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Arithmetic hip-knee-ankle angle and stressed hip-knee-ankle angle: equivalent methods for estimating constitutional lower limb alignment in kinematically aligned total knee arthroplasty
PURPOSE: Kinematically aligned total knee arthroplasty (KA TKA) relies on precise determination of constitutional alignment to set resection targets. The arithmetic hip-knee-ankle angle (aHKA) is a radiographic method to estimate constitutional alignment following onset of arthritis. Intraoperativel...
Autores principales: | , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Springer Berlin Heidelberg
2022
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9418303/ https://www.ncbi.nlm.nih.gov/pubmed/35819463 http://dx.doi.org/10.1007/s00167-022-07038-8 |
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author | Tarassoli, Payam Wood, Jil A. Chen, Darren B. Griffiths-Jones, Will Bellemans, Johan MacDessi, Samuel J. |
author_facet | Tarassoli, Payam Wood, Jil A. Chen, Darren B. Griffiths-Jones, Will Bellemans, Johan MacDessi, Samuel J. |
author_sort | Tarassoli, Payam |
collection | PubMed |
description | PURPOSE: Kinematically aligned total knee arthroplasty (KA TKA) relies on precise determination of constitutional alignment to set resection targets. The arithmetic hip-knee-ankle angle (aHKA) is a radiographic method to estimate constitutional alignment following onset of arthritis. Intraoperatively, constitutional alignment may also be approximated using navigation-based angular measurements of deformity correction, termed the stressed HKA (sHKA). This study aimed to investigate the relationship between these methods of estimating constitutional alignment to better understand their utility in KA TKA. METHODS: A radiological and intraoperative computer-assisted navigation study was undertaken comparing measurements of the aHKA using radiographs and computed tomography (CT-aHKA) to the sHKA in 88 TKAs meeting the inclusion criteria. The primary outcome was the difference in the paired means between the three methods to determine constitutional alignment (aHKA, CT-aHKA, sHKA). Secondary outcomes included testing agreement across measurements using Bland-Altman plots and analysis of subgroup differences based on different patterns of compartmental arthritis. RESULTS: There were no statistically significant differences between any paired comparison or across groups (aHKA vs. sHKA: 0.1°, p = 0.817; aHKA vs. CT-aHKA: 0.3°, p = 0.643; CT-aHKA vs. sHKA: 0.2°, p = 0.722; ANOVA, p = 0.845). Bland-Altman plots were consistent with good agreement for all comparisons, with approximately 95% of values within limits of agreement. There was no difference in the three paired comparisons (aHKA, CT-aHKA, and sHKA) for knees with medial compartment arthritis. However, these findings were not replicated in knees with lateral compartment arthritis. CONCLUSIONS: There was no significant difference between the arithmetic HKA (whether obtained using CT or radiographs) and the stressed HKA in this analysis. These findings further validate the preoperative arithmetic method and support use of the intraoperative stressed HKA as techniques to restore constitutional lower limb alignment in KA TKA. LEVEL OF EVIDENCE: III. |
format | Online Article Text |
id | pubmed-9418303 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2022 |
publisher | Springer Berlin Heidelberg |
record_format | MEDLINE/PubMed |
spelling | pubmed-94183032022-08-28 Arithmetic hip-knee-ankle angle and stressed hip-knee-ankle angle: equivalent methods for estimating constitutional lower limb alignment in kinematically aligned total knee arthroplasty Tarassoli, Payam Wood, Jil A. Chen, Darren B. Griffiths-Jones, Will Bellemans, Johan MacDessi, Samuel J. Knee Surg Sports Traumatol Arthrosc Knee PURPOSE: Kinematically aligned total knee arthroplasty (KA TKA) relies on precise determination of constitutional alignment to set resection targets. The arithmetic hip-knee-ankle angle (aHKA) is a radiographic method to estimate constitutional alignment following onset of arthritis. Intraoperatively, constitutional alignment may also be approximated using navigation-based angular measurements of deformity correction, termed the stressed HKA (sHKA). This study aimed to investigate the relationship between these methods of estimating constitutional alignment to better understand their utility in KA TKA. METHODS: A radiological and intraoperative computer-assisted navigation study was undertaken comparing measurements of the aHKA using radiographs and computed tomography (CT-aHKA) to the sHKA in 88 TKAs meeting the inclusion criteria. The primary outcome was the difference in the paired means between the three methods to determine constitutional alignment (aHKA, CT-aHKA, sHKA). Secondary outcomes included testing agreement across measurements using Bland-Altman plots and analysis of subgroup differences based on different patterns of compartmental arthritis. RESULTS: There were no statistically significant differences between any paired comparison or across groups (aHKA vs. sHKA: 0.1°, p = 0.817; aHKA vs. CT-aHKA: 0.3°, p = 0.643; CT-aHKA vs. sHKA: 0.2°, p = 0.722; ANOVA, p = 0.845). Bland-Altman plots were consistent with good agreement for all comparisons, with approximately 95% of values within limits of agreement. There was no difference in the three paired comparisons (aHKA, CT-aHKA, and sHKA) for knees with medial compartment arthritis. However, these findings were not replicated in knees with lateral compartment arthritis. CONCLUSIONS: There was no significant difference between the arithmetic HKA (whether obtained using CT or radiographs) and the stressed HKA in this analysis. These findings further validate the preoperative arithmetic method and support use of the intraoperative stressed HKA as techniques to restore constitutional lower limb alignment in KA TKA. LEVEL OF EVIDENCE: III. Springer Berlin Heidelberg 2022-07-11 2022 /pmc/articles/PMC9418303/ /pubmed/35819463 http://dx.doi.org/10.1007/s00167-022-07038-8 Text en © The Author(s) 2022 https://creativecommons.org/licenses/by/4.0/Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/ (https://creativecommons.org/licenses/by/4.0/) . |
spellingShingle | Knee Tarassoli, Payam Wood, Jil A. Chen, Darren B. Griffiths-Jones, Will Bellemans, Johan MacDessi, Samuel J. Arithmetic hip-knee-ankle angle and stressed hip-knee-ankle angle: equivalent methods for estimating constitutional lower limb alignment in kinematically aligned total knee arthroplasty |
title | Arithmetic hip-knee-ankle angle and stressed hip-knee-ankle angle: equivalent methods for estimating constitutional lower limb alignment in kinematically aligned total knee arthroplasty |
title_full | Arithmetic hip-knee-ankle angle and stressed hip-knee-ankle angle: equivalent methods for estimating constitutional lower limb alignment in kinematically aligned total knee arthroplasty |
title_fullStr | Arithmetic hip-knee-ankle angle and stressed hip-knee-ankle angle: equivalent methods for estimating constitutional lower limb alignment in kinematically aligned total knee arthroplasty |
title_full_unstemmed | Arithmetic hip-knee-ankle angle and stressed hip-knee-ankle angle: equivalent methods for estimating constitutional lower limb alignment in kinematically aligned total knee arthroplasty |
title_short | Arithmetic hip-knee-ankle angle and stressed hip-knee-ankle angle: equivalent methods for estimating constitutional lower limb alignment in kinematically aligned total knee arthroplasty |
title_sort | arithmetic hip-knee-ankle angle and stressed hip-knee-ankle angle: equivalent methods for estimating constitutional lower limb alignment in kinematically aligned total knee arthroplasty |
topic | Knee |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9418303/ https://www.ncbi.nlm.nih.gov/pubmed/35819463 http://dx.doi.org/10.1007/s00167-022-07038-8 |
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