The Optimal Variation Range of Posterior Condylar Offset Associated with Positive Clinical Outcomes of Primary Total Knee Arthroplasty: A Retrospective Analysis

Abstract

Objective: Posterior condylar offset (PCO) and anterior condylar offset (ACO) exert an influence on the sagittal alignment in total knee arthroplasty (TKA). However, there is no common consensus that the variation range of posterior condylar offset (PCO) is associated with patient-reported outcome measures (PROMs) and the optimum variation range of PCO. This study aims to investigate the correlation between PCO and the PROMs of primary TKA for osteoarthritis (OA) and find out the optimal variation range of the PCO.

Methods: In this study, we performed a radiographic analysis of 106 patients (112 knees) with primary TKA. Patients were divided into two cohorts (A and B) according to the Western Ontario and McMaster Universities Osteoarthritis index (WOMAC). Correlations between the sagittal parameter and WOMAC were investigated using univariate and multivariate analysis. The receiver operating characteristic (ROC) curve was used to establish the cut-off value for the optimal variation range. We then further investigated how different variation range affects the WOMAC subscale score and forgotten-joint-score-12 (FJS-12).

Results: Univariate analysis revealed a correlation between the variation range of PCO (p < 0.01), ACO (p < 0.01) and PROMs. Multivariate analysis showed that only PCO was associated with PROMs. In the ROC graph, the cut-off value of the variation range of PCO is 2.85 mm (AUC = 0.66, Youden index = 0.26). The WOMAC functional ability score of the group outside the PCO variation range of 2.85 mm significantly increased compared to the group within the range.

Conclusion: In this study, PCO variation was significantly associated with clinical outcomes in TKA and the optimal PCO variation range was within 2.85 mm. Maintaining the PCO variation within 2.85 mm could enhance functional recovery and patient satisfaction.

Keywords

Knee / Osteoarthritis / Posterior condylar offset / Total knee arthroplasty

References

[1] Hunter DJ, Bierma-Zeinstra S. Osteoarthritis. Lancet. 2019; 393(10182): 1745–1759.

[2] Li H, Zhu F, Liao S, Wang X, Zhong Y, Wen X, et al. Higher pelvic incidence was associated with a higher risk of sagittal malposition of femoral component and poor outcomes of primary Total knee arthroplasty: a retrospective cohort analysis. J Knee Surg. 2023; 36(8): 806–813.

[3] Bonnin MP, Beckers L, Leon A, Chauveau J, Müller JH, Tibesku CO, et al. Custom total knee arthroplasty facilitates restoration of constitutional coronal alignment. Knee Surg Sports Traumatol Arthrosc. 2022; 30(2): 464–475.

[4] An H-M, Gu W, Nan S-K, Liu Z, Li R, Chai W. Sagittal alignment in total knee arthroplasty: are there any discrepancies between robotic-assisted and manual axis orientation? J Bone Jt Surg. 2023; 105(17): 1338–1343.

[5] Farooq H, Deckard ER, Carlson J, Ghattas N, Meneghini RM. Coronal and sagittal component position in contemporary Total knee arthroplasty: targeting native alignment optimizes clinical outcomes. J Arthroplasty. 2023; 38(7 Suppl 2): S245–S251.

[6] Clement ND, MacDonald DJ, Hamilton DF, Burnett R. Posterior condylar offset is an independent predictor of functional outcome after revision total knee arthroplasty. Bone Joint Res. 2017; 6(3): 172–178.

[7] Bracey DN, Brown ML, Beard HR, Mannava S, Nazir OF, Seyler TM, et al. Effects of patellofemoral overstuffing on knee flexion and patellar kinematics following total knee arthroplasty: a cadaveric study. Int Orthop. 2015; 39(9): 1715–1722.

[8] Li CY, Ng Cheong Chung KJ, Ali OME, Chung NDH, Li CH. Literature review of the causes of pain following total knee replacement surgery: prosthesis, inflammation and arthrofibrosis. EFORT Open Rev. 2020; 5(9): 534–543.

[9] Benazzo F, Ghiara M, Rossi SMP, Pruneri E, Tiwari V, Perelli S. Clinical and radiological analysis of a personalized total knee arthroplasty system design. Int Orthop. 2019; 43(5): 1113–1121.

