Knee Joint Space Research Articles

The In-Vivo Medial and Lateral Collateral Elongation Correlated with Knee Functional Score and Joint Space Following Unicompartmental Knee Arthroplasty.

The medial collateral ligament (MCL) and lateral collateral ligament (LCL) are paramount for joint stability. Their elongation patterns may change during fixed-bearing and mobile-bearing unicompartmental knee arthroplasty (FB and MB UKA). This study aims to explore the relationship between the elongation of MCL, LCL, and changes in joint space, as well as their correlation with functional scale scores during FB and MB UKA. We hypothesize that MCL and LCL have different elongation patterns in UKA patients, and there is a correlation between elongation and joint space and functional scores. The study recruited 24 patients undergoing UKA on a unilateral knee (13 FB and 11 MB). A dual fluoroscopic imaging system was employed to assess in-vivo knee kinematics during static standing and single-leg lunge. The superficial and deep MCL (sMCL, dMCL) and LCL were divided into anterior, medium, and posterior portions. The virtual ligament method quantified in-vivo ligament lengths. Analysis focused on the correlation of normalized ligament lengths with functional scores and joint space. 1. LCL Elongation in FB UKA: There is a significant increase in LCL elongation during early and mid-flexion of the single-leg lunge (p < 0.05). 2. MCL Elongation in MB UKA: Both sMCL and dMCL exhibit significant elongation during early and mid-flexion of the single-leg lunge (p < 0.05). 3. Correlation with Functional Scores: Differences in collateral ligament elongation in FB UKA are significantly correlated with the OKS and KSS, highlighting the impact on functional outcomes. In MB UKA, differences in ligament elongation are significantly correlated with the FJS. 4. Joint Space Correlation: There is a significant correlation between the elongation of the anterior and medium portions of dMCL and joint space in the surgical compartment during mid- and deep flexion (30-100 °, p < 0.05, r > 0.64). The study reveals distinct ligament elongation patterns between UKA and native knees in LCL for FB UKA and MCL for MB UKA. These patterns are associated with knee functional scores. Moreover, dMCL elongation correlates significantly with the joint space for MB UKA during middle and deep flexion phases. III; prospective retrospective cohort study.

Influences of mechanical decompression using different forces on knee joint space, range of motion, and hamstring flexibility in asymptomatic subjects

INTRODUCTION: Knee joint decompression is one of the promising methods for the treatment of osteoarthritis. Yet, the most appropriate decompression force is not conclusive. OBJECTIVES: To compare the effect of different distraction force magnitudes on knee joint space, active range of motion (ROM), hamstring flexibility, and self-reported discomfort in asymptomatic subjects. METHODS AND MATERIALS: Twenty-five asymptomatic participants were recruited in this study. The dominant knee was distracted for 30 minutes in a 30° flexion position using three force magnitudes (10%, 20%, and 30% body weight (BW)). The traction forces were randomized with one week in between knee distractions. Joint space, range of motion (ROM), and hamstring flexibility were assessed before, immediately after, and 30 minutes after the distraction. The self-reported discomfort was assessed immediately after the distraction only. RESULTS: Medial joint space, ROM, and discomfort showed a significant difference between different force magnitudes post-distraction. The 20% and 30% BW force magnitudes significantly, but equally, increased joint space and ROM post distraction. The discomfort level was directly related to distraction force magnitude and the least comforting was the 30% BW force. Follow-up data was not significantly different than that for post-distraction. Hamstring muscle flexibility showed a significant. Yet, small increase after the 30% BW distraction force. CONCLUSION: Continued mechanical distraction of the knee joint using force magnitudes of 20% and 30% of body weight was effective in increasing medial joint space, active knee ROM, and hamstring flexibility in asymptomatic individuals. 20% force magnitude was more comfortable than the 30% percent.

A new injection method for identifying the subpopliteal recess of the knee.

