nach oben

Knee Surgery, Sports Traumatology, Arthroscopy

Erschienen in:

10.07.2018 | Knee

Weight-bearing radiography depends on limb loading

verfasst von: Robert Karl Zahn, Lisa Renner, Carsten Perka, Hagen Hommel

Erschienen in: Knee Surgery, Sports Traumatology, Arthroscopy | Ausgabe 5/2019

Einloggen, um Zugang zu erhalten

Abstract

Purpose

The mechanical axis of the lower limb has shown to vary between different weight-bearing conditions and change after total knee arthroplasty (TKA). The purpose of this study was to investigate the correlation between mechanical axis alignment in standing long-leg radiographs and limb loading after TKA.

Methods

Mechanical axis of the lower limb and limb loading have been prospectively evaluated in 115 patients 10 days and 3 months after TKA. By the moment of standing long-leg radiography for analysis of the mechanical leg axis, two digital scales separately captured the load of each limb.

Results

Mechanical axis changed from an initial − 1° ± 2° valgus alignment to a varus axis of + 1° ± 2° (p < 0.01). This change in alignment was associated with an increase of limb loading from 89.9 ± 10.7 to 93.0 ± 7.0% (p < 0.01). The mechanical axis strongly correlated with relative limb loading at the first and second measurements (r = 0.804, p < 0.001, respectively, r = 0.562, p < 0.001). A significant change in the rate of outliers was registered within the observation period. These alterations and distinctions were much more pronounced in patients with postoperative incomplete extension (n = 15).

Conclusions

The postoperative mechanical axis correlates with limb loading. A clinical relevant change in frontal alignment of the lower limb is associated with increased limb loading after TKA. The actual mechanical axis can only be assessed at physiological limb loading in long-leg radiographs with complete extension at full weight bearing.

Level of evidence

Diagnostic study, Level II.

Abane L, Anract P, Boisgard S, Descamps S, Courpied JP, Hamadouche M (2015) A comparison of patient-specific and conventional instrumentation for total knee arthroplasty: a multicentre randomised controlled trial. Bone Joint J 97-B:56–63CrossRefPubMed

Abdel MP, Oussedik S, Parratte S, Lustig S, Haddad FS (2014) Coronal alignment in total knee replacement: historical review, contemporary analysis, and future direction. Bone Joint J 96-B:857–862CrossRefPubMed

Alnahdi AH, Zeni JA, Snyder-Mackler L (2016) Quadriceps strength asymmetry predicts loading asymmetry during sit-to-stand task in patients with unilateral total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 24:2587–2594CrossRefPubMed

Amis AA (2013) Biomechanics of high tibial osteotomy. Knee Surg Sports Traumatol Arthrosc 21:197–205CrossRefPubMed

Babazadeh S, Dowsey MM, Bingham RJ, Ek ET, Stoney JD, Choong PF (2013) The long leg radiograph is a reliable method of assessing alignment when compared to computer-assisted navigation and computer tomography. Knee 20:242–249CrossRefPubMed

Bae DK, Lee JW, Cho SJ, Song SJ (2017) Comparison of mechanical axis and dynamic range assessed with weight bearing radiographs and navigation system in closed wedge high tibial osteotomy. Knee Surg Relat Res 29:225–231CrossRefPubMedPubMedCentral

Becker R, Kopf S, Karlsson J (2013) Loading conditions of the knee: what does it mean? Knee Surg Sports Traumatol Arthrosc 21:2659–2660CrossRefPubMed

Bellemans J, Colyn W, Vandenneucker H, Victor J (2012) The Chitranjan Ranawat award: is neutral mechanical alignment normal for all patients? The concept of constitutional varus. Clin Orthop Relat Res 470:45–53CrossRefPubMed

Bowman A, Shunmugam M, Watts AR, Bramwell DC, Wilson C, Krishnan J (2016) Inter-observer and intra-observer reliability of mechanical axis alignment before and after total knee arthroplasty using long leg radiographs. Knee 23:203–208CrossRefPubMed

10.

Calliess T, Bauer K, Stukenborg-Colsman C, Windhagen H, Budde S, Ettinger M (2017) PSI kinematic versus non-PSI mechanical alignment in total knee arthroplasty: a prospective, randomized study. Knee Surg Sports Traumatol Arthrosc 25:1743–1748CrossRefPubMed

11.

Edwards JZ, Greene KA, Davis RS, Kovacik MW, Noe DA, Askew MJ (2004) Measuring flexion in knee arthroplasty patients. J Arthroplasty 19:369–372CrossRefPubMed

12.

