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The significance of the pelvic incidence measurement as a possible predictor of TKA outcome

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Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Purpose

To evaluate the association between the sagittal alignment of the pelvis and residual knee flexion contracture after total knee arthroplasty (TKA). This is important as a flexion contraction can be associated with the risk of poor outcomes and patient satisfaction after TKA.

Methods

This was a retrospective, case–control, study of 200 osteoarthritic knees, contributed by 200 patients, over a mean follow-up of 2.4 years. The following factors were compared between patients ‘with’ (46 knees) and ‘without’ (154 knees) a residual flexion contracture ≥ 10° after TKA: age, sex, pelvic incidence (PI), anterior femoral bowing, femoral component flexion angle (FFA), and patient-reported outcomes. Logistic regression and receiver operating characteristic curve analyses were used to identify predictive factors.

Results

The following factors were predictive of a residual flexion contracture ≥ 10°: a pelvic incidence ≥ 55° (odds ratio, 1.29; 95% confidence interval, 1.05−1.59; P = 0.031) and the FFA (odds ratio, 1.08; 95% confidence interval, 1.03−1.14; P = 0.044). A pelvic incidence cutoff of 55° yielded a significant between-group difference, with a sensitivity of 78.4% and specificity of 89.9% to differentiate a residual knee flexion contracture ≥ 10° (P = 0.001), patient satisfaction (P = 0.029), EuroQol 5-Dimension score (P = 0.028), anterior femoral curvature (P = 0.031), and Knee Injury and Osteoarthritis Outcome Score-Joint Replacement score (P = 0.046).

Conclusion

A pelvic incidence > 55° is associated with a residual knee flexion contracture ≥ 10° after TKA. The significance of the pelvic incidence measurement as a possible predictor of TKA outcome was highlighted, including its impact on patient satisfaction.

Level of evidence

III.

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References

  1. Akiyama K, Shibuya T (2018) Influence of femoral bowing on range of motion after total hip arthroplasty. Int Orthop 42(8):1795–1802

    Article  PubMed  Google Scholar 

  2. Arima H, Dimar JR 2nd, Glassman SD, Yamato Y, Matsuyama Y, Mac-Thiong JM, Roussouly P, Cook B, Carreon LY (2018) Differences in lumbar and pelvic parameters among African American, Caucasian and Asian populations. Eur Spine J 27(12):2990–2998

    Article  PubMed  Google Scholar 

  3. Bellemans J, Banks S, Victor J, Vandenneucker H, Moemans A (2002) Fluoroscopic analysis of the kinematics of deep flexion in total knee arthroplasty. Influence of posterior condylar offset. J Bone Joint Surg Br 84(1):50–53

    Article  CAS  PubMed  Google Scholar 

  4. Bourne RB, Chesworth BM, Davis AM, Mahomed NN, Charron KD (2010) Patient satisfaction after total knee arthroplasty: who is satisfied and who is not? Clin Orthop Relat Res 468(1):57–63

    Article  PubMed  Google Scholar 

  5. Chung BJ, Kang YG, Chang CB, Kim SJ, Kim TK (2009) Differences between sagittal femoral mechanical and distal reference axes should be considered in navigated TKA. Clin Orthop Relat Res 467(9):2403–2413

    Article  PubMed  PubMed Central  Google Scholar 

  6. Danoff JR, Goel R, Sutton R, Maltenfort MG, Austin MS (2018) How much pain is significant? Defining the minimal clinically important difference for the visual analog scale for pain after total joint arthroplasty. J Arthroplasty 33(7S):S71-S75.e2

    Article  PubMed  Google Scholar 

  7. Ewald FC (1989) The Knee Society total knee arthroplasty roentgenographic evaluation and scoring system. Clin Orthop Relat Res 248:9–12

    Article  Google Scholar 

  8. Gebhart JJ, Weinberg DS, Bohl MS, Liu RW (2016) Relationship between pelvic incidence and osteoarthritis of the hip. Bone Joint Res 5(2):66–72