The posterolateral region of the knee has a complex and diverse anatomy. Hydrarthrosis of the knee can potentially communicate with other parts of the joint space. The joint fluid distribution reflects anatomical communications between synovial spaces. To observe the continuity between the knee joint cavity and the surrounding bursa, we devised a dissection method with a new injection agent, an eosin-containing congealed liquid that spreads uniformly over the entire space. The purpose of this study was to perform a detailed examination of the subpopliteal recess (SPR) where a bursa connects to the knee joint capsule. We also reported the advantages of this new injection agent compared with conventional materials (latex and epoxy resin). Twenty-two formalin-fixed cadavers (34 knees), two N-vinyl-pyrrolidone (NVP)-fixed cadavers (4 knees), and two cadavers (3 knees) fixed by Thiel's method were used. After filling the knee joint space and SPR with eosin congealed liquid, the specimens were dissected to investigate the morphology of the SPR. In addition, three different types of injection agents were assessed. The SPR extended distally along the popliteus tendon. The SPR length was 22.64 ± 11.38 mm from the upper end of the lateral tibial condyle to the lower end of the depression. The existence of a fabellofibular ligament made the SPR significantly longer, but abrasion of the femoral articular cartilage did not affect the SPR. Furthermore, the relationship between the popliteus muscle and the SPR was classified into three types (types 1-3). Types 2 and 3 in which the SPR extended to the proximal tibiofibular joint may cause instability of the knee joint. The eosin congealed liquid was highly useful in many aspects, such as fluidity and injection workability. The new dissection method with eosin congealed liquid provides insights into the anatomy of the posterior lateral knee, which are useful for radiological diagnoses and clinical treatments.

A Systematic Review of the Management of Knee Osteoarthritis by Proximal Fibular Osteotomy in the Indian Population.

This systematic review aims to assess the management of knee osteoarthritis through proximal fibular osteotomy (PFO) in the Indian population by synthesizing data from various prospective cohort and interventional studies. We seek to provide an overview of the effectiveness and safety of PFO as a treatment modality and offer insights into its potential implications for clinical practice in India. A systematic search strategy was employed, targeting multiple medical databases to identify relevant studies published from 2018 to2023. Inclusion criteria encompassed studies involving Indian patients with medial compartment knee osteoarthritis and varus deformity who underwent PFO. Data were extracted and evaluated according to the Newcastle-Ottawa Scale for observational studies. Eight studies were included in this review, each displaying varying designs, patient populations, and follow-up duration. The findings consistently indicated that PFO improved pain, knee function, and radiological outcomes, such as knee joint space and tibio-femoral angles. These improvements were generally sustained over several months to a year. The available evidence underscores the potential of PFO as a promising intervention for managing knee osteoarthritis in the Indian population, particularly in patients with medial compartment involvement and varus deformity. While these results are promising, the limitations inherent in the current literature, including study design variations and small sample sizes, necessitate further research with more extensive and diverse patient populations. This systematic review provides valuable insights for healthcare professionals and researchers, highlighting the need for more rigorous investigations and supporting the consideration of PFO as a viable treatment option for knee osteoarthritis in India.

ФУНКЦИОНАЛЬНАЯ ОЦЕНКА РЕЗУЛЬТАТОВ ПРОКСИМАЛЬНОЙ СЕГМЕНТАРНОЙ РЕЗЕКЦИИ МАЛОБЕРЦОВОЙ КОСТИ ПРИ ОСТЕОАРТРОЗЕ МЕДИАЛЬНОГО ОТДЕЛА КОЛЕННОГО СУСТАВА

Osteoarthritis (OA) of the knee joint is the commonest form of OA. It occurs commonly in the medial compartment because of a preponderance of varus knees. High tibial osteotomy, total knee replacement and unicompartmental knee replacement are technically demanding procedures, while proximal segmental fibular resection (PSFR) significantly relieves pain and improves joint function in knee osteoarthritis (OA). This study was conducted at the department of traumatology and orthopedics at the Belarusian state medical university. The objective of this study was to assess functional outcomes after PSFR and its correlation with bone mineral density. 23 patients with unicompartmental OA with varus deformity were included in the study. Inclusion criteria included patients with moderate-to-severe symptomatic medial unicom- partmental OA of the knee, who had an indication for a surgical procedure, and who were able to give informed consent for the surgery. Exclusion criteria included patients with posttraumatic knee OA or inflammatory joint disease and patients with a history of previous operations or fractures the primary outcome was measured by calculating the ratio of knee joint space. The secondary outcome measure was pain measured by the visual analog scale (VAS).

