The radiographic predictors of symptom severity in advanced knee osteoarthritis with varus deformity

Objective.To assess the relationship between bone mineral density (BMD) and varus deformity arising from bone structural changes caused by knee osteoarthritis (OA) in postmenopausal women.Methods.This cross-sectional study involved 135 consecutive postmenopausal female patients who had varus knee OA and a Kellgren-Lawrence grade ≥ 2. Knee radiographs were obtained with the patient standing on one leg, and subjects were classified into 3 tertile groups according to femorotibial angle, which was taken as a measure of varus knee OA severity. We also measured the 3 subangles that make up the femorotibial angle, and focused on the varus inclination of the tibial plateau. BMD was measured in the lumbar spine, femoral neck, and medial and lateral tibial condyles using dual-energy X-ray absorptiometry. Differences between femorotibial angle tertile groups were assessed, and associations between femorotibial sub-angles and BMD values at various points were evaluated.Results.After adjustment for age and body mass index, there was no significant association between the varus inclination of the tibial plateau and lumbar spine BMD. A weak but statistically significant negative correlation existed between varus inclination of the tibial plateau and BMD at the ipsilateral proximal femur and lateral tibial condyle.Conclusion.Varus inclination of the tibial plateau was significantly more severe in the femorotibial angle tertile 3 group, and in patients with lower BMD in the ipsilateral lower limb. Varus knee OA may result not only from cartilage loss but also from structural changes of the bone.

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Treatment of knee osteoarthritis associated with extraarticular varus deformity of the femur: staged total knee arthroplasty following corrective osteotomy

Journal of Orthopaedic Science ◽

10.1007/s00776-006-1035-8 ◽

2006 ◽

Vol 11 (4) ◽

pp. 386-389 ◽

Cited By ~ 7

Author(s):

Keisuke Yagi ◽

Yoshito Matsui ◽

Shunji Nakano ◽

Hiroshi Egawa ◽

Takahiko Tsutsui ◽

...

Keyword(s):

Total Knee Arthroplasty ◽

Knee Osteoarthritis ◽

Knee Arthroplasty ◽

Corrective Osteotomy ◽

Varus Deformity ◽

Total Knee

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The Truth Behind Subchondral Cysts in Osteoarthritis of the Knee

The Open Orthopaedics Journal ◽

10.2174/1874325001408010007 ◽

2014 ◽

Vol 8 (1) ◽

pp. 7-10 ◽

Cited By ~ 13

Author(s):

Han Xinyun Audrey ◽

Hamid Rahmatullah Bin Abd Razak ◽

Tan Hwee Chye Andrew

Keyword(s):

Knee Osteoarthritis ◽

Varus Deformity ◽

Female Gender ◽

Joint Space ◽

Radiological Feature ◽

Osteoarthritis Of The Knee ◽

Functional Deficits ◽

Radiological Evidence ◽

Study Population ◽

Subchondral Sclerosis

Background: Subchondral cysts have always been taught to be one of the cardinal radiological features of knee osteoarthritis but are not well understood. We aimed to evaluate the radiological prevalence and epidemiology of subchondral cysts in patients with knee osteoarthritis to determine if they are truly a cardinal radiological feature. Methods: All patients of a single surgeon with symptoms of knee osteoarthritis were selected for this study. All patients had failed a trial of conservative therapy and were planned for total knee arthroplasty. Patients with symptoms of and documentary evidence of inflammatory arthritis, other neurological and orthopaedic problems causing functional deficits were excluded from this study. A total of 806 plain radiographs were analyzed with the aid of an atlas for the presence of narrowed joint space, osteophytes, subchondral sclerosis and subchondral cysts. The radiological prevalence of each feature was then calculated. Demographics and pre-operative measurements were compared between patients with and without radiological evidence of subchondral cysts. Results: Subchondral cysts were only present in 30.6% of the study population. Narrowed joint space was present in 99.5%, osteophytes in 98.1% and subchondral sclerosis in 88.3% of all radiographs. The differences in prevalence were statistically significant. There was a higher proportion of females in patients with radiological evidence of subchondral cysts. These patients also had a greater varus deformity preoperatively. Conclusion: With a radiological prevalence of 30.6%, subchondral cysts should not be considered a cardinal radiological feature of osteoarthritis. Subchondral cysts may be associated with the female gender and genu varum.

