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A comparison of radiographic anatomic axis knee alignment measurements and cross-sectional associations with knee osteoarthritis

A comparison of radiographic anatomic axis knee alignment measurements and cross-sectional associations with knee osteoarthritis
A comparison of radiographic anatomic axis knee alignment measurements and cross-sectional associations with knee osteoarthritis
Objective: Malalignment is associated with knee osteoarthritis (KOA), however, the optimal anatomic axis (AA) knee alignment measurement on a standard limb radiograph (SLR) is unknown. This study compares one-point (1P) and two-point (2P) AA methods using three knee joint centre locations and examines cross-sectional associations with symptomatic radiographic knee osteoarthritis (SRKOA), radiographic knee osteoarthritis (RKOA) and knee pain.

Methods: AA alignment was measured six different ways using the KneeMorf software on 1058 SLRs from 584 women in the Chingford Study. Cross-sectional associations with principal outcome SRKOA combined with greatest reproducibility determined the optimal 1P and 2P AA method. Appropriate varus/neutral/valgus alignment categories were established using logistic regression with generalised estimating equation models fitted with restricted cubic spline function.

Results: The tibial plateau centre displayed greatest reproducibility and associations with SRKOA. As mean 1P and 2P values differed by >2°, new alignment categories were generated for 1P: varus <178°, neutral 178–182°, valgus >182° and for 2P methods: varus <180°, neutral 180–185°, valgus >185°. Varus vs neutral alignment was associated with a near 2-fold increase in SRKOA and RKOA, and valgus vs neutral for RKOA using 2P method. Nonsignificant associations were seen for 1P method for SRKOA, RKOA and knee pain.

Conclusions: AA alignment was associated with SRKOA and the tibial plateau centre had the strongest association. Differences in AA alignment when 1P vs 2P methods were compared indicated bespoke alignment categories were necessary. Further replication and validation with mechanical axis alignment comparison is required.
anatomic axis, knee alignment, knee osteoarthritis, radiography
1063-4584
612-622
Goulston, L.M.
f0c12aca-b683-4093-98dc-f0ad99e022d9
Sanchez-Santos, M.T.
4624bb05-b067-472b-b128-927b1ff8df7a
D'Angelo, S.
13375ecd-1117-4b6e-99c0-32239f52eed6
Leyland, K.M.
bc5505c2-497c-4aa8-8b9b-29ee14853651
Hart, D.J.
00e78191-ce14-4b5f-a720-9f1bb51b2b62
Spector, T.D.
87d1f285-3f22-4c9a-b006-d65cfda6d3e0
Cooper, C.
e05f5612-b493-4273-9b71-9e0ce32bdad6
Dennison, E.M.
ee647287-edb4-4392-8361-e59fd505b1d1
Hunter, D.
c92c57bd-661e-44ce-81c2-3668494ba672
Arden, N.K.
23af958d-835c-4d79-be54-4bbe4c68077f
Goulston, L.M.
f0c12aca-b683-4093-98dc-f0ad99e022d9
Sanchez-Santos, M.T.
4624bb05-b067-472b-b128-927b1ff8df7a
D'Angelo, S.
13375ecd-1117-4b6e-99c0-32239f52eed6
Leyland, K.M.
bc5505c2-497c-4aa8-8b9b-29ee14853651
Hart, D.J.
00e78191-ce14-4b5f-a720-9f1bb51b2b62
Spector, T.D.
87d1f285-3f22-4c9a-b006-d65cfda6d3e0
Cooper, C.
e05f5612-b493-4273-9b71-9e0ce32bdad6
Dennison, E.M.
ee647287-edb4-4392-8361-e59fd505b1d1
Hunter, D.
c92c57bd-661e-44ce-81c2-3668494ba672
Arden, N.K.
23af958d-835c-4d79-be54-4bbe4c68077f

Goulston, L.M., Sanchez-Santos, M.T., D'Angelo, S., Leyland, K.M., Hart, D.J., Spector, T.D., Cooper, C., Dennison, E.M., Hunter, D. and Arden, N.K. (2016) A comparison of radiographic anatomic axis knee alignment measurements and cross-sectional associations with knee osteoarthritis. Osteoarthritis and Cartilage, 24 (4), 612-622. (doi:10.1016/j.joca.2015.11.009). (PMID:26700504)

Record type: Article

Abstract

Objective: Malalignment is associated with knee osteoarthritis (KOA), however, the optimal anatomic axis (AA) knee alignment measurement on a standard limb radiograph (SLR) is unknown. This study compares one-point (1P) and two-point (2P) AA methods using three knee joint centre locations and examines cross-sectional associations with symptomatic radiographic knee osteoarthritis (SRKOA), radiographic knee osteoarthritis (RKOA) and knee pain.

Methods: AA alignment was measured six different ways using the KneeMorf software on 1058 SLRs from 584 women in the Chingford Study. Cross-sectional associations with principal outcome SRKOA combined with greatest reproducibility determined the optimal 1P and 2P AA method. Appropriate varus/neutral/valgus alignment categories were established using logistic regression with generalised estimating equation models fitted with restricted cubic spline function.

Results: The tibial plateau centre displayed greatest reproducibility and associations with SRKOA. As mean 1P and 2P values differed by >2°, new alignment categories were generated for 1P: varus <178°, neutral 178–182°, valgus >182° and for 2P methods: varus <180°, neutral 180–185°, valgus >185°. Varus vs neutral alignment was associated with a near 2-fold increase in SRKOA and RKOA, and valgus vs neutral for RKOA using 2P method. Nonsignificant associations were seen for 1P method for SRKOA, RKOA and knee pain.

Conclusions: AA alignment was associated with SRKOA and the tibial plateau centre had the strongest association. Differences in AA alignment when 1P vs 2P methods were compared indicated bespoke alignment categories were necessary. Further replication and validation with mechanical axis alignment comparison is required.

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Accepted/In Press date: 17 November 2015
e-pub ahead of print date: 14 December 2015
Published date: April 2016
Keywords: anatomic axis, knee alignment, knee osteoarthritis, radiography
Organisations: Faculty of Medicine

Identifiers

Local EPrints ID: 385383
URI: http://eprints.soton.ac.uk/id/eprint/385383
ISSN: 1063-4584
PURE UUID: 9b8ce8c4-2a7f-4605-aa89-6924c24bea60
ORCID for S. D'Angelo: ORCID iD orcid.org/0000-0002-7267-1837
ORCID for C. Cooper: ORCID iD orcid.org/0000-0003-3510-0709
ORCID for E.M. Dennison: ORCID iD orcid.org/0000-0002-3048-4961

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Date deposited: 19 Jan 2016 14:23
Last modified: 18 Feb 2021 17:20

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Contributors

Author: L.M. Goulston
Author: M.T. Sanchez-Santos
Author: S. D'Angelo ORCID iD
Author: K.M. Leyland
Author: D.J. Hart
Author: T.D. Spector
Author: C. Cooper ORCID iD
Author: E.M. Dennison ORCID iD
Author: D. Hunter
Author: N.K. Arden

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