Pujol Oriol, Hinarejos Pedro, Pons Albert, Famada Ernest, Zumel Angela, Erquicia Juan, Leal-Blanquet Joan
Knee Surgery Unit, Orthopaedic Surgery Department, Vall d'Hebron University Hospital, Universitat Autònoma de Barcelona (Departament de Cirurgia), Barcelona, Spain.
Knee Surgery Unit, iMove Traumatology, Barcelona, Spain.
Knee Surg Sports Traumatol Arthrosc. 2025 Oct;33(10):3621-3628. doi: 10.1002/ksa.12714. Epub 2025 Jun 5.
To assess the symmetry of coronal alignment in the lower limbs of patients with knee osteoarthritis to evaluate whether the contralateral lower limb can serve as a reliable reference for guiding coronal positioning and alignment in total knee arthroplasty (TKA) surgery.
This is a multicentric cross-sectional observational study. Preoperative full-leg weight-bearing radiographies from patients with knee osteoarthritis treated with a TKA between 2022 and 2024 were analyzed. Radiological parameters were measured in both lower limbs: medial proximal tibial angle, tibial mechanical angle (TMA), lateral distal femoral angle, femoral mechanical angle (FMA), hip-knee-ankle angle (HKA) and Kellgren-Lawrence. Lower limb coronal symmetry was assessed using the HKA, coronal plane alignment of the knee (CPAK) and phenotypes classifications. The relationship between concordance rates and osteoarthritis severity and symmetry was also analyzed.
Seventy-six patients were included. The operated-to-contralateral concordance for the HKA classification was 57%. It was higher when the operated knee was neutral (81%), compared to varus (58%) or valgus (27%). The CPAK concordance was 38%; it was similar across different CPAK types. The phenotype classification concordance was only 11%; 30% for the HKA parameter, 39% for FMA and 34% for TMA. There was no relationship between osteoarthritis severity or symmetry and coronal concordance rates.
Patients with knee osteoarthritis have poor side-to-side symmetry in lower limb coronal alignment. The concordance rate was 56% for the HKA classification, 39% for the CPAK classification and 11% for the phenotype classification. Therefore, the contralateral lower limb may not be a reliable reference for guiding coronal positioning and alignment in TKA surgery.
Level III.
评估膝骨关节炎患者下肢冠状位对线的对称性，以评估对侧下肢能否作为全膝关节置换术（TKA）中指导冠状位定位和对线的可靠参考。
这是一项多中心横断面观察性研究。分析了2022年至2024年间接受TKA治疗的膝骨关节炎患者术前的全腿负重X线片。在双下肢测量放射学参数：胫骨近端内侧角、胫骨机械角（TMA）、股骨远端外侧角、股骨机械角（FMA）、髋-膝-踝角（HKA）和凯尔格伦-劳伦斯分级。使用HKA、膝关节冠状面排列（CPAK）和表型分类评估下肢冠状位对称性。还分析了一致性率与骨关节炎严重程度和对称性之间的关系。
纳入76例患者。HKA分类的手术侧与对侧的一致性为57%。与内翻（58%）或外翻（27%）相比，手术膝为中立位时一致性更高（81%）。CPAK一致性为38%；在不同CPAK类型中相似。表型分类一致性仅为11%；HKA参数为30%，FMA为39%，TMA为34%。骨关节炎严重程度或对称性与冠状位一致性率之间无关联。
膝骨关节炎患者下肢冠状位对线的左右对称性较差。HKA分类的一致性率为56%，CPAK分类为39%，表型分类为11%。因此，对侧下肢可能不是TKA手术中指导冠状位定位和对线的可靠参考。
III级。
