J Korean Med Sci.  2023 May;38(20):e148. 10.3346/jkms.2023.38.e148.

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

Affiliations
  • 1Department of Orthopaedic Surgery, Veterans Health Service Medical Center, Seoul, Korea
  • 2Department of Orthopaedic Surgery, Seoul National University Bundang Hospital, Seongnam, Korea
  • 3Department of Orthopaedic Surgery, Seoul National University Bundang Hospital, Seongnam, Korea
  • 4Department of Orthopaedic Surgery, Seoul National University College of Medicine, Seoul, Korea
  • 5Department of Orthopedic Surgery, Seoul National University Hospital, Seoul, Korea
  • 6Kay Joint Center, Cheil Orthopaedic Hospital, Seoul, Korea

Abstract

Background
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.
Methods
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.
Results
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.
Conclusion
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.

Keyword

Hip–Knee–Ankle Angle; Total Hip Arthroplasty; Neck Shaft Angle; Knee Osteoarthritis

Figure

  • Fig. 1 Flow chart of patient enrollment in this study.THA = total hip arthroplasty, AP = anteroposterior, OA = osteoarthritis, ONFH = osteonecrosis of the femoral head, KL = Kellgren-Lawrence.

  • Fig. 2 Radiographic measurements. (A) HKA, FL. (B) LDFA. (C) FBA. (D) LLD. (E) Medial and lateral joint space widths. (F) V-COR: black line ‘a’; H-COR: black line ‘b’; FO, NSA: angle formed by white line ‘c’ and white line ‘d’; NL: white line ‘c’.HKA = hip–knee–ankle angle, FL = femur length, LDFA = lateral distal femoral angle, FBA = femoral bowing angle, LLD = limb-length discrepancy, V-COR = vertical center of rotation, H-COR = horizontal center of rotation, FO = femoral offset, NSA = neck shaft angle, NL = neck length.

  • Fig. 3 Difference in the mean value of the pre- and post-operative HKA in the three subgroups based on the change in NSA induced by THA. HKA is presented as means ± standard deviations.HKA = hip–knee–ankle, NSA = neck shaft angle, THA = total hip arthroplasty, ΔNSA = Postoperative NSA − Preoperative NSA, ns = not significant.***Statistically significant (P < 0.001).

  • Fig. 4 Difference in the mean value of the pre- and post-operative HKA in the three prosthesis groups based on the neck length. HKA is presented as means ± standard deviations. Short neck: ANOVA test (P = 0.002), post hoc analysis (B vs. T, P = 0.009; C vs T, P < 0.001; B vs C, P = 0.292). Medium neck: ANOVA test (P = 0.004), post hoc analysis (B vs. T, P = 0.016; C vs. T, P = 0.006; B vs. C, P = 0.882). Long neck: ANOVA test (P = 0.298).HKA = hip–knee–ankle angle, ns = not significant, B = Bencox M Stem, C = Corail Stem, T = Taperloc Stem, ANOVA = analysis of variance.aStatistically significant.

  • Fig. 5 Exemplar change in HKA and medial knee joint space width after THA.THA = total hip arthroplasty, HKA = hip–knee–ankle, NSA = neck shaft angle.


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