Qin Xun, Liu Hengzhi, Liu Yinghao, Hu Aixin
The First College of Clinical Medical Science, China Three Gorges University, Yi Chang, China.
Yichang Central People's Hospital, Yi Chang, China.
PLoS One. 2025 Jun 24;20(6):e0327168. doi: 10.1371/journal.pone.0327168. eCollection 2025.
To investigate the correlation between fibular head height and the deviation and severity of lower limb alignment after TKA in patients with varus deformity and knee osteoarthritis.
Based on the varus angle (γ = 10°), the sample was divided into two groups: < 10° and ≥10°, The differences in fibular head height between the two groups of patients were analyzed using an independent samples t-test; The Mann-Whitney test was used to analyze the differences in fibular head height between genders. An unordered multinomial logistic regression analysis was conducted to evaluate the effects of age, gender, height, weight, body mass index, and fibular head height on postoperative lower limb alignment; Pearson correlation analysis was used to assess the correlation between fibular head height and varus angle, preoperative HKA angle, and postoperative HKA angle; A Multiple linear regression was performed to evaluate the effects of gender, age, height, weight, body mass index, fibular head height, preoperative HKA angle, and varus angle on the postoperative HKA angle.
The sample was divided into two groups based on the varus angle: ≥ 10° and <10°. The fibular head height was 8.1825 ± 2.72505 mm in one group and 9.2234 ± 2.68225 mm in the other group (p = 0.028 < 0.05), which was statistically significant; The median fibular head height in females was 8.050 mm, compared to 10.645 mm in males (p < 0.05), which was statistically significant. In the unordered multinomial logistic regression, with postoperative lower limb alignment (varus, valgus, neutral) as the dependent variable, In the unordered multinomial logistic regression with postoperative lower limb alignment as the dependent variable, Height, weight, and body mass index are influencing factors for postoperative lower limb alignment in patients with varus deformity knee osteoarthritis, affecting both varus and valgus alignment, while fibular head height is a significant factor for postoperative varus alignment. In the Pearson correlation analysis, fibular head height was positively correlated with postoperative HKA angle (r = 0.212, p < 0.05). In the multiple linear regression with postoperative HKA angle as the dependent variable, fibular head height and preoperative HKA angle were identified as significant factors influencing the postoperative HKA angle (p < 0.05).
This study found that in patients with varus deformity knee osteoarthritis, a greater degree of varus was associated with a lower fibular head height. Additionally, the fibular head in female patients was positioned closer to the lateral tibial plateau compared to male patients. In varus deformity knee osteoarthritis, fibular head height is a risk factor for postoperative lower limb varus alignment following total knee arthroplasty (TKA). Patients with a higher-positioned fibular head (lower fibular head height) are more likely to develop postoperative varus malalignment after TKA. Therefore, routine measurement of fibular head height is warranted in clinical practice for patients with varus deformity knee osteoarthritis.
探讨膝内翻畸形和膝骨关节炎患者全膝关节置换术（TKA）后腓骨头高度与下肢力线偏差及严重程度之间的相关性。
根据内翻角度（γ = 10°）将样本分为两组：<10°组和≥10°组，采用独立样本t检验分析两组患者腓骨头高度的差异；采用曼-惠特尼检验分析不同性别患者腓骨头高度的差异。进行无序多项逻辑回归分析，以评估年龄、性别、身高、体重、体重指数和腓骨头高度对术后下肢力线的影响；采用Pearson相关性分析评估腓骨头高度与内翻角度、术前髋膝踝角（HKA）和术后HKA角之间的相关性；进行多元线性回归分析，以评估性别、年龄、身高、体重、体重指数、腓骨头高度、术前HKA角和内翻角度对术后HKA角的影响。
根据内翻角度将样本分为两组：≥10°组和<10°组。一组患者的腓骨头高度为8.1825±2.72505mm，另一组为9.2234±2.68225mm（p = 0.028<0.05），差异具有统计学意义；女性患者腓骨头高度的中位数为8.050mm，男性为10.645mm（p<0.05），差异具有统计学意义。在无序多项逻辑回归中，以术后下肢力线（内翻、外翻、中立）为因变量，在以术后下肢力线为因变量的无序多项逻辑回归中，身高、体重和体重指数是膝内翻畸形膝骨关节炎患者术后下肢力线的影响因素，对内翻和外翻力线均有影响，而腓骨头高度是术后内翻力线的重要因素。在Pearson相关性分析中，腓骨头高度与术后HKA角呈正相关（r = 0.212，p<0.05）。在以术后HKA角为因变量的多元线性回归中，腓骨头高度和术前HKA角被确定为影响术后HKA角的重要因素（p<0.05）。
本研究发现，在膝内翻畸形膝骨关节炎患者中，内翻程度越大，腓骨头高度越低。此外，与男性患者相比，女性患者的腓骨头位置更靠近胫骨外侧平台。在膝内翻畸形膝骨关节炎中，腓骨头高度是全膝关节置换术（TKA）后下肢内翻力线的危险因素。腓骨头位置较高（腓骨头高度较低）的患者在TKA后更易发生术后内翻畸形。因此，在临床实践中，对于膝内翻畸形膝骨关节炎患者，常规测量腓骨头高度是必要的。
