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The contralateral limb is no reliable reference to restore coronal alignment in TKA.

Lucas Beckers^1,2,3, William Colyn⁴, Johan Bellemans^5,6,7

¹Department of Orthopaedic Surgery and Traumatology, Sint-Jan Hospital, Ruddershove 10, 8000, Bruges, Belgium.

Knee Surgery, Sports Traumatology, Arthroscopy : Official Journal of the ESSKA

|July 23, 2020

Summary

Coronal alignment in the lower limb does not exhibit strict left-to-right symmetry. The contralateral limb is not a reliable reference for reconstructing frontal plane alignment in total knee arthroplasty (TKA).

Keywords:

Alignment Arthroplasty Contralateral Coronal Knee Knee replacement Lower extremity Symmetry

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Area of Science:

Orthopedic surgery
Biomechanical analysis
Radiographic imaging

Background:

Morphometric reference data from the contralateral limb is often suggested for coronal plane alignment reconstruction in total knee arthroplasty (TKA).
Limited radiographic evidence confirms left-to-right symmetry in coronal alignment.
The reliability of using the unaffected limb as a reference for frontal plane alignment reconstruction is not well-established.

Purpose of the Study:

To verify the presence of left-to-right symmetry in coronal alignment using full-leg standing radiographs.
To assess the reliability of the contralateral lower limb as a reference for reconstructing frontal plane alignment in TKA.

Main Methods:

Review of full-leg standing radiographs from 250 volunteers (125 male, 125 female).
Analysis of three alignment parameters: Hip-Knee-Ankle angle (HKA), Femoral Mechanical Angle (FMA), and Tibial Mechanical Angle (TMA).
Evaluation of symmetry using HKA subdivisions and limb, femoral, and tibial phenotypes; calculation of inter- and within-subject variability, correlation coefficients, and coefficients of determination.

Main Results:

Symmetrical coronal alignment distribution was observed in 79% (HKA subdivision) and 59% (limb phenotype) of the cohort.
Gender differences were noted in common symmetric limb phenotypes.
Inter-subject variability exceeded within-subject side differences; correlation analyses showed moderate to weak left-to-right relationships, with only moderate predictability for HKA and FMA in females.
Only 60% of left knees fell within a 3° interval of the contralateral right knee alignment.

Conclusions:

Strict left-to-right symmetry in coronal alignment measurements was not observed.
Insufficient left-to-right agreement exists to consider the contralateral unaffected limb an idealized reference for frontal plane alignment reconstruction based on radiographs.