Fuchs MC, Janssen RP (2015) Clinical evaluation of 292 Genesis II posterior stabilized high-flexion total knee arthroplasty: range of motion and predictors. Eur J Orthop Surg Traumatol 25:161–166CrossRefPubMed

13.

Gbejuade HO, White P, Hassaballa M, Porteous AJ, Robinson JR, Murray JR (2013) Do long leg supine CT scanograms correlate with weight-bearing full-length radiographs to measure lower limb coronal alignment? Knee 21:549–552CrossRefPubMed

14.

Holme TJ, Henckel J, Hartshorn K, Cobb JP, Hart AJ (2015) Computed tomography scanogram compared to long leg radiograph for determining axial knee alignment. Acta Orthop 86:440–443CrossRefPubMedPubMedCentral

15.

Hommel H, Perka C (2015) Gap-balancing technique combined with patient-specific instrumentation in TKA. Arch Orthop Trauma Surg 135:1603–1608CrossRefPubMed

16.

Hopkins S, Smith C, Toms A, Brown M, Welsman J, Knapp K (2013) Evaluation of a dual-scales method to measure weight-bearing through the legs, and effects of weight-bearing inequalities on hip bone mineral density and leg lean tissue mass. J Rehabil Med 45:206–210CrossRefPubMed

17.

Jamali AA, Meehan JP, Moroski NM, Anderson MJ, Lamba R, Parise C (2017) Do small changes in rotation affect measurements of lower extremity limb alignment? J Orthop Surg Res 12:77CrossRefPubMedPubMedCentral

18.

Jiang J, Kang X, Lin Q, Teng Y, An L, Ma J et al (2015) Accuracy of patient-specific instrumentation compared with conventional instrumentation in total knee arthroplasty. Orthopedics 38:e305–e313CrossRefPubMed

19.

Kannan A, Hawdon G, McMahon SJ (2012) Effect of flexion and rotation on measures of coronal alignment after TKA. J Knee Surg 25:407–410CrossRefPubMed

20.

Khare R, Jaramaz B (2017) Accuracy of leg alignment measurements from antero-posterior radiographs. Biomed Tech (Berl) 62:315–320CrossRef

21.

Kim AD, Scott RD (2016) Can the visibility of both prosthetic posterior femoral condyles on a postoperative radiograph assure that limb rotation is appropriate to allow accurate measurement of the anatomic knee axis? J Arthroplasty 31:2593–2596CrossRefPubMed

22.

Kutzner I, Bender A, Dymke J, Duda G, von Roth P, Bergmann G (2017) Mediolateral force distribution at the knee joint shifts across activities and is driven by tibiofemoral alignment. Bone Joint J 99-B:779–787CrossRefPubMed

23.

Lavernia C, D’Apuzzo M, Rossi MD, Lee D (2008) Accuracy of knee range of motion assessment after total knee arthroplasty. J Arthroplasty 23:85–91CrossRefPubMed

24.

Lee DH, Park SC, Park HJ, Han SB (2016) Effect of soft tissue laxity of the knee joint on limb alignment correction in open-wedge high tibial osteotomy. Knee Surg Sports Traumatol Arthrosc 24:3704–3712CrossRefPubMed

25.

Lee YS, Howell SM, Won YY, Lee OS, Lee SH, Vahedi H et al (2017) Kinematic alignment is a possible alternative to mechanical alignment in total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 25:3467–3479CrossRefPubMed

26.

Lee YS, Lee BK, Lee SH, Park HG, Jun DS, Moon DH (2013) Effect of foot rotation on the mechanical axis and correlation between knee and whole leg radiographs. Knee Surg Sports Traumatol Arthrosc 21:2542–2547CrossRefPubMed

27.

Lombardi AV, Berend KR, Adams JB (2014) Why knee replacements fail in 2013: patient, surgeon, or implant? Bone Joint J 96-B:101–104CrossRefPubMed

28.

Lonner JH, Laird MT, Stuchin SA (1996) Effect of rotation and knee flexion on radiographic alignment in total knee arthroplasties. Clin Orthop Relat Res 331:102–106CrossRef

29.

Loyd BJ, Jennings JM, Falvey JR, Kim RH, Dennis DA, Stevens-Lapsley JE (2017) Magnitude of deformity correction may influence recovery of quadriceps strength after total knee arthroplasty. J Arthroplasty 32:2730–2737CrossRefPubMedPubMedCentral

30.

Manjunath KS, Gopalakrishna KG, Vineeth G (2015) Evaluation of alignment in total knee arthroplasty: a prospective study. Eur J Orthop Surg Traumatol 25:895–903CrossRefPubMed

31.