An accurate method for measuring knee joint space width despite variations in beam projection angles

BackgroundAssessing knee osteoarthritis (OA) severity through joint space width (JSW) measurements can be difficult due to anatomical variations, beam projection angle (BPA) errors, and patient posture during X-rays. Although various methods address these issues, a consensus on the reference point for accurate measurement is lacking. Therefore, establishing a precise evaluation method for JSW is imperative. MethodsSimulation on 30 knees with advanced OA to measure the JSW using digital reconstruction radiographs from computed tomography (CT) images was conducted. The distance between the medial femoral condyle and the anterior and posterior borders of the medial tibial plateau (represented by DAB and DPB, respectively) and their average (AVD) were used to evaluate JSW. Discrepancies were analyzed for various BPAs. Additionally, the reliability of measuring JSW using DAB, DPB, and AVD was evaluated in a proof-of-concept study on 100 knees using anteroposterior X-rays at three BPAs (neutral, 5° caudal, and 5° cephalic tilt). ResultsIn the simulation study, the AVD method had discrepancies below 1 mm from BPA 0° of 5°, 10° caudal tilt, and 5° cephalic tilt (P = 0.066, P = 0.120, and P < 0.001, respectively). However, the values of DAB and DPB showed significant discrepancies from BPA 0° (all over 1 mm and all P < 0.001) for various BPAs. The AVD measurement demonstrated the least discrepancy in JSW measurements based on BPA variations compared with DAB and DPB methods in the proof-of-concept study. ConclusionsA simple method for accurately measuring joint space width, even when X-rays are taken at unintended angles can be applied in clinical practice.

Imaging of knee osteoarthritis: a review of multimodal diagnostic approach.

Knee osteoarthritis (KOA) is a common chronic condition among the elderly population that significantly affects the quality of life. Imaging is crucial in the diagnosis, evaluation, and management of KOA. This manuscript reviews the various imaging modalities available until now, with a little focus on the recent developments with Artificial Intelligence. Currently, radiography is the first-line imaging modality recommended for the diagnosis of KOA, owing to its wide availability, affordability, and ability to provide a clear view of bony components of the knee. Although radiography is useful in assessing joint space narrowing (JSN), osteophytes and subchondral sclerosis, it has limited effectiveness in detecting early cartilage damage, soft tissue abnormalities and synovial inflammation. Ultrasound is a safe and affordable imaging technique that can provide information on cartilage thickness, synovial fluid, JSN and osteophytes, though its ability to evaluate deep structures such as subchondral bone is limited. Magnetic resonance imaging (MRI) represents the optimal imaging modality to assess soft tissue structures. New MRI techniques are able to detect early cartilage damage measuring the T1ρ and T2 relaxation time of knee cartilage. Delayed gadolinium-enhanced MRI of cartilage, by injecting a contrast agent to enhance the visibility of the cartilage on MRI scans, can provide information about its integrity. Despite these techniques can provide valuable information about the biochemical composition of knee cartilage and can help detect early signs of osteoarthritis (OA), they may not be widely available. Computed tomography (CT) has restricted utility in evaluating OA; nonetheless, weight-bearing CT imaging, using the joint space mapping technique, exhibits potential in quantifying knee joint space width and detecting structural joint ailments. PET-MRI is a hybrid imaging technique able to combine morphological information on bone and soft tissue alterations with the biochemical changes, but more research is needed to justify its high cost and time involved. The new tools of artificial intelligence, including machine learning models, can assist in detecting patterns and correlations in KOA that may be useful in the diagnosis, grading, predicting the need for arthroplasty, and improving surgical accuracy.

Medial Knee Joint Space in Relation to Joint Function and Early Knee Pain in 20-45-Year Adults: A Cross Sectional Study.

