Varus alignment of the proximal tibia is associated with structural progression in early to moderate varus osteoarthriti
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KNEE
Varus alignment of the proximal tibia is associated with structural progression in early to moderate varus osteoarthritis of the knee Jonathan S. Palmer1 · Luke D. Jones2 · A. Paul Monk3 · Michael Nevitt4 · John Lynch4 · David J. Beard5 · M. K. Javaid5 · Andrew J. Price5 Received: 11 September 2019 / Accepted: 16 December 2019 © The Author(s) 2020
Abstract Purpose Lower limb malalignment is a strong predictor of progression in knee osteoarthritis. The purpose of this study is to identify the individual alignment variables that predict progression in early to moderate osteoarthritis of the knee. Method A longitudinal cohort study using data from the Osteoarthritis Initiative. Intotal, 955 individuals (1329 knees) with early to moderate osteoarthritis (Kellgren-Lawrence grade 1, 2 or 3) were identified. All subjects had full-limb radiographsanalysed using the Osteotomy module within Medicad® Classic (Hectec GMBH) togive a series of individual alignment variables relevant to the coronal alignment of thelower limb. Logistic regression models, with generalised estimating equations wereused to identify which of these individual alignment variables predict symptomworsening (WOMAC score > 9 points) and or structural progression (joint spacenarrowing progression in the medial compartment > 0.7mm) over 24 months. Results Individual alignment variable were associated with both