Download PDF
J Knee Surg 2015; 28(03): 207-212
DOI: 10.1055/s-0034-1376327
Original Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Limb Alignment, Subluxation, and Bone Density Relationship in the Osteoarthritic Varus Knee

Saker Khamaisy
1   Department of Orthopedic Surgery, Hospital for Special Surgery, New York, New York
,
Denis Nam
2   Department of Joint Preservation, Resurfacing and Replacement Service, Washington University Orthopedics, St. Louis, Missouri
,
Ran Thein
1   Department of Orthopedic Surgery, Hospital for Special Surgery, New York, New York
,
Gurion Rivkin
3   Department of Orthopedic Surgery, Hadassah University Hospital, Jerusalem, Israel
,
Meir Liebergall
3   Department of Orthopedic Surgery, Hadassah University Hospital, Jerusalem, Israel
,
Andrew Pearle
1   Department of Orthopedic Surgery, Hospital for Special Surgery, New York, New York
› Author Affiliations
Further Information

Publication History

27 August 2013

06 March 2014

Publication Date:
12 May 2014 (online)

    Permissions and Reprints

Abstract

Lower limb alignment, tibiofemoral (TF) subluxation, and bone density changes around the knee are significant factors related to the development of knee osteoarthritis (OA) and have great impact on its severity. The relation of each factor to knee OA was evaluated separately in previous studies; however, few studies have attempted to integrate their respective effects. The purpose of this study was to determine if an identifiable interaction exists between coronal limb alignment, TF subluxation, and bone density in the development of knee OA. A total of 120 patients with symptomatic, varus knee OA, with preoperative standing anteroposterior (AP) hip-to-ankle radiographs and a computed tomographic scan of the knee, were included in this study. Overall mechanical lower extremity alignment, and TF subluxation were measured on the AP radiographs, while trabecular bone density (TBD) was measured in four regions of interest for both the tibial plateau and distal femur in all patients. The patients were stratified into the following four cohorts: (A) high subluxation, high angulation; (B) high subluxation, low angulation; (C) low subluxation, high angulation; and (D) low subluxation, low angulation. The mean TBD in group B was significantly higher than in groups C and D (p = 0.003 and 0.03, respectively). In addition, the mean TBD in group A was significantly higher than in group C. This study highlights the relationship between limb alignment, knee subluxation, and bone density in the osteoarthritic knee. These preliminary results present a proof-of-principle, that bone mineral density affects the degree of coronal alignment and TF subluxation in OA.