Anterior knee pain is very common in the young and active age groups but there are no significant studies on the normal population. Therefore, the objective of the study was to understand the relation between medial knee joint space to the development of knee pain and functional disability with special reference to the 20-45-year age group. 250 cases with mean age of 36.36years presenting with knee pain for at least 1month were included in this prospective study (July 2021 and June 2022) and were asked to self-complete questionnaires on knee pain which included KNEST, AKPQ, VAS and IPAQ. Patients underwent X-rays of bilateral knees in AP view with weight bearing and then medial and lateral knee joint spaces were calculated. There was a higher incidence of knee pain in women compared to men. The average medial and lateral joint space widths (MJSW and LJSW) of the right knee were 4.22mm and 4.57mm, respectively. For the left knee it was 4.19mm and 4.42mm, respectively. There is a decrease in MJSW with increasing age, level of pain and BMI. Also, with an increase in physical activity, there was a higher incidence of knee pain. Overuse injuries are the main cause of knee pain in this age group. There is a significant association between medial joint space width and age, gender, level of pain, and BMI. Rising BMI patterns at a young age, leads to an increase in physical activity, which in turn leads to early knee pain and also predisposes to osteoarthritis.

Deep learning based phenotyping of medical images improves power for gene discovery of complex disease

Electronic health records are often incomplete, reducing the power of genetic association studies. For some diseases, such as knee osteoarthritis where the routine course of diagnosis involves an X-ray, image-based phenotyping offers an alternate and unbiased way to ascertain disease cases. We investigated this by training a deep-learning model to ascertain knee osteoarthritis cases from knee DXA scans that achieved clinician-level performance. Using our model, we identified 1931 (178%) more cases than currently diagnosed in the health record. Individuals diagnosed as cases by our model had higher rates of self-reported knee pain, for longer durations and with increased severity compared to control individuals. We trained another deep-learning model to measure the knee joint space width, a quantitative phenotype linked to knee osteoarthritis severity. In performing genetic association analysis, we found that use of a quantitative measure improved the number of genome-wide significant loci we discovered by an order of magnitude compared with our binary model of cases and controls despite the two phenotypes being highly genetically correlated. In addition we discovered associations between our quantitative measure of knee osteoarthritis and increased risk of adult fractures- a leading cause of injury-related death in older individuals-, illustrating the capability of image-based phenotyping to reveal epidemiological associations not captured in the electronic health record. For diseases with radiographic diagnosis, our results demonstrate the potential for using deep learning to phenotype at biobank scale, improving power for both genetic and epidemiological association analysis.

Indications of musculoskeletal health in deceased male individuals with lower-limb amputations: comparison to non-amputee and diabetic controls

Individuals with lower-limb amputations, many of whom have type 2 diabetes, experience impaired musculoskeletal health. This study: (1) compared residual and intact limbs of diabetic and non-diabetic post-mortem individuals with amputation to identify structures vulnerable to injury, and (2) compared findings to diabetic and healthy control groups to differentiate influences of amputation and diabetes on musculoskeletal health. Postmortem CT scans of three groups, ten individuals each, were included: (1) individuals with transtibial or transfemoral amputations, half with diabetes (2) diabetic controls, and (3) healthy controls. Hip and knee joint spaces, cross-sectional thigh muscle and fat areas, and cross-sectional bone properties (e.g. area, thickness, geometry) were measured. Wilcoxon Signed-Rank and Kruskal–Wallis tests assessed statistical significance. Asymmetry percentages between limbs assessed clinical significance. Residual limbs of individuals with amputation, particularly those with diabetes, had significantly less thigh muscle area and thinner distal femoral cortical bone compared to intact limbs. Compared to control groups, individuals with amputation had significantly narrower joint spaces, less thigh muscle area bilaterally, and thinner proximal femoral cortical bone in the residual limb. Diabetic individuals with amputation had the most clinically significant asymmetry. Findings tended to align with those of living individuals. However, lack of available medical information and small sample sizes reduced the anticipated clinical utility. Larger sample sizes of living individuals are needed to assess generalizability of findings. Quantifying musculoskeletal properties and differentiating influences of amputation and diabetes could eventually help direct rehabilitation techniques.

