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Coronal plane alignment of the knee (CPAK) classification and its impact on medial unicompartmental knee arthroplasty: exposing a unexpected external shift of limb mechanical axis in case of prearthritic constitutional valgus alignment: a retrospective radiographic study

Vitantonio Digennaro|Riccardo Ferri|Alessandro Panciera|Barbara Bordini|Davide Cecchin|Lorenzo Benvenuti|Francesco Traina|Cesare Faldini
대한슬관절학회 (Korean Knee Society)|2024.12|Knee Surgery and Related Research|제36권 |pp. 14-14|DOI 10.1186/s43019-024-00217-6

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키워드

AlignmentKneeUnicompartmentalaHKACPAKLDFA

초록

Purpose: This radiographic study aimed to evaluate the amount of pre-arthritic constitutional valgus alignment in patients with isolated medial osteoarthritis (OA) treated by medial unicompartmental knee arthroplasty (UKA), and its influence on the post-operative limb alignment. Methods: A retrospective analysis of 179 consecutive patients was conducted. Lateral distal femoral angle (LDFA), arithmetic hip-knee-ankle angle (aHKA), and joint line obliquity (JLO) were evaluated to assess epiphyseal deformity of the distal femur and pre-arthritic constitutional alignment according to the Coronal Plane Alignment of the Knee (CPAK) classification. The displacement of the limb’s mechanical axis from pre- to post-operative was evaluated both in its coronal relationship with the centre of the knee, and in the magnitude of modification in mechanical HKA (mHKA) and mechanical axis deviation (MAD). Results: Out of 179 patients, 16 (8.92%) exhibited pre-arthritic constitutional valgus alignment, characterized by reduced LDFA (range 84.2°/86.4°), positive values of aHKA (range +0.5°/+5.8°) and apex distal JLO (range 171.7°/174.2°), thus belonging to type III sub-group of the CPAK classification. In all 16 patients, the limb’s mechanical axis shifted from internal to external in relation to the center of the knee following the procedure, with possible risk of OA progression in the lateral unaffected compartment as alerted by recent literature. This unexpected shift occurred due to the restoration of the medial compartment height without any overcorrection, thereby returning the limb to its valgus alignment that was present prior to the OA onset. Moreover, the axial displacement was greater than in those with constitutional varus alignment, as indicated by the absolute value of ΔHKA (5.79° ± 3.10° versus 3.17° ± 0.51°, p=0.203) and ΔMAD (2.81cm ± 1.12cm versus 1.34cm ± 0.28cm, p= 0.024). Conclusion: These findings suggest the importance of expanding radiological criteria for medial UKA beyond traditional assessments of limb deviation and tibial deformity, considering also epiphyseal deformity of the distal femur and pre-arthritic constitutional alignment.

Abstract

Purpose: This radiographic study aimed to evaluate the amount of pre-arthritic constitutional valgus alignment in patients with isolated medial osteoarthritis (OA) treated by medial unicompartmental knee arthroplasty (UKA), and its influence on the post-operative limb alignment. Methods: A retrospective analysis of 179 consecutive patients was conducted. Lateral distal femoral angle (LDFA), arithmetic hip-knee-ankle angle (aHKA), and joint line obliquity (JLO) were evaluated to assess epiphyseal deformity of the distal femur and pre-arthritic constitutional alignment according to the Coronal Plane Alignment of the Knee (CPAK) classification. The displacement of the limb’s mechanical axis from pre- to post-operative was evaluated both in its coronal relationship with the centre of the knee, and in the magnitude of modification in mechanical HKA (mHKA) and mechanical axis deviation (MAD). Results: Out of 179 patients, 16 (8.92%) exhibited pre-arthritic constitutional valgus alignment, characterized by reduced LDFA (range 84.2°/86.4°), positive values of aHKA (range +0.5°/+5.8°) and apex distal JLO (range 171.7°/174.2°), thus belonging to type III sub-group of the CPAK classification. In all 16 patients, the limb’s mechanical axis shifted from internal to external in relation to the center of the knee following the procedure, with possible risk of OA progression in the lateral unaffected compartment as alerted by recent literature. This unexpected shift occurred due to the restoration of the medial compartment height without any overcorrection, thereby returning the limb to its valgus alignment that was present prior to the OA onset. Moreover, the axial displacement was greater than in those with constitutional varus alignment, as indicated by the absolute value of ΔHKA (5.79° ± 3.10° versus 3.17° ± 0.51°, p=0.203) and ΔMAD (2.81cm ± 1.12cm versus 1.34cm ± 0.28cm, p= 0.024). Conclusion: These findings suggest the importance of expanding radiological criteria for medial UKA beyond traditional assessments of limb deviation and tibial deformity, considering also epiphyseal deformity of the distal femur and pre-arthritic constitutional alignment.

참고문헌 (38)

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