a total of 619 patients. The majority of studies reported improved pain outcomes using valgus offloader braces. However, variable results were reported as to whether valgus offloader braces significantly improved functional outcomes and stiffness. Offloader bracing was more effective at reducing pain when compared with neutral braces or neoprene sleeves. CONCLUSION::Valgus offloader bracing is an effective treatment for improving pain secondary to medial compartment knee osteoarthritis. The literature remains unclear on the effectiveness of valgus offloader braces with regard to functional outcomes and stiffness. Larger prospective randomized trials with consistent outcome assessment tools and consideration of patient compliance would be beneficial to more accurately determine treatment effects of valgus offloader bracing.

Project description:ObjectiveTo determine the comparative prevalence, associations with selected patient characteristics, and clinical outcomes of medial and lateral compartment patellofemoral (PF) joint osteoarthritis (OA).MethodsInformation was collected by questionnaires, clinical assessment, and radiographs from 745 eligible community-dwelling symptomatic adults age ≥50 years. PF joint space narrowing (JSN) and osteophytes were scored from skyline radiographs using the Osteoarthritis Research Society International atlas. Multilevel models were used to assess associations of compartmental PF joint OA with age, sex, body mass index (BMI) and varus-valgus malalignment, while median regression was used to examine associations with clinical outcomes (current pain intensity on a numeric rating scale [0-10] and the function subscale of the Western Ontario and McMaster Universities Osteoarthritis Index [0-68]).ResultsIsolated lateral PF joint OA was more common than isolated medial PF joint OA, particularly at higher severity thresholds. Irrespective of severity threshold, age (≥2 odds ratio [OR] 1.19 [95% confidence interval (95% CI) 1.12, 1.26]), BMI (≥2 OR 1.15 [95% CI 1.07, 1.24]), and valgus malalignment (≥2 OR 2.58 [95% CI 1.09, 6.07]) were associated with increased odds of isolated lateral JSN, but isolated medial JSN was only associated with age (≥2 OR 1.20 [95% CI 1.14, 1.27]). The pattern of association was less clear for PF joint osteophytes. Isolated lateral PF joint OA, defined by JSN or osteophytes, was associated with higher pain scores than isolated medial PF joint OA, but these differences were modest and were not significant. A similar pattern of association was seen for functional limitation but only when PF joint OA was defined by JSN.ConclusionIsolated lateral PF joint OA is more common than isolated medial PF joint OA, and it is more consistently associated with established OA risk factors. It is also associated with higher, but clinically nonsignificant, pain and function scores than isolated medial PF joint OA, particularly when PF joint OA is defined using JSN.

Project description:BackgroundOsteoarthritis (OA) of the knee causes changes in knee alignment. A detailed knowledge of knee alignment is needed for correct assessment of the extent of disease progression, determination of treatment strategy, and confirmation of treatment effectiveness. However, deterioration of knee alignment during progression of OA has not been adequately characterized. The aims of this study were to clarify the changes in three-dimensional static knee alignment as knee OA stage progressed and to lay a foundation for an optimal treatment strategy to prevent knee malalignment.MethodsA total of 106 knees of 81 patients ((men/women) 45/36; mean age 48.4 ± 19.9 years; body mass index (BMI) 25.7 ± 4.4 kg/m2) were enrolled in this cross-sectional study, comprising 34 (33/1) in Kellgren-Lawrence (KL) grade 0, 17 (8/9) in KL grade 1, 26 (5/21) in KL grade 2, 19 (4/15) in KL grade 3, and 10 (1/9) in KL grade 4. In all cases, computed tomography images were obtained with the subject in a reclined and relaxed position with the knee straight. Three-dimensional bone models were created from the images and knee alignment was calculated with six degrees-of-freedom. Then, 40 knees were selected consisting of 10 sex- and BMI-matched knees from each KL grade group: KL grade 1 (mean age 54.6 ± 8.4 years; BMI 23.3 ± 3.5 kg/m2), grade 2 (64.7 ± 10.9 years; 27.3 ± 3.2 kg/m2), grade 3 (69.2 ± 11.4 years; 27.1 ± 4.3 kg/m2), and grade 4 (71.9 ± 9.2 years; 27.2 ± 3.6 kg/m2). The Mann-Whitney U test with Bonferroni correction for multiple comparisons was used to analyze static alignment (α < 0.05/6).ResultsAlignment of the knee in flexion was -4.0 [95% confidence interval (CI): -6.4, -1.5] degrees, -3.4 [-8.0, 1.3] degrees, -0.1 [-3.7, 3.5] degrees, and 0.4 [-0.9, 1.6] degrees in the order of KL grade 1 to 4. There were significant differences between KL grade 1 and 4 (p = 0.0081). Anterior tibial translation was 6.6 [4.6, 8.6] mm, 5.8 [1.9, 9.7] mm, 1.0 [-2.5, 4.5] mm, and 1.3 [-2.4, 5.1] mm in the order of grade 1 to 4. There were significant differences between KL grade 1 and 4 (p = 0.0081). There were no significant differences in lateral tibial translation nor tibial rotation.ConclusionsThe severely osteoarthritic knee joint was flexed and the tibia was displaced posteriorly with respect to the femur. Preventing these changes in alignment would assist in the prevention and treatment of knee OA.

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Dynamic deformation of femur during medial compartment knee osteoarthritis.

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