Assessment of joint line obliquity and its related frontal deformity using long-standing radiographs

PurposeTo investigate how radiographic techniques and osteoarthritis grade influence measurements of knee joint line obliquity (KJLO) and KJLO-related frontal deformity, and to propose preferable KJLO measurement methods. MethodsForty patients with symptomatic medial knee osteoarthritis indicated for high tibial osteotomy were assessed. Measurements were compared between single-leg and double-leg standing radiographs for KJLO measurement methods including joint line orientation angle by femoral condyles (JLOAF), joint line orientation angle by middle knee joint space (JLOAM), joint line orientation angle by tibial plateau (JLOAT), Mikulicz joint line angle (MJLA) and medial proximal tibial angle (MPTA), as well as KJLO-related frontal deformity parameters including joint line convergence angle (JLCA), knee ankle joint angle (KAJA) and hip-knee-ankle angle (HKA). Influences of bipedal distance in double-leg standing and osteoarthritis grade on the above measurements were analysed. Measurement reliability was evaluated by intraclass correlation coefficient. ResultsFrom single-leg to double-leg standing radiographs MPTA and KAJA did not change significantly, whereas the other measurements showed significant changes: JLOAF, JLOAM and JLOAT decreased 0.88°, 1.24° and 1.77°, MJLA and JLCA decreased 0.63° and 0.85°, and HKA increased 1.11° (p < 0.05). Bipedal distance in double-leg standing radiographs moderately correlated with JLOAF, JLOAM and JLOAT (rp = −0.555, −0.574 and −0.549). Osteoarthritis grade moderately correlated with JLCA in single-leg and double-leg standing radiographs (rs = 0.518 and 0.471). All measurements had at least good reliability. ConclusionIn long-standing radiographs, measurements of JLOAF, JLOAM, JLOAT, MJLA, JLCA and HKA are all influenced by single-leg/double-leg standing; JLOAF, JLOAM and JLOAT are also affected by bipedal distance in double-leg standing; and JLCA is affected by osteoarthritis grade. Knee joint obliquity as assessed by MPTA measurement is independent of single-leg/double-leg standing, bipedal distance or osteoarthritis grade, and has excellent measurement reliability. We therefore propose MPTA as the preferable KJLO measurement method for clinical practice and future research. Level of evidenceIII, cross-sectional study.

Outcomes of combined proximal fibular osteotomy and arthroscopic intervention for treatment of medial compartment knee osteoarthritis

Background This study aimed to evaluate the outcomes of combined proximal fibular osteotomy (PFO) and arthroscopic intervention for the treatment of medial compartment knee osteoarthritis. Patients and methods This prospective study included 49 knees in 44 patients (34 females and 10 males). Their mean age was 48.4 ± 5.4 years, and the mean BMI was 26.23 ± 2.44. There were 11 knees with Kellgren–Lawrence grade II, 33 with grade III, and five with grade IV. There was varus deformity (range, 6.1°–9.5°) in 34 knees. Combined PFO with arthroscopic lavage and debridement were done. Results The mean follow-up was 19.48 ± 2.45 months. There was significant improvement in the mean visual analog score (from 7.24 preoperatively to 1.7 at 12-month follow-up) and Knee Society Score (from 44.79 preoperatively to 72.95 at the final follow-up). There was significant increase in the medial knee joint space (from 1.9 preoperatively to 4.82 postoperatively). The varus angle improved significantly (from 7.8 preoperatively to 1.7 postoperatively). Till the final follow-up, there was no conversion to total knee arthroplasty. Conclusion In selected patients, PFO in combination with arthroscopic lavage and debridement could be an alternative option for treating medial compartment knee osteoarthritis through decreasing varus deformity and improving symptoms. These combined procedures could be a suitable surgical option in most developing countries that lack financial and medical resources. However, more multicentric comparative studies with long-term follow-up are required to extract more significant conclusions. Level of evidence This study was a level IV case series.