Matsuda S, Kawahara S, Okazaki K, Tashiro Y, Iwamoto Y (2013) Postoperative alignment and ROM affect patient satisfaction after TKA. Clin Orthop Relat Res 471:127–133CrossRefPubMed

32.

Maus U, Marques CJ, Scheunemann D, Lampe F, Lazovic D, Hommel H et al (2017) No improvement in reducing outliers in coronal axis alignment with patient-specific instrumentation. Knee Surg Sports Traumatol Arthrosc. https://doi.org/10.1007/s00167-017-4741-1 CrossRefPubMed

33.

Miller EJ, Pagnano MW, Kaufman KR (2014) Tibiofemoral alignment in posterior stabilized total knee arthroplasty: static alignment does not predict dynamic tibial plateau loading. J Orthop Res 32:1068–1074CrossRefPubMed

34.

Paley D, Pfeil J (2000) Principles of deformity correction around the knee. Orthopade 29:18–38PubMed

35.

Paternostre F, Schwab PE, Thienpont E (2014) The difference between weight-bearing and non-weight-bearing alignment in patient-specific instrumentation planning. Knee Surg Sports Traumatol Arthrosc 22:674–679CrossRefPubMed

36.

Petterwood J, Dowsey MM, Rodda D, Choong PF (2014) The immediate post-operative radiograph is an unreliable measure of coronal plane alignment in total knee replacement. Front Surg 1:35CrossRefPubMedPubMedCentral

37.

Pfitzner T, Abdel MP, von Roth P, Perka C, Hommel H (2014) Small improvements in mechanical axis alignment achieved with MRI versus CT-based patient-specific instruments in TKA: a randomized clinical trial. Clin Orthop Relat Res 472:2913–2922CrossRefPubMedPubMedCentral

38.

Radtke K, Becher C, Noll Y, Ostermeier S (2010) Effect of limb rotation on radiographic alignment in total knee arthroplasties. Arch Orthop Trauma Surg 130:451–457CrossRefPubMed

39.

Schoenmakers DAL, Feczko PZ, Boonen B, Schotanus MGM, Kort NP, Emans PJ (2017) Measurement of lower limb alignment: there are within-person differences between weight-bearing and non-weight-bearing measurement modalities. Knee Surg Sports Traumatol Arthrosc 25:3569–3575CrossRefPubMedPubMedCentral

40.

Schroter S, Ateschrang A, Lowe W, Nakayama H, Stockle U, Ihle C (2017) Early full weight-bearing versus 6-week partial weight-bearing after open wedge high tibial osteotomy leads to earlier improvement of the clinical results: a prospective, randomised evaluation. Knee Surg Sports Traumatol Arthrosc 25:325–332CrossRefPubMed

41.

Sharma L, Song J, Felson DT, Cahue S, Shamiyeh E, Dunlop DD (2001) The role of knee alignment in disease progression and functional decline in knee osteoarthritis. JAMA 286:188–195CrossRefPubMed

42.

Shelton TJ, Nedopil AJ, Howell SM, Hull ML (2017) Do varus or valgus outliers have higher forces in the medial or lateral compartments than those which are in-range after a kinematically aligned total knee arthroplasty? limb and joint line alignment after kinematically aligned total knee arthroplasty. Bone Joint J 99-B:1319–1328CrossRefPubMed

43.

Shimada N, Deie M, Hirata K, Hiate Y, Orita N, Iwaki D et al (2016) Courses of change in knee adduction moment and lateral thrust differ up to 1 year after TKA. Knee Surg Sports Traumatol Arthrosc 24:2506–2511CrossRefPubMed

44.

Silva M, Shepherd EF, Jackson WO, Pratt JA, McClung CD, Schmalzried TP (2003) Knee strength after total knee arthroplasty. J Arthroplasty 18:605–611CrossRefPubMed

45.

Sim JA, Kwak JH, Yang SH, Choi ES, Lee BK (2010) Effect of weight-bearing on the alignment after open wedge high tibial osteotomy. Knee Surg Sports Traumatol Arthrosc 18:874–878CrossRefPubMed

46.

Slevin O, Hirschmann A, Schiapparelli FF, Amsler F, Huegli RW, Hirschmann MT (2017) Neutral alignment leads to higher knee society scores after total knee arthroplasty in preoperatively non-varus patients: a prospective clinical study using 3D-CT. Knee Surg Sports Traumatol Arthrosc. https://doi.org/10.1007/s00167-017-4744-y CrossRefPubMed

47.

Slevin O, Schmid FA, Schiapparelli FF, Rasch H, Amsler F, Hirschmann MT (2017) Coronal femoral TKA position significantly influences in vivo patellar loading in unresurfaced patellae after primary total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 25:3605–3610CrossRefPubMed

48.

Specogna AV, Birmingham TB, Hunt MA, Jones IC, Jenkyn TR, Fowler PJ et al (2007) Radiographic measures of knee alignment in patients with varus gonarthrosis: effect of weightbearing status and associations with dynamic joint load. Am J Sports Med 35:65–70CrossRefPubMed

49.

Stevens-Lapsley JE, Balter JE, Kohrt WM, Eckhoff DG (2010) Quadriceps and hamstrings muscle dysfunction after total knee arthroplasty. Clin Orthop Relat Res 468:2460–2468CrossRefPubMedPubMedCentral

50.

Thomas AC, Judd DL, Davidson BS, Eckhoff DG, Stevens-Lapsley JE (2014) Quadriceps/hamstrings co-activation increases early after total knee arthroplasty. Knee 21:1115–1119CrossRefPubMedPubMedCentral

51.

Wang JH, Shin JM, Kim HH, Kang SH, Lee BH (2017) Discrepancy of alignment in different weight bearing conditions before and after high tibial osteotomy. Int Orthop 41:85–92CrossRefPubMed

52.

Yaffe MA, Koo SS, Stulberg SD (2008) Radiographic and navigation measurements of TKA limb alignment do not correlate. Clin Orthop Relat Res 466:2736–2744CrossRefPubMedPubMedCentral

53.

Zahn RK, Fussi J, von Roth P, Perka CF, Hommel H (2016) postoperative increased loading leads to an alteration in the radiological mechanical axis after total knee arthroplasty. J Arthroplasty 31:1803–1807CrossRefPubMed

Titel: Weight-bearing radiography depends on limb loading
verfasst von: Robert Karl Zahn
Lisa Renner
Carsten Perka
Hagen Hommel
Publikationsdatum: 10.07.2018
Verlag: Springer Berlin Heidelberg
Erschienen in: Knee Surgery, Sports Traumatology, Arthroscopy / Ausgabe 5/2019
Print ISSN: 0942-2056
Elektronische ISSN: 1433-7347
DOI: https://doi.org/10.1007/s00167-018-5056-6

Arthropedia

Grundlagenwissen der Arthroskopie und Gelenkchirurgie. Erweitert durch Fallbeispiele, Videos und Abbildungen.
» Jetzt entdecken

Neu im Fachgebiet Orthopädie und Unfallchirurgie

Notfall-TEP der Hüfte ist auch bei 90-Jährigen machbar

26.04.2024 Hüft-TEP Nachrichten

Ob bei einer Notfalloperation nach Schenkelhalsfraktur eine Hemiarthroplastik oder eine totale Endoprothese (TEP) eingebaut wird, sollte nicht allein vom Alter der Patientinnen und Patienten abhängen. Auch über 90-Jährige können von der TEP profitieren.

Arthroskopie kann Knieprothese nicht hinauszögern

25.04.2024 Gonarthrose Nachrichten

Ein arthroskopischer Eingriff bei Kniearthrose macht im Hinblick darauf, ob und wann ein Gelenkersatz fällig wird, offenbar keinen Unterschied.

Therapiestart mit Blutdrucksenkern erhöht Frakturrisiko

25.04.2024 Hypertonie Nachrichten

Beginnen ältere Männer im Pflegeheim eine Antihypertensiva-Therapie, dann ist die Frakturrate in den folgenden 30 Tagen mehr als verdoppelt. Besonders häufig stürzen Demenzkranke und Männer, die erstmals Blutdrucksenker nehmen. Dafür spricht eine Analyse unter US-Veteranen.

Ärztliche Empathie hilft gegen Rückenschmerzen

23.04.2024 Leitsymptom Rückenschmerzen Nachrichten

Personen mit chronischen Rückenschmerzen, die von einfühlsamen Ärzten und Ärztinnen betreut werden, berichten über weniger Beschwerden und eine bessere Lebensqualität.

Update Orthopädie und Unfallchirurgie

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.

Newsletter bestellen

Springer Medizin

Abstract

Purpose

Methods

Results

Conclusions

Level of evidence

Bitte loggen Sie sich ein, um Zugang zu diesem Inhalt zu erhalten

Weitere Artikel der Ausgabe 5/2019

TKA design-integrated trochlea groove rotation reduces patellofemoral pressure

Highly variable coronal tibial and femoral alignment in osteoarthritic knees: a systematic review

An accelerometer-based portable navigation system improved prosthetic alignment after total knee arthroplasty in 3D measurements

The medial constrained insert restores native knee rotational kinematics after bicruciate-retaining total knee arthroplasty

Medial soft tissue contracture does not always exist in varus osteoarthritis knees in total knee arthroplasty