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  9. Gustke KA, Cherian JJ, Simon P, Morrison TA (2022) Effect of posterior osteophytes on total knee arthroplasty coronal soft tissue balance: do they matter? J Arthroplasty 37(6S):S226–S230

    Article  PubMed  Google Scholar 

  10. Hernandez RJ, Tachdjian MO, Poznanski AK, Dias LS (1981) CT determination of femoral torsion. AJR Am J Roentgenol 137(1):97–101

    Article  CAS  PubMed  Google Scholar 

  11. Insall JN, Dorr LD, Scott RD, Scott WN (1989) Rationale of the Knee Society clinical rating system. Clin Orthop Relat Res 248:13–14

    Article  Google Scholar 

  12. Katsumi R, Mannen EM, Bajaj G, Smith JR, Mears SC, Stambough JB, Barnes CL (2022) The influence of knee osteoarthritis on spinopelvic alignment and global sagittal balance. J Knee Surg. https://doi.org/10.1055/s-0042-1747947

    Article  PubMed  Google Scholar 

  13. Koh IJ, Chang CB, Kang YG, Seong SC, Kim TK (2013) Incidence, predictors, and effects of residual flexion contracture on clinical outcomes of total knee arthroplasty. J Arthroplasty 28(4):585–590

    Article  PubMed  Google Scholar 

  14. Konda S, Tomita T, Yamazaki T, Oda K, Nakajima M, Nakane K, Kono K, Fujito T, Yoshikawa H, Sugamoto K (2019) Comparison of finite helical axes of normal and anatomically designed prosthetic knees. Clin Biomech 65:57–64

    Article  Google Scholar 

  15. Kwon HM, Yang IH, Park KK, Cho BW, Kam JH, Kong Y, Yang JH, Lee WS (2020) High pelvic incidence is associated with disease progression in nontraumatic osteonecrosis of the femoral head. Clin Orthop Relat Res 478(8):1870–1876

    Article  PubMed  PubMed Central  Google Scholar 

  16. Kwon HM, Cho BW, Kim S, Yang IH, Park KK, Son NH (2022) Lee WS (2022) Acetabular labral tear is associated with high pelvic incidence with or without femoroacetabular impingement morphology. Knee Surg Sports Traumatol Arthrosc 30(10):3526–3534

    Article  PubMed  PubMed Central  Google Scholar 

  17. Lee CM, Liu RW (2022) Comparison of pelvic incidence measurement using lateral x-ray, standard ct versus ct with 3d reconstruction. Eur Spine J 31(2):241–247

    Article  PubMed  Google Scholar 

  18. Legaye J, Duval-Beaupère G, Hecquet J, Marty C (1998) Pelvic incidence: a fundamental pelvic parameter for three-dimensional regulation of spinal sagittal curves. Eur Spine J 7(2):99–103

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  19. Li H, Zhu F, Liao S, Wang X, Zhong Y, Wen X, Zhao X, Liao W, Zhang Z (2022) Higher pelvic incidence was associated with a higher risk of sagittal malposition of femoral component and poor outcomes of primary total knee arthroplasty: a retrospective cohort analysis. J Knee Surg. https://doi.org/10.1055/s-0042-1743494

    Article  PubMed  PubMed Central  Google Scholar 

  20. Lyman S, Lee YY, Franklin PD, Li W, Cross MB, Padgett DE (2016) Validation of the KOOS, JR: a short-form knee arthroplasty outcomes survey. Clin Orthop Relat Res 474(6):1461–1471

    Article  PubMed  PubMed Central  Google Scholar 

  21. Miyazaki Y, Nakamura T, Kogame K, Saito M, Yamamoto K, Suguro T (2011) Analysis of the kinematics of total knee prostheses with a medial pivot design. J Arthroplasty 26(7):1038–1044

    Article  PubMed  Google Scholar 

  22. Moreland JR, Bassett LW, Hanker GJ (1987) Radiographic analysis of the axial alignment of the lower extremity. J Bone Joint Surg Am 69(5):745–749

