Coronal axis deviations in medial unicompartmental knee arthroplasty failures: an imaging study of patients revised for aseptic loosening
European journal of medical research, vol. 30, pp. 832
Abstract
PURPOSE: Aseptic loosening remains a leading cause of revision in medial unicompartmental knee arthroplasty (UKA). This imaging study aimed to identify recurrent patterns of coronal alignment deviation in patients undergoing revision to total knee arthroplasty (TKA) to explore whether subtle malalignment may contribute to biomechanical failure. METHODS: Imaging of patients who underwent revision surgery of a medial UKA to TKA for aseptic loosening of the tibial or femoral component was retrieved. Lower limb axes were evaluated using anteroposterior plain radiographs of the leg using the software MediCAD Knie 2D (mediCAD Hectec GmbH, Altdorf, Germany). The radiographic axes of revised patients were compared with established reference values, as defined by the MediCAD Knie 2D software and published literature, to identify common alignment patterns potentially associated with aseptic loosening. RESULTS: Data from 62 patients were analysed. Before the revision surgery, the joint line convergence angle (JLCA, P = 0.002) and the anatomical-mechanical angle (AMA, P < 0.0001) were statistically significantly greater than the corresponding reference values. In contrast, the mechanical lateral distal femoral angle (mLDFA, P < 0.0001), the mechanical and anatomical medial proximal tibial angle (mMPTA and aMPTA, P < 0.0001), and the mechanical and anatomical lateral distal tibial angle (mLDTA and aLDTA, P < 0.0001) were significantly lower than reference. No statistically significant difference was found in the mechanical lateral proximal femoral angle (mLPFA, P = 0.9) or in the mechanical axis deviation (MAD, P = 0.5) when compared to normative data. CONCLUSION: Our cohort of patients revised from medial UKA to TKA for aseptic loosening frequently exhibited consistent deviations in lower limb alignment, particularly increased AMA and JLCA, and reduced mLDFA, mMPTA, and mLDTA. These subtle but recurrent patterns may alter load distribution across the medial compartment, contributing to implant micromotion and loosening. A detailed preoperative axis assessment may help identify patients at a higher biomechanical risk.
Authors 6
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Filippo Migliorini corresponding
Ospedale di Bolzano · University Hospital in Halle · Link Campus University · Azienda Sanitaria dell'Alto Adige · Martin Luther University Halle-Wittenberg
Affiliation as printed
Department of Life Sciences, Health, and Health Professions, Link Campus University, Via del Casale di San Pio V, 00165, Rome, Italy. filippo.migliorini@uk-halle.de
Department of Orthopaedic and Trauma Surgery, Academic Hospital of Bolzano (SABES-ASDAA), Via Lorenz Böhler 5, 39100, Bolzano, Italy. filippo.migliorini@uk-halle.de
Department of Orthopaedic and Trauma Surgery, Eifelklinik St. Brigida, 52152, Simmerath, Germany. filippo.migliorini@uk-halle.de
Department of Trauma and Reconstructive Surgery, University Hospital of Halle, Martin-Luther University Halle-Wittenberg, Ernst-Grube-Street 40, 06097, Halle (Saale), Germany. filippo.migliorini@uk-halle.de
Department of Trauma and Reconstructive Surgery, University Hospital of Halle, Martin-Luther University Halle-Wittenberg, Ernst-Grube-Street 40, 06097, Halle (Saale), Germany
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University of London · Queen Mary University of London · Mile End Hospital · Keele University · Sapienza University of Rome
Affiliation as printed
Centre for Sports and Exercise Medicine, Barts and the London School of Medicine and Dentistry, Mile End Hospital, Queen Mary University of London, London, E1 4DG, UK
Faculty of Medicine and Psychology, University "La Sapienza" of Rome, Rome, Italy
School of Pharmacy and Bioengineering, Keele University Faculty of Medicine, Stoke On Trent, ST4 7QB, UK
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Affiliation as printed
Department of Orthopaedic and Trauma Surgery, Eifelklinik St. Brigida, 52152, Simmerath, Germany
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Universitätsklinikum Aachen · RWTH Aachen University
Affiliation as printed
Department of Orthopaedic, Trauma, and Reconstructive Surgery, RWTH University Hospital, 52074, Aachen, Germany
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University Hospital in Halle · Martin Luther University Halle-Wittenberg
Affiliation as printed
Department of Trauma and Reconstructive Surgery, University Hospital of Halle, Martin-Luther University Halle-Wittenberg, Ernst-Grube-Street 40, 06097, Halle (Saale), Germany
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Affiliation as printed
Department of Orthopaedic and Trauma Surgery, Eifelklinik St. Brigida, 52152, Simmerath, Germany
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