The influence of femoral and tibial bony anatomy on valgus OA of the knee

Purpose

Approximately 10% of all patients that require a total knee arthroplasty present with valgus osteoarthritis (OA) of the knee. Valgus OA goes along with posterolateral bone loss and lateral soft tissue tightness. The role of malalignment on the development of OA is not fully understood. The current study investigates whether the femoral offset (FO), femoral mechanical–anatomical (FMA) angle, anatomical lateral distal femur angle (aLDFA), mechanical lateral distal femur angle (mLDFA), medial proximal femur angle (MPFA), medial proximal tibia angle (MPTA) or lateral distal tibia angle (LDTA) differ in patients with valgus OA of the knee.

Methods

FO, FMA angle, aLDFA, mLDFA, MPFA, MPTA and LDTA were assessed and compared between 100 consecutive knees with minimal valgus OA (50 male, 50 female) and 100 consecutive knees with minimal varus OA (50 male, 50 female).

Results

FO was significantly higher in males with valgus OA (p = 0.002) and females with varus OA (p = 0.01). The observed values for the FMA angle were significantly higher in males with valgus OA (p = 0.002) and females with varus OA (p = 0.041). The aLDFA and mLDFA were significantly smaller in all patients with valgus OA (p < 0.001). No differences between the varus and valgus groups were detected regarding MPFA (males: p = 0.052; females: p = 0.719). Tibial measurements showed significantly higher values for the MPTA (p < 0.001) in both valgus groups and no difference for LDTA (men: p = 0.139; women: p = 0.196).

Conclusion

Bony alterations in the femoral anatomy seem to be more important than in the tibial anatomy. While in male patients with valgus OA, the main anatomic variation is the hypoplasia of the lateral femoral condyle, in females both decreased femoral offset of the hip as well as hypoplasia of the lateral condyle are present.

Level of evidence

III.