STATIC RADIOLOGICAL MEASURES ARE NOT INDICATORS OF THE KNEE DYNAMIC ALIGNMENT AND KINEMATIC BEHAVIOUR PRE- AND POST-TOTAL KNEE ARTHROPLASTY
Notice bibliographique
Résumé
Static radiographic measures, such as arithmetic hip-knee-ankle angle (aHKA; i.e., angle between tibia and femur anatomic axis) and joint line obliquity (JLO) are parameters of interest in surgical planning for total knee arthroplasty (TKA) to define realignment targets. While mechanical HKA (i.e., angle between tibia anatomic and knee-hip centers axis) has been reported to be associated with one biomechanical marker (i.e., frontal plane alignment during the terminal stance phase of gait), it is insufficient to use it as an indicator of the knee dynamic behavior. It is still unknown if other radiographic measures could provide more valuable information to predict dynamic alignment behavior, thus the aim of this study was to assess the associations between three-dimensional (3D) kinematic biomechanical markers and both aHKA and JLO pre- and post-TKA. This was a secondary data analysis from a prospective TKA study with nineteen patients. All patients gave their informed consent to participate, 63.2% were women and the mean age was 61 years (95%CI: 57.9;63.3). Eight patients (42.1%) received a posterior-stabilized implant while the others had a bicruciate-retaining design. All participants underwent a knee kinesiography exam before and 1-year after surgery. This exam allows to quantify kinematic biomechanical markers in the three planes of movement while the patient is walking on a treadmill (see Figure 1). From a standardized full-length weight-bearing lower limb radiograph, a senior orthopaedic surgeon measured the lateral distal femoral angle (LDFA) and medial proximal tibial angle (MPTA), used to calculate aHKA (MPTA-LDFA) and JLO (MPTA+LDFA). Bivariate Pearson correlations were calculated between 11 specific 3D kinematic biomechanical markers and both aHKA and JLO, before and 1-year after TKA. Detailed results are presented in Table 1. Out of the 44 evaluated associations, only one was statistically significant (i.e., p<0.05) in pre-TKA patients, between JLO and the frontal (i.e., varus-valgus) alignment at heel strike. A smaller JLO (i.e., towards a knee in apex distal) was associated with a more varus knee at heel strike (p=0.04). However, this association was moderate as it explained less than 25% of the variance (r=−0.482). Interestingly, aHKA was not significantly associated with any 3D kinematic biomechanical marker before nor after TKA. Results show that aHKA and JLO are not significantly associated with 3D knee kinematic biomechanical markers before nor after TKA. This suggests that these static radiographic alignment measures should not be used as indicators of the knee dynamic alignment or kinematic behavior in TKA patients. Therefore, to adequately consider the knee dynamic behavior to restore joint function with TKA, surgeons must integrate more objective measures related to function in their surgical planning. Further research with larger cohorts should be carried out to control the influence of implant designs and soft tissue balancing on kinematic biomechanical markers post-surgery to better understand the impact of TKA intervention on the knee dynamic behavior and achieve more functional knee dynamic alignment and better outcomes post-surgery. For any figures or tables, please contact the authors directly.
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Comment cette classification a été obtenuedéplier
Prédiction distillée sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Apprise à partir de 10 348 étiquettes directes de Codex et de 10 348 étiquettes directes de Gemma. Le mode candidate est l'union des têtes enseignantes seuillées; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont ni des étiquettes humaines ni des étiquettes directes de modèles de pointe.
Scores Codex et Gemma par catégorie
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,000 | 0,001 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,001 | 0,000 |
| Bibliométrie | 0,000 | 0,000 |
| Études des sciences et des technologies | 0,000 | 0,001 |
| Communication savante | 0,000 | 0,000 |
| Science ouverte | 0,000 | 0,000 |
| Intégrité de la recherche | 0,000 | 0,000 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,000 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule tête enseignante, pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».