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Asymmetric transepicondylar axis between varus and valgus osteoarthritic knees in windswept deformity can be predicted by hip–knee–ankle angle difference

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Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Purpose

Studies regarding the best strategy to determine appropriate femoral component rotation during bilateral total knee arthroplasty (TKA) in wind swept deformities (WSD) are very limited. The purpose of this study was (1) to evaluate whether femoral rotational profiles differ between varus and valgus osteoarthritic knees in WSD and (2) to analyze the correlation between femoral rotational profiles and coronal radiologic parameters.

Methods

A total of 40 patients who were diagnosed with bilateral knee osteoarthritis with WSD between January 2010 and December 2020 at a single institution were retrospectively reviewed. On axial computed tomography scans, femoral rotational profile parameters such as the clinical transepicondylar axis (cTEA) and anterior–posterior (AP) axis were compared between valgus and varus osteoarthritic knees. In standing full-limb AP radiographs, coronal radiographic parameters including hip–knee–ankle angle (HKA), valgus correction angle (VCA), lateral distal femoral angle (LDFA), medial proximal tibial angle (MPTA), and joint line convergence angle (JLCA) were measured in both knees. The correlation between the varus-valgus cTEA difference, and differences in coronal radiologic parameters was analyzed.

Results

In valgus osteoarthritic knees, cTEA was significantly increased compared to varus osteoarthritic knees by 1.5° (valgus: 7.65° ± 1.82°, varus: 6.15° ± 1.58°, p < 0.001). All coronal radiologic parameters, including HKA, LDFA, MPTA, JLCA, and VCA, were significantly different between valgus and varus knees. In correlation analysis, the varus-valgus cTEA difference was significantly correlated with LDFA (r = 0.365, p = 0.021), MPTA (r = 0.442, p = 0.004), and HKA differences (r = 0.693, p < 0.001), with the HKA difference showing the strongest correlation with the cTEA difference.

Conclusion

In bilateral knee osteoarthritis with WSD, valgus knees showed significantly increased cTEA compared to varus knees, and the cTEA difference positively correlated with the HKA difference between valgus and varus knees. To determine the optimal femoral component rotation during TKA in WSD, assessment of cTEA with pre-operative CT scans or careful intra-operative measurement is recommended, especially in patients with large HKA difference.

Level of evidence

III, Retrospective cohort study.

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Funding

This research was supported by the Bio & Medical Technology Development Program of the National Research Foundation (NRF) funded by the Korean government (MSIT) (2017M3A9D8063538).

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Author notes

  1. Yun Seong Choi and Tae Woo Kim have contributed equally to this work.

Authors and Affiliations

  1. Department of Orthopedic Surgery, Seoul National University College of Medicine, SMG-SNU Boramae Medical Center, 5 Gil 20, Boramae-road, Dongjak-gu, Seoul, 07061, South Korea

    Yun Seong Choi, Tae Woo Kim, Seung Cheol Song, Sang Yoon Kim, Moon Jong Chang & Seung-Baik Kang

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  1. Yun Seong Choi
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  2. Tae Woo Kim
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  3. Seung Cheol Song
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  4. Sang Yoon Kim
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  5. Moon Jong Chang
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  6. Seung-Baik Kang
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Contributions

YSC: design, data acquisition, data analysis, data interpretation, and drafting manuscript. TWK: design, data acquisition, data analysis, data interpretation, and drafting manuscript. SCS: data acquisition, data analysis, and data interpretation. SYK: data acquisition, data analysis, and data interpretation. MJC: data acquisition, data analysis, and data interpretation. S-BK: design, data interpretation, and manuscript revision.

Corresponding author

Correspondence to Seung-Baik Kang.

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The authors declare that they have no conflict of interest.

Ethical approval

This study was approved by the institutional review board of Seoul National University Seoul Metropolitan Government Boramae Medical Center (IRB NO: 20-2021-36).

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Choi, Y.S., Kim, T.W., Song, S.C. et al. Asymmetric transepicondylar axis between varus and valgus osteoarthritic knees in windswept deformity can be predicted by hip–knee–ankle angle difference. Knee Surg Sports Traumatol Arthrosc 30, 3024–3031 (2022). https://doi.org/10.1007/s00167-021-06661-1

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  • DOI: https://doi.org/10.1007/s00167-021-06661-1

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