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Patient Characteristics Independently Associated With Knee Osteoarthritis Symptom Severity at Initial Orthopedic Consultation

JCR Journal of Clinical Rheumatology ◽

10.1097/rhu.0000000000001726 ◽

2021 ◽

Vol Publish Ahead of Print ◽

Author(s):

Harel G. Schwartzberg ◽

Ryan Roy ◽

Kyle Wilson ◽

Hunter Starring ◽

Claudia Leonardi ◽

...

Keyword(s):

Knee Osteoarthritis ◽

Symptom Severity ◽

Patient Characteristics

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Factors Correlated with the Reducibility of Varus Deformity in Knee Osteoarthritis: An Analysis Using Navigation Guided TKA

Clinics in Orthopedic Surgery ◽

10.4055/cios.2013.5.1.36 ◽

2013 ◽

Vol 5 (1) ◽

pp. 36 ◽

Cited By ~ 11

Author(s):

Young Wan Moon ◽

Jae Gyoon Kim ◽

Jung Hoon Han ◽

Kwan Hong Do ◽

Jai Gon Seo ◽

...

Keyword(s):

Knee Osteoarthritis ◽

Varus Deformity

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Tibial condylar valgus osteotomy (TCVO): Surgical technique and clinical results for knee osteoarthritis with varus deformity

Journal of Clinical Orthopaedics and Trauma ◽

10.1016/j.jcot.2021.101589 ◽

2021 ◽

pp. 101589

Author(s):

Tsukasa Teramoto ◽

Shota Harada ◽

Nobuyuki Takenaka ◽

Takashi Matsushita

Keyword(s):

Surgical Technique ◽

Knee Osteoarthritis ◽

Varus Deformity ◽

Clinical Results ◽

Valgus Osteotomy ◽

Tibial Condylar Valgus Osteotomy

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Knee Arthroplasty in Severe Varus Advanced Knee Osteoarthritis with Proximal Tibia Malunion: a case report

Orthopaedic Journal of Sports Medicine ◽

10.1177/2325967120s00054 ◽

2020 ◽

Vol 8 (5_suppl5) ◽

pp. 2325967120S0005

Author(s):

Nyoman Aditya Sindunata ◽

Prettysia Suvarly ◽

Rio Aditya ◽

John Butarbutar

Keyword(s):

Knee Osteoarthritis ◽

Knee Arthroplasty ◽

Proximal Tibia ◽

Varus Deformity ◽

Left Knee ◽

Tibial Osteotomy ◽

Posterior Stabilized ◽

Stem Extension ◽

Closed Wedge ◽

And Function

Alignment is crucial for successful knee arthroplasty.1 Tibia malunion will make arthroplasty more challenging. In this case, we present advanced knee osteoarthritis with tibia vara due to malunion that needs corrective osteotomy during knee arthroplasty. Case Presentation: A 70 years old female presented to our office complaining pain in both knees markedly on the left, profoundly felt during walking. She has a history of being hit by motorcycle 15 months ago and left knee was more bent since then. Physical examination of the left knee showed severe varus, mild effusion, tenderness on medial tibial condyle, otherwise normal. Plain radiographs showed advanced bilateral knee osteoarthritis with left proximal tibia malunion. Patient underwent left knee arthroplasty with corrective tibia and fibula osteotomy. Solutions and Outcome: Patient underwent closed wedge tibial osteotomy together with fibula osteotomy followed by knee arthroplasty with posterior-stabilized implant and tibial stem extension in a single surgery. Tibial osteotomy was reinforced using plate and screws. Partial weight bearing was achieved in second postoperative day and discharged on the third day. Patient able to walk with painless left knee after 1 month. Discussion: Severe deformity that causes huge malalignment makes knee arthroplasty difficult. Some methods are available to correct malalignment.1 In this case, the surgeon chose to do closed wedge tibial osteotomy reinforced with plate and screws to correct the proximal tibia malunion. Arthroplasty was done using posterior-stabilized implant and tibial stem extension. Patient shows good result in alignment and function. Conclusion: Correcting the associated deformity is crucial in achieving good alignment in knee arthroplasty. Even in our case of severe genu varus due to proximal tibia malunion, correcting proximal tibia varus deformity prior to knee arthroplasty shows good alignment and function. References: Mullaji AB, Padmanabhan V, Jindal G. Total Knee Arthroplasty for Profound Varus Deformity. 2005;20(5):550–61.

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