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Contralateral preoperative templating of lower limbs’ mechanical angles is a reasonable option

  • Knee
  • Published:
Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Purpose

In cases where the femur or tibia exhibits abnormal mechanical angulation due to degenerative changes or fracture, the contralateral leg is often used to complete preoperative templating. The aim of this study was to determine the degree of asymmetry between knee joints in healthy individuals and to determine whether it is affected by differing demographic parameters.

Methods

A CT scan-based modelling and analysis system was used to examine the lower limb of 233 patients (102 males, 131 women; mean age 61.2 ± 15.2 years, mean body mass index 24.9 ± 4.4 kg/m2) The hip–knee angle (HKA), lateral distal femoral angle (LDFA), medial proximal tibial angle (MPTA), posterior proximal tibial angle (ppta) and posterior distal femoral angle (PDFA) were then calculated for each patient. Results were then analysed to calculate femoral symmetry based on absolute differences (AD) and percentage asymmetry (%AS) using a previously validated method.

Results

Our results do not demonstrate any considerable asymmetry (percentage of asymmetry > 2%) for all the anatomical parameters analysed: HKA (mean AD = 1.5°; mean AS % = 0.8, n.s), MPTA (AD = 1.1°; AS % = 1.3, n.s), PPTA (AD = 1.4°; AS % = 1.0, n.s), LDFA (AD = 1.2 mm; AS % = 1.4, n.s) and PDFA (AD = 0.9°; AS % = 1.0, n.s). Gender and ethnicity were not associated with significantly higher AD asymmetry. A significant correlation of AD asymmetry was observed between BMI and HKA, BMI and MPTA, and between patients’ age and the MPTA.

Conclusion

This data demonstrate that there is a non-statistically significant mechanical angle asymmetry between the two lower limbs. In cases where contralateral templating is used, such asymmetry will induce minimal (if any) clinical differences.

Level of evidence

IV.

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References

  1. Almaawi AM, Hutt JRB, Masse V, Lavigne M, Vendittoli P-A (2017) The impact of mechanical and restricted kinematic alignment on knee anatomy in total knee arthroplasty. J Arthroplasty 32:2133–2140

    Article  Google Scholar 

  2. Anderson AF, Snyder RB, Federspiel CF, Lipscomb AB (1992) Instrumented evaluation of knee laxity: a comparison of five arthrometers. Am J Sports Med 20:135–140

    Article  CAS  Google Scholar 

  3. Arnal-Burró J, Pérez-Mañanes R, Gallo-Del-Valle E, Igualada-Blazquez C, Cuervas-Mons M, Vaquero-Martín J (2017) Three dimensional-printed patient-specific cutting guides for femoral varization osteotomy: do it yourself. Knee 24:1359–1368

    Article  Google Scholar 

  4. Banerjee S, Faizan A, Nevelos J, Kreuzer S, Burgkart R, Harwin SF, Mont MA (2014) Innovations in hip arthroplasty three-dimensional modeling and analytical technology (SOMA). Surg Technol Int 24:288–294

    PubMed  Google Scholar 

  5. Cooper C, Snow S, McAlindon TE, Kellingray S, Stuart B, Coggon D, Dieppe PA (2000) Risk factors for the incidence and progression of radiographic knee osteoarthritis. Arthritis Rheum 43:995–1000

    Article  CAS  Google Scholar 

  6. Dargel J, Feiser J, Gotter M, Pennig D, Koebke J (2009) Side differences in the anatomy of human knee joints. Knee Surg Sports Traumatol Arthrosc 17:1368–1376

    Article  Google Scholar 

  7. Eckstein F, Müller S, Faber SC, Englmeier K-H, Reiser M, Putz R (2002) Side differences of knee joint cartilage volume, thickness, and surface area, and correlation with lower limb dominance—an MRI-based study. Osteoarthr Cartilage 10:914–921

    Article  CAS  Google Scholar 

  8. Fürnstahl P, Vlachopoulos L, Schweizer A, Fucentese SF, Koch PP (2015) Complex osteotomies of tibial plateau malunions using computer-assisted planning and patient-specific surgical guides. J Orthop Trauma 29:e270–e276

    Article  Google Scholar 

  9. Hommel H, Abdel MP, Perka C (2017) Kinematic femoral alignment with gap balancing and patient-specific instrumentation in total knee arthroplasty: a randomized clinical trial. Eur J Orthop Surg Traumatol 27:683–688

    Article  Google Scholar 

  10. Howell SM, Papadopoulos S, Kuznik KT, Hull ML (2013) Accurate alignment and high function after kinematically aligned TKA performed with generic instruments. Knee Surg Sports Traumatol Arthrosc 21:2271–2280

    Article  Google Scholar 

  11. Jaffry Z, Masjedi M, Clarke S, Harris S, Karia M, Andrews B, Cobb J (2014) Unicompartmental knee arthroplasties: robot vs. patient specific instrumentation. Knee 21:428–434

    Article  Google Scholar 

  12. Laumonerie P, Ollivier M, LiArno S, Faizan A, Cavaignac E, Argenson J-N (2018) Which factors influence proximal femoral asymmetry? Bone Joint J 100:839–844

    Article  Google Scholar 

  13. Maderbacher G, Keshmiri A, Krieg B, Greimel F, Grifka J, Baier C (2018) Kinematic component alignment in total knee arthroplasty leads to better restoration of natural tibiofemoral kinematics compared to mechanic alignment. Knee Surg Sports Traumatol Arthrosc