Keywords

knee - arthroplasty - subluxation - angulation
 

  • References

  • 1 Sharma L, Song J, Felson DT, Cahue S, Shamiyeh E, Dunlop DD. The role of knee alignment in disease progression and functional decline in knee osteoarthritis. JAMA 2001; 286 (2) 188-195
    CrossrefPubMedGoogle Scholar
  • 2 Tetsworth K, Paley D. Malalignment and degenerative arthropathy. Orthop Clin North Am 1994; 25 (3) 367-377
    PubMedGoogle Scholar
  • 3 Boone DC, Azen SP. Normal range of motion of joints in male subjects. J Bone Joint Surg Am 1979; 61 (5) 756-759
    PubMedGoogle Scholar
  • 4 Chang CB, Koh IJ, Seo ES, Kang YG, Seong SC, Kim TK. The radiographic predictors of symptom severity in advanced knee osteoarthritis with varus deformity. Knee 2011; 18 (6) 456-460
    CrossrefPubMedGoogle Scholar
  • 5 Scott RD, Santore RF. Unicondylar unicompartmental replacement for osteoarthritis of the knee. J Bone Joint Surg Am 1981; 63 (4) 536-544
    PubMedGoogle Scholar
  • 6 Berger RA, Della Valle CJ. Unicompartmental knee arthroplasty: indications, techniques, and results. Instr Course Lect 2010; 59: 47-56
    PubMedGoogle Scholar
  • 7 Zysset PK, Sonny M, Hayes WC. Morphology-mechanical property relations in trabecular bone of the osteoarthritic proximal tibia. J Arthroplasty 1994; 9 (2) 203-216
    CrossrefPubMedGoogle Scholar
  • 8 Kamibayashi L, Wyss UP, Cooke TD, Zee B. Trabecular microstructure in the medial condyle of the proximal tibia of patients with knee osteoarthritis. Bone 1995; 17 (1) 27-35
    CrossrefPubMedGoogle Scholar
  • 9 Sharma L, Song J, Dunlop D , et al. Varus and valgus alignment and incident and progressive knee osteoarthritis. Ann Rheum Dis 2010; 69 (11) 1940-1945
    CrossrefPubMedGoogle Scholar
  • 10 Hulet C, Sabatier JP, Souquet D, Locker B, Marcelli C, Vielpeau C. Distribution of bone mineral density at the proximal tibia in knee osteoarthritis. Calcif Tissue Int 2002; 71 (4) 315-322
    CrossrefPubMedGoogle Scholar
  • 11 Bennell KL, Creaby MW, Wrigley TV, Hunter DJ. Tibial subchondral trabecular volumetric bone density in medial knee joint osteoarthritis using peripheral quantitative computed tomography technology. Arthritis Rheum 2008; 58 (9) 2776-2785
    CrossrefPubMedGoogle Scholar
  • 12 Akamatsu Y, Mitsugi N, Taki N, Kobayashi H, Saito T. Medial versus lateral condyle bone mineral density ratios in a cross-sectional study: a potential marker for medial knee osteoarthritis severity. Arthritis Care Res (Hoboken) 2012; 64 (7) 1036-1045
    PubMedGoogle Scholar
  • 13 Nam D, Khamaisy S, Gladnick BP, Paul S, Pearle AD. Is tibiofemoral subluxation correctable in unicompartmental knee arthroplasty?. J Arthroplasty 2013; 28 (9) 1575-1579
    CrossrefPubMedGoogle Scholar
  • 14 Cann CE, Genant HK. Precise measurement of vertebral mineral content using computed tomography. J Comput Assist Tomogr 1980; 4 (4) 493-500
    CrossrefPubMedGoogle Scholar
  • 15 Zheng Y, Lu WW, Zhu Q, Qin L, Zhong S, Leong JC. Variation in bone mineral density of the sacrum in young adults and its significance for sacral fixation. Spine 2000; 25 (3) 353-357
    CrossrefPubMedGoogle Scholar
  • 16 Munro BH. Statistical Methods for Health Care Research. 3rd ed. Philadelphia, PA: Lippincott; 1997
    Google Scholar
  • 17 Khan FA, Koff MF, Noiseux NO , et al. Effect of local alignment on compartmental patterns of knee osteoarthritis. J Bone Joint Surg Am 2008; 90 (9) 1961-1969
    CrossrefPubMedGoogle Scholar
  • 18 Hunter DJ, Sharma L, Skaife T. Alignment and osteoarthritis of the knee. J Bone Joint Surg Am 2009; 91 (Suppl. 01) 85-89
    CrossrefPubMedGoogle Scholar
