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Coronal Alignment of the Lower Extremity: A Gender-Based Radio-Graphic Analysis in Indian Patients

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Abstract

Background

Variation in the shape of the femur and tibia has been shown to influence hip–kneeankle-axis angle (HKAA) and bears a role in reconstructive surgeries such as total knee arthroplasty (TKA). However, data on the axial alignment of the lower extremity specific to sex largely remains unavailable. Thus, we conducted a study with an aim to measure alignment and calculate differences in both the sexes in Indian population.

Materials and Methods

The following radiological parameters were measured from weight-bearing long leg radiographs of 966 limbs of Indian subjects via a morphometric software (Matlab R2009a) (1) Hip–Knee–Ankle angle (HKAA), (2) femoral bowing, (3) tibial bowing, (4) condylar plateau angle (CPA). The knees were classified according to the Kellegren and Lawrence grading and the differences between both the sexes were calculated with appropriate statistical tests.

Results

56.04% of the subjects were female. An increase in the mean age was observed for both the genders with an increase in the severity of OA. Height did not show any significant association with the alignment of the limb. The mean HKAA observed was − 5.88° ± 0.35° in females and − 4.99° ± 0.41° in males. The overall mean femoral bow and tibial bow was − 1.26° ± 0.24°, − 1.60° ± 0.18° in females and − 1.09 ± 0.28, − 1.47° ± 0.21° in males. The mean condylar plateau angle was higher in females − 2.67 ± 0.34 as compared to males − 2.35° ± 0.39°. A greater lateral bow was seen in males at higher grades of OA for femur and at lower grades of OA for tibia.

Conclusion

This study provides gender-based differences in the various axial radio-graphic parameters in a long leg radio-graphs in Indian population which might help in a better understanding of the etiopathogenesis of osteoarthritis and also help planning and execution of reconstructive surgeries such as TKA.

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Acknowledgements

The study was conducted under a project approved by UK-India Education and Research Initiative (UKIERI) and funded by Department of Science and Technology, Ministry of Science and Technology, New Delhi, India.

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Authors and Affiliations

  1. Department of Orthopaedics, All India Institute of Medical Sciences (AIIMS), New Delhi, 110029, India

    Mayur Nayak, Vijay Kumar, Rahul Yadav, Siddhartha Maredupaka & Rajesh Malhotra

  2. Department of Radiodiagnosis, All India Institute of Medical Sciences (AIIMS), New Delhi, 110029, India

    Deep Narayan Srivastava

  3. Chapel Allerton Hospital, University of Leeds, Leeds, UK

    Hemant Pandit

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  1. Mayur Nayak
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  2. Vijay Kumar
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  3. Rahul Yadav
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Correspondence to Vijay Kumar.

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Conflict of interest

Mayur Nayak, Vijay Kumar, Rahul Yadav, Siddhartha Maredupaka, Deep Narayan Srivastava, Rajesh Malhotra and Hemant Pandit declare that they have no conflict of interest.

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This article does not contain any studies with human or animal subjects performed by any of the authors.

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Informed written consent was obtained from all patients.

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Nayak, M., Kumar, V., Yadav, R. et al. Coronal Alignment of the Lower Extremity: A Gender-Based Radio-Graphic Analysis in Indian Patients. JOIO 54, 504–512 (2020). https://doi.org/10.1007/s43465-020-00050-5

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  • DOI: https://doi.org/10.1007/s43465-020-00050-5

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