    Article  CAS  PubMed  Google Scholar 

  23. Okamoto Y, Nakajima M, Jotoku T, Otsuki S, Neo M (2016) Capsular release around the intercondylar notch increases the extension gap in posterior-stabilized rotating-platform total knee arthroplasty. Knee 23(4):730–735

    Article  PubMed  Google Scholar 

  24. Okamoto Y, Otsuki S, Jotoku T, Nakajima M, Neo M (2017) Clinical usefulness of hindfoot assessment for total knee arthroplasty: persistent post-operative hindfoot pain and alignment in pre-existing severe knee deformity. Knee Surg Sports Traumatol Arthrosc 25(8):2632–2639

    Article  PubMed  Google Scholar 

  25. Okamoto Y, Otsuki S, Nakajima M, Jotoku T, Wakama H, Neo M (2019) Sagittal alignment of the femoral component and patient height are associated with persisting flexion contracture after primary total knee arthroplasty. J Arthroplasty 34(7):1476–1482

    Article  PubMed  Google Scholar 

  26. Okamoto Y, Wakama H, Okayoshi T, Matsuyama J, Otsuki S, Neo M (2022) Spinopelvic mismatch is associated with patient-reported outcome measures after total knee arthroplasty at a mean follow-up of 15 years. Knee 34:156–166

    Article  PubMed  Google Scholar 

  27. Reikerås O, Bjerkreim I, Kolbenstvedt A (1983) Anteversion of the acetabulum and femoral neck in normals and in patients with osteoarthritis of the hip. Acta Orthop Scand 54(1):18–23

    Article  PubMed  Google Scholar 

  28. Ritter MA, Lutgring JD, Davis KE, Berend ME, Pierson JL, Meneghini RM (2007) The role of flexion contracture on outcomes in primary total knee arthroplasty. J Arthroplasty 22(8):1092–1096

    Article  PubMed  Google Scholar 

  29. Roussouly P, Gollogly S, Berthonnaud E, Labelle H, Weidenbaum M (2006) Sagittal alignment of the spine and pelvis in the presence of L5–s1 isthmic lysis and low-grade spondylolisthesis. Spine 31(21):2484–2490

    Article  PubMed  Google Scholar 

  30. Yapp LZ, Scott CEH, Howie CR, MacDonald DJ, Simpson AHRW, Clement ND (2022) Meaningful values of the EQ-5D-3L in patients undergoing primary knee arthroplasty. Bone Joint Res 11(9):619–628

    Article  PubMed  PubMed Central  Google Scholar 

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Acknowledgements

We would like to thank Editage (www.editage.com) for English language editing.

Funding

This study was supported by the Grants-in-Aid for Scientific Research of Japan Society KAKENHI for the Promotion of Science (Grant Number 21K09239), and Johnson and Johnson Medical Research Grant (AS2121A000040442).

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Authors and Affiliations

  1. Department of Orthopedic Surgery, Osaka Medical and Pharmaceutical University, 2-7 Daigaku-Machi, Takatsuki, 569-8686, Japan

    Yoshinori Okamoto, Hitoshi Wakama, Junya Matsuyama, Kaito Nakamura, Shuhei Otsuki & Masashi Neo

Authors
  1. Yoshinori Okamoto
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  2. Hitoshi Wakama
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  3. Junya Matsuyama
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  4. Kaito Nakamura
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Correspondence to Yoshinori Okamoto.

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The authors declare that they have no conflicts of interest.

Ethical approval

This study was performed in line with the principles of the Declaration of Helsinki (1964) and its subsequent amendments and was approved by the institutional review board of Osaka Medical and Pharmaceutical University hospital (approval number- 2020–098-1).

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Okamoto, Y., Wakama, H., Matsuyama, J. et al. The significance of the pelvic incidence measurement as a possible predictor of TKA outcome. Knee Surg Sports Traumatol Arthrosc 31, 3106–3115 (2023). https://doi.org/10.1007/s00167-022-07224-8

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  • DOI: https://doi.org/10.1007/s00167-022-07224-8

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