  14. Maderbacher G, Keshmiri A, Zeman F, Grifka J, Baier C (2015) Assessing joint line positions by means of the contralateral knee: a new approach for planning knee revision surgery? Knee Surg Sports Traumatol Arthrosc 23:3244–3250

    Article  Google Scholar 

  15. Michaëlsson K, Byberg L, Ahlbom A, Melhus H, Farahmand BY (2011) Risk of severe knee and hip osteoarthritis in relation to level of physical exercise: a prospective cohort study of long-distance skiers in Sweden. PLoS One 6:e18339

    Article  Google Scholar 

  16. Mochizuki T, Tanifuji O, Koga Y, Sato T, Kobayashi K, Nishino K, Watanabe S, Ariumi A, Fujii T, Yamagiwa H, Omori G, Endo N (2017) Sex differences in femoral deformity determined using three-dimensional assessment for osteoarthritic knees. Knee Surg Sports Traumatol Arthrosc 25:468–476

    Article  Google Scholar 

  17. Munier M, Donnez M, Ollivier M, Flecher X, Chabrand P, Argenson J-N, Parratte S (2017) Can three-dimensional patient-specific cutting guides be used to achieve optimal correction for high tibial osteotomy? Pilot study. Orthop Traumatol Surg Res 103:245–250

    Article  CAS  Google Scholar 

  18. Pérez-Mañanes R, Burró JA, Manaute JR, Rodriguez FC, Martín JV (2016) 3D surgical printing cutting guides for open-wedge high tibial osteotomy: do it yourself. J Knee Surg 29:690–695

    Article  Google Scholar 

  19. Roland M, Hull ML, Howell SM (2010) Virtual axis finder: a new method to determine the two kinematic axes of rotation for the tibio-femoral joint. J Biomech Eng 132:011009

    Article  Google Scholar 

  20. Schenk P, Vlachopoulos L, Hingsammer A, Fucentese SF, Fürnstahl P (2018) Is the contralateral tibia a reliable template for reconstruction: a three-dimensional anatomy cadaveric study. Knee Surg Sports Traumatol Arthrosc 26:2324–2331

    Article  Google Scholar 

  21. Schmidt W, LiArno S, Khlopas A, Petersik A, Mont MA (2018) Stryker orthopaedic modeling and analytics (SOMA): a review. Surg Technol Int 32:315–324

    PubMed  Google Scholar 

  22. Stone AH, Sibia US, MacDonald JH (2018) Functional outcomes and accuracy of patient-specific instruments for total knee arthroplasty. Surg Innov 25:470–475 (1553350618787074)

    Article  Google Scholar 

  23. Teitz CC, Lind BK, Sacks BM (1997) Symmetry of the femoral notch width index. Am J Sports Med 25:687–690

    Article  CAS  Google Scholar 

  24. Thienpont E, Paternostre F, Pietsch M, Hafez M, Howell S (2013) Total knee arthroplasty with patient-specific instruments improves function and restores limb alignment in patients with extra-articular deformity. Knee 20:407–411

    Article  Google Scholar 

  25. Thienpont E, Schwab PE, Cornu O, Bellemans J, Victor J (2017) Bone morphotypes of the varus and valgus knee. Arch Orthop Trauma Surg 137:393–400

    Article  CAS  Google Scholar 

  26. Victor J, Premanathan A (2013) Virtual 3D planning and patient specific surgical guides for osteotomies around the knee: a feasibility and proof-of-concept study. Bone Jt J 95:153–158

    Article  Google Scholar 

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Funding

No funding was needed for this study.

Author information

Authors and Affiliations

  1. Aix-Marseille Université, CNRS, ISM, UMR 7287, 13288, Marseille Cedex 09, France

    Christophe Jacquet, Akash Sharma, Louis Dagneaux & Matthieu Ollivier

  2. Department of Orthopedics and Traumatology, Institute of Movement and Locomotion, St. Marguerite Hospital, 270 Boulevard Sainte Marguerite, BP 29, 13274, Marseille, France

    Christophe Jacquet, Akash Sharma, Louis Dagneaux & Matthieu Ollivier

  3. Department of Orthopedics, Hôpital Pierre-Paul Riquet, 31000, Toulouse, France

    Pierre Laumonerie

  4. Anatomy Laboratory, Faculty of Medicine, 31000, Toulouse, France

    Pierre Laumonerie

  5. Stryker, Mahwah, NJ, USA

    Sally LiArno & Ahmad Faizan

Authors
  1. Christophe Jacquet
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  2. Pierre Laumonerie
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  3. Sally LiArno
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  4. Ahmad Faizan
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  5. Akash Sharma
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  6. Louis Dagneaux
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  7. Matthieu Ollivier
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Contributions

MO and PL designed the protocol. SL and FA made all CT measurements. MO and PL performed statistical analysis. CJ and LD wrote the initial draft. MO, LD and AS edited the different versions of the draft. CJ, PL, SL, FA, LD, MO and AS approved the submitted and final versions.

Corresponding author

Correspondence to Matthieu Ollivier.

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Conflict of interest

CJ,AS, LD and PL have nothing to disclose. SL and FA are employees of Stryker. MO is an educational consultant for Stryker.

Ethical approval

The local ethics committee approved our study protocol prior to investigation.

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Jacquet, C., Laumonerie, P., LiArno, S. et al. Contralateral preoperative templating of lower limbs’ mechanical angles is a reasonable option. Knee Surg Sports Traumatol Arthrosc 28, 1445–1451 (2020). https://doi.org/10.1007/s00167-019-05524-0

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  • DOI: https://doi.org/10.1007/s00167-019-05524-0

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