[10] Matziolis G, Brodt S, Windisch C, Roehner E. Changes of posterior condylar offset results in midflexion instability in single-radius total knee arthroplasty. Arch Orthop Trauma Surg. 2017; 137(5): 713–717.

[11] Kang KT, Koh YG, Son J, Kwon OR, Lee JS, Kwon SK. A computational simulation study to determine the biomechanical influence of posterior condylar offset and tibial slope in cruciate retaining total knee arthroplasty. Bone Joint Res. 2018; 7(1): 69–78.

[12] Han HS, Kang SB. Interactive effect of femoral posterior condylar offset and tibial posterior slope on knee flexion in posterior cruciate ligament-substituting total knee arthroplasty. Knee. 2018; 25(2): 335–340.

[13] Ko JH, Han CD, Shin KH, Nguku L, Yang IH, Lee WS, et al. Femur bowing could be a risk factor for implant flexion in conventional total knee arthroplasty and notching in navigated total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc. 2016; 24(8): 2476–2482.

[14] Akiyama K, Shibuya T. Influence of femoral bowing on range of motion after total hip arthroplasty. Int Orthop. 2018; 42(8): 1795–1802.

[15] Lewis GN, Rice DA, McNair PJ, Kluger M. Predictors of persistent pain after total knee arthroplasty: a systematic review and meta-analysis. Br J Anaesth. 2015; 114(4): 551–561.

[16] Tanikawa H, Tada M, Harato K, Okuma K, Nagura T. Influence of Total knee arthroplasty on patellar kinematics and patellofemoral pressure. J Arthroplasty. 2017; 32(1): 280–285.

[17] Alattas SA, Smith T, Bhatti M, Wilson-Nunn D, Donell S. Greater pre-operative anxiety, pain and poorer function predict a worse outcome of a total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc. 2017; 25(11): 3403–3410.

[18] Degen RM, Matz J, Teeter MG, Lanting BA, Howard JL, McCalden RW. Does posterior condylar offset affect clinical results following Total knee arthroplasty? J Knee Surg. 2018; 31(8): 754–760.

[19] Geijsen GJ, Heesterbeek PJ, van Stralen G, Anderson PG, Wymenga AB. Do tibiofemoral contact point and posterior condylar offset influence outcome and range of motion in a mobile-bearing total knee arthroplasty? Knee Surg Sports Traumatol Arthrosc. 2014; 22(3): 550–555.

[20] Khow YZ, Liow MHL, Lee M, Chen JY, Lo NN, Yeo SJ. Posterior condylar offset and posterior tibial slope targets to optimize knee flexion after unicompartmental knee arthroplasty. Knee Surg Sports Traumatol Arthrosc. 2022; 30(3): 822–831.

[21] Bellemans J, Banks S, Victor J, Vandenneucker H, Moemans A. Fluoroscopic analysis of the kinematics of deep flexion in total knee arthroplasty. Influence of posterior condylar offset. J Bone Joint Surg. 2002; 84(1): 50–53.

[22] Antony J, Tetsworth K, Hohmann E. Influence of sagittal plane component alignment on kinematics after total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc. 2017; 25(6): 1686–1691.

[23] Matz J, Howard JL, Morden DJ, MacDonald SJ, Teeter MG, Lanting BA. Do changes in patellofemoral joint offset Lead to adverse outcomes in Total knee arthroplasty with patellar resurfacing? A Radiographic Review. J Arthroplasty. 2017; 32(3): 783–787.

[24] Puranik HG, Mukartihal R, Patil SS, Dhanasekaran SR, Menon VK. Does femoral notching during Total knee arthroplasty influence Periprosthetic fracture. A Prospective Study. J Arthroplasty. 2019; 34(6): 1244–1249.

[25] Singh JA, Jensen M, Lewallen D. Predictors of periprosthetic fracture after total knee replacement: an analysis of 21, 723 cases. Acta Orthop. 2013; 84(2): 170–177.

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2024 The Author(s). Orthopaedic Surgery published by Tianjin Hospital and John Wiley & Sons Australia, Ltd.