Constitutional Varus Does Not Affect Joint Line Orientation in the Coronal Plane

• Published in: Clinical orthopaedics and related research Vol. 472; no. 1; pp. 98 - 104
• Main Authors: Victor, Jan M. K., Bassens, David, Bellemans, Johan, Gürsu, Sarper, Dhollander, Aad A. M., Verdonk, Peter C. M.
• Format: Journal Article
• Language: English
• Published: Boston Springer US 01.01.2014; Lippincott Williams & Wilkins Ovid Technologies
• Subjects: Adult; Bone Malalignment - diagnostic imaging; Conservative Orthopedics; Female; Humans; Knee; Knee Joint - diagnostic imaging; Male; Medicine; Medicine & Public Health; Middle Aged; Orientation; Orthopedics; Osteoarthritis, Knee - diagnostic imaging; Radiography; Reference Values; Sports Medicine; Surgery; Surgical Orthopedics; Symposium: 2013 Knee Society Proceedings; Varus Deformity; Joint Line; Coronal Plane; High Tibial Osteotomy; Mechanical Axis
• ISSN: 0009-921X; 1528-1132; 1528-1132
• DOI: 10.1007/s11999-013-2898-6

Background In a previous study, we described the distribution of coronal alignment in a normal asymptomatic population and recognized the occurrence of constitutional varus in one of four individuals. It is important to further investigate the influence of this condition on the joint line orientation and how the latter is affected by the onset and progression of arthritis. Questions/purposes The purposes of this study are (1) to describe the distribution of joint line orientation in the coronal plane in the normal population; (2) to compare joint line orientation between patients with constitutional varus and neutral mechanical alignment; and (3) to compare joint line orientation between a cohort of patients with prearthritic constitutional varus and a cohort of patients with established symptomatic varus arthritis. Methods Full-leg standing hip-to-ankle digital radiographs were performed in 248 young healthy individuals and 532 patients with knee arthritis. Hip-knee-ankle (HKA) angle and tibial joint line angle (TJLA) were measured in the coronal plane. Patients were subdivided into varus (HKA ≤ −3°), neutral, and valgus (HKA ≥ 3°). Results The mean TJLA in healthy subjects was 0.3° (SD 2.0°). TJLA was parallel to the floor in healthy subgroups with neutral alignment (TJLA 0.3°, SD 1.9) and constitutional varus (TJLA 0.2°, SD 2.2°). In patients with symptomatic arthritis and varus alignment, the TJLA opened medially (mean −1.9°, SD 3.5°). Conclusions Constitutional varus does not affect joint line orientation. Advanced medial arthritis causes divergence of the joint line from parallel to the floor. These findings influence decision-making for osteotomy and alignment in total knee arthroplasty. Level of Evidence Level III, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.