  • 19 Chang A, Hayes K, Dunlop D , et al. Thrust during ambulation and the progression of knee osteoarthritis. Arthritis Rheum 2004; 50 (12) 3897-3903
    CrossrefPubMedGoogle Scholar
  • 20 Karachalios T, Sarangi PP, Newman JH. Severe varus and valgus deformities treated by total knee arthroplasty. J Bone Joint Surg Br 1994; 76 (6) 938-942
    Google Scholar
  • 21 Dixon MC, Parsch D, Brown RR, Scott RD. The correction of severe varus deformity in total knee arthroplasty by tibial component downsizing and resection of uncapped proximal medial bone. J Arthroplasty 2004; 19 (1) 19-22
    CrossrefPubMedGoogle Scholar
  • 22 Emerson Jr RH. Preoperative and postoperative limb alignment after Oxford unicompartmental knee arthroplasty. Orthopedics 2007; 30 (5, Suppl): 32-34
    PubMedGoogle Scholar
  • 23 Bae DK, Song SJ, Heo DB, Tak DH. Does the severity of preoperative varus deformity influence postoperative alignment in both conventional and computer-assisted total knee arthroplasty?. Knee Surg Sports Traumatol Arthrosc 2013; 21 (10) 2248-2254
    CrossrefPubMedGoogle Scholar
  • 24 Parratte S, Pagnano MW, Trousdale RT, Berry DJ. Effect of postoperative mechanical axis alignment on the fifteen-year survival of modern, cemented total knee replacements. J Bone Joint Surg Am 2010; 92 (12) 2143-2149
    Google Scholar
  • 25 Ritter MA, Davis KE, Meding JB, Pierson JL, Berend ME, Malinzak RA. The effect of alignment and BMI on failure of total knee replacement. J Bone Joint Surg Am 2011; 93 (17) 1588-1596
    CrossrefPubMedGoogle Scholar
  • 26 Cicuttini F, Wluka A, Davis S, Strauss BJ, Yeung S, Ebeling PR. Association between knee cartilage volume and bone mineral density in older adults without osteoarthritis. Rheumatology (Oxford) 2004; 43 (6) 765-769
    CrossrefPubMedGoogle Scholar
  • 27 Bruyere O, Dardenne C, Lejeune E , et al. Subchondral tibial bone mineral density predicts future joint space narrowing at the medial femoro-tibial compartment in patients with knee osteoarthritis. Bone 2003; 32 (5) 541-545
    CrossrefPubMedGoogle Scholar
  • 28 Krischak GD, Wachter NJ, Zabel T , et al. Influence of preoperative mechanical bone quality and bone mineral density on aseptic loosening of total hip arthroplasty after seven years. Clin Biomech (Bristol, Avon) 2003; 18 (10) 916-923
    CrossrefPubMedGoogle Scholar
  • 29 Petersen MM, Nielsen PT, Lebech A, Toksvig-Larsen S, Lund B. Preoperative bone mineral density of the proximal tibia and migration of the tibial component after uncemented total knee arthroplasty. J Arthroplasty 1999; 14 (1) 77-81
    CrossrefPubMedGoogle Scholar
  • 30 Minoda Y, Kobayashi A, Iwaki H, Ikebuchi M, Inori F, Takaoka K. Comparison of bone mineral density between porous tantalum and cemented tibial total knee arthroplasty components. J Bone Joint Surg Am 2010; 92 (3) 700-706
    CrossrefPubMedGoogle Scholar
  • 31 Seki T, Omori G, Koga Y, Suzuki Y, Ishii Y, Takahashi HE. Is bone density in the distal femur affected by use of cement and by femoral component design in total knee arthroplasty?. J Orthop Sci 1999; 4 (3) 180-186
    CrossrefPubMedGoogle Scholar
  • 32 Cawthon PM. Gender differences in osteoporosis and fractures. Clin Orthop Relat Res 2011; 469 (7) 1900-1905
    CrossrefPubMedGoogle Scholar
  • 33 Burge R, Dawson-Hughes B, Solomon DH, Wong JB, King A, Tosteson A. Incidence and economic burden of osteoporosis-related fractures in the United States, 2005-2025. J Bone Miner Res 2007; 22 (3) 465-475
    CrossrefPubMedGoogle Scholar
  • 34 Watts NB, Adler RA, Bilezikian JP , et al; Endocrine Society. Osteoporosis in men: an Endocrine Society clinical practice guideline. J Clin Endocrinol Metab 2012; 97 (6) 1802-1822
    CrossrefPubMedGoogle Scholar