The effect of hypertonic dextrose prolotherapy on knee osteoarthritis outpatients in Dr. Ramelan Navy Hospital Surabaya: case series

Background: The high use and pressure on the knee cause osteoarthritis to occur frequently. Prolotherapy is a non-surgical injection therapy used to treat chronic pain in musculoskeletal conditions, including knee OA. This solution can create local irritation, inflammation, and tissue regeneration, thereby increasing the strength of damaged ligaments, tendons, and intra-articular structures. Therefore, the aim of this research is to assess the changes in VAS and WOMAC scores, as well as plain radiographs of knee OA patients after hypertonic dextrose prolotherapy. Methods: This experimental case series was done at the Physical Medicine and Rehabilitation Polyclinic of dr. Ramelan Navy Hospital Surabaya from December 2021 to April 2022, by giving hypertonic dextrose prolotherapy injection intraarticularly to 3 knee OA subjects using a 22G or 23G needle. This procedure was performed 3 times on each subject, with an interval of 4 weeks each. The assessments were carried out with VAS and WOMAC scores, as well as plain radiographs of the knees before the procedure and 1 month after the third injection for evaluation. Results: In all 3 subjects, the knee joint spaces were slightly widened on plain radiographs, as well as decreased VAS and WOMAC scores after injection. Conclusion: Hypertonic dextrose prolotherapy here had minimal side effects, affordable prices, and a fast process. It also causes a reduction in pain and joint stiffness and causes functional improvement. Prolotherapy may be considered a therapy for knee OA patients.

A Framework of Faster CRNN and VGG16-Enhanced Region Proposal Network for Detection and Grade Classification of Knee RA

We developed a framework to detect and grade knee RA using digital X-radiation images and used it to demonstrate the ability of deep learning approaches to detect knee RA using a consensus-based decision (CBD) grading system. The study aimed to evaluate the efficiency with which a deep learning approach based on artificial intelligence (AI) can find and determine the severity of knee RA in digital X-radiation images. The study comprised people over 50 years with RA symptoms, such as knee joint pain, stiffness, crepitus, and functional impairments. The digitized X-radiation images of the people were obtained from the BioGPS database repository. We used 3172 digital X-radiation images of the knee joint from an anterior-posterior perspective. The trained Faster-CRNN architecture was used to identify the knee joint space narrowing (JSN) area in digital X-radiation images and extract the features using ResNet-101 with domain adaptation. In addition, we employed another well-trained model (VGG16 with domain adaptation) for knee RA severity classification. Medical experts graded the X-radiation images of the knee joint using a consensus-based decision score. We trained the enhanced-region proposal network (ERPN) using this manually extracted knee area as the test dataset image. An X-radiation image was fed into the final model, and a consensus decision was used to grade the outcome. The presented model correctly identified the marginal knee JSN region with 98.97% of accuracy, with a total knee RA intensity classification accuracy of 99.10%, with a sensitivity of 97.3%, a specificity of 98.2%, a precision of 98.1%, and a dice score of 90.1% compared with other conventional models.

Synovial lipoma of the ankle and foot: a rare case report

Synovial lipomatosis is an extremely rare type of disease in which there is an excess of adipose tissue involving the synovium layer of joints or synovial sheath around the tendons causing pain, paraesthesia, and weakness. The most common site being reported till now is Knee joint or parapatellar space other joints such as elbows and shoulders are being reported after the knee joint, and the ankle joint is rarely reported 2 cases have been reported in the English literature. We report a case of a 28-year-old male presenting with swelling of the right foot for 12 years and developed symptoms of pain and tingling on the toes for 2-3 weeks. Multiple bony hard lesions were palpated on the base of the foot, ultrasonography (USG) showed a subcutaneous lesion around the extensor tendons of the foot and fine needle aspiration cytology (FNAC) had a picture of the synovial cyst. Surgical excision was done and histopathology was reported to be as a fibrofatty tissue with multiple adipocytes suggesting lipoma arborescent.

Association of physical activity with loss of knee joint space width over two years: a compositional data analysis in the Osteoarthritis Initiative

There is continued debate as to how engaging in physical activity (PA), including moderate-to-vigorous PA (MVPA), light PA (LPA), and sedentary time (SED), affects one's risk for knee osteoarthritis (OA). Traditional regression methods do not account for the codependence of these categories of PA, whereby when one category increases, the others must decrease. Thus, we used compositional data analysis (CoDA) to examine time spent in each category of PA, or PA composition, and its association with loss of knee joint space width (JSW), a common indicator of knee OA progression. We performed a secondary analysis of data from a subset of participants in the Osteoarthritis Initiative. These participants had minute-by-minute activity data collected over 7 days at baseline; we then categorized each minute as MVPA, LPA, or SED. Our exposure, PA composition, represented min/day spent in each category. Our outcome, medial JSW loss, was the difference in medial tibiofemoral JSW from baseline to 2years later. We employed CoDA, using an isometric log-ratio transformation, to examine the association of PA composition with medial JSW loss over 2years, adjusting for potential confounders. We included 969 participants (age: 64.5 years, 56% female, body mass index [BMI]: 28.8kg/m2). Mean PA composition was: MVPA 9.1min/day, LPA 278min/day, SED 690min/day. Per adjusted regression models, higher MVPA was not associated with greater medial JSW loss (β=-0.0005, P=0.97), nor was LPA (β=0.06, P=0.27) or SED (β=-0.06, P=0.21). Using CoDA, PA composition was not associated with medial JSW loss over 2years.

Effect of Total Hip Arthroplasty on Ipsilateral Lower Limb Alignment and Knee Joint Space Width: Minimum 5-Year Follow-up.

This study aimed to 1) assess the effect of total hip arthroplasty (THA) on coronal limb alignment, namely, the hip-knee-ankle angle (HKA), 2) identify factors that determine changes in the HKA, and 3) determine whether alignment changes influence the knee joint space width. We retrospectively evaluated 266 limbs of patients who underwent THA. Three types of prostheses with neck shaft angles (NSAs) of 132°, 135°, and 138° were used. Several radiographic parameters were measured in the preoperative and final radiographs (at least 5 years after THA). A paired t-test was used to confirm the effect of THA on HKA change. Multiple regression analysis was performed to identify radiographic parameters related to HKA changes following THA and changes in knee joint space width. Subgroup analyses were performed to reveal the effect of NSA change on the HKA change, and the proportion of total knee arthroplasty usage and changes in radiographic parameters between maintained joint space and narrowed joint space groups were compared. The preoperative mean HKA was 1.4° varus and increased to 2.7° varus after THA. This change was related to changes in the NSA, lateral distal femoral angle, and femoral bowing angle. In particular, in the group with a decrease in NSA of > 5°, the preoperative mean HKA was largely changed from 1.4° varus to 4.6° varus after THA. The prostheses with NSA of 132° and 135° also led to greater varus HKA changes than those with an NSA of 138°. Narrowing of the medial knee joint space was related to changes in the varus direction of the HKA, decrease in NSA, increase in femoral offset. A large reduction in NSA can lead to considerable varus limb alignment after THA, which can have adverse effects on the medial compartment of the ipsilateral knee.

Statistical modeling: Assessing the anatomic variability of knee joint space width

Population-based knee joint space width (JSW) assessments are promising for the prevention and early diagnosis of osteoarthritis. This study aimed to establish the statistical shape and alignment model (SSAM) of knee joints for assessing anatomic variation in knee JSW in the healthy Chinese male population. CT scans of asymptomatic knee joints of healthy male participants (n = 107) were collected for manual segmentation to create mesh samples. The as-scanned positional error was reduced by a standard processing flow of deformable mesh registration. Principal component analysis (PCA) was performed to create a tibiofemoral SSAM that was trained on all mesh samples. The anatomic variability of the JSW in the healthy Chinese male population was then assessed using the SSAM with regression analysis and 3D analysis by color-coded mapping. Almost all PCA modes had a linear influence on the anatomic variation of the medial and lateral JSW. The JSW variability within the SSAM was mainly explained by mode 1 (45.1 % of variation), demonstrating that this mode had the greatest influence on JSW variation. 3D assessment of the JSW showed that the minimum medial JSW varied from 2.76 to 3.23 mm, and its site shifted a short distance on the medial tibial plateau. The root-mean-square fitting and generalization errors of the SSAM were below 1 mm. This study will benefit the design and optimization of prosthetic devices, and may be applicable to the prevention and early diagnosis of osteoarthritis.

A STUDY ON FUNCTIONAL OUTCOME AFTER HIGH FIBULAR OSTEOTOMY IN MEDIAL COMPARTMENT OSTEOARTHRITIS KNEE.

Background: Primary Osteoarthritis of the knee is more prevalent than that of the other joints. Treatment for knee osteoarthritis can be broken down into nonsurgical and surgical management. Initial treatment begins with nonsurgical modalities and moves to surgical treatment once the nonsurgical methods are no longer effective. Various treatment modalities available include intraarticular injections, physiotherapy, visco supplementation, arthroscopic debridement, high tibial osteotomy, and knee replacement with uni compartmental arthroplasty. All of it has its complications. Hence, there is a necessity for a modest technique, easily reproducible, provides decent functional outcomes and associated with a smaller recovery period, and develops the quality of life for the affected patients. In this scenario, this study is designed to know the functional outcomes, when an osteotomy of the bula at proximal 3rd is performed in medial compartment osteoarthritis knee. The present study was conducted at the depart Methods: ment of orthopaedics Andhra medical college/ king George hospital Visakhapatnam between 2019 and 2021.Thirtypatients who fullled inclusion criteria were taken up for study n=30. Statistical Analysis: Statistical analysis was performed using SPSS version 19.0 statistical software for the window. Continuous variables were expressed as mean, ±SD, and dichotomous variables were expressed as percentages. A two-tailed t-test was applied to analyze the postoperative weightbearing ratio of knee joint space (medial/lateral compartment) data. In addition, the nonparametric test (Wilcoxson's signed-rank test) was applied to analyze the OKS, AKSS, and VAS scores. The chi-square test will analyze the Comparison of qualitative variable, and Comparison of the quantitative variable will be analyzed by independent samples unpaired T-test. A P-value less than 0.05 was considered to be signicant. Data will be entered in Microsoft Excel, and data analysis was performed using windows MEDCALC software on a personal computer. Results: Sample size of the present study was 30 (n=30). Average age of the patients was 56 years. with males accounting to 56.66% and female's 43.33 percent. There were 17 males and 13 females among the 30 patients. The majority of the patients have grade 2 medial compartment osteo arthritis. Preoperatively, the mean medial/lateral joint space ratio was 0.26+/-0.12, which increased in the postoperative phase, reaching 0.67+/- 0.29 after six months. Proximal bular osteotomy effectively reduces the pain of m Conclusion: edial compartment osteoarthritis. It also improves the mean vas pain score earliest postoperatively. We observed modest improvement in both oxford knee scores and American knee society score.

Research progress of lower limb alignment correction and prosthesis position angle in unicompartmental knee arthroplasty

The angle between the lower extremity force line and the position of the unicondylar prosthesis is an important factor affecting the long-term survival and rate clinical outcome of the unicondylar replacement prostheses. Insufficient lower limb alignment will accelerate the wear of prosthesis and reduce the survival rate of prosthesis. Excessive lower limb alignment will accelerate the progress of contralateral interventricular arthritis. It is generally believed that the lower limb force line should be corrected in mild varus after unicompartmental knee arthroplasty. However, some scholars believe that the lower limb alignment has no effect on the functional score and prosthesis survival rate after unicompartmental knee arthroplasty. The poor position of femoral and tibial prosthesis will cause unexplained pain and even prosthesis wear, but the optimal position of femoral and tibial prosthesis is controversial. It is generally believed that the posterior tibial slope should be corrected in the range of 3° to 7° in unicompartmental knee arthroplasty, but some scholars believe that excessive change of posterior tibial slope will also affect the balance of knee joint space and knee joint range of motion. This study shows that the correction of lower limb alignment to mild varus is still the best lower limb alignment for unicompartmental knee arthroplasty. The best position of femoral and tibial prosthesis needs to be confirmed by further biomechanical research. The correction of tposterior tibial slope should be changed according to the specific original dissection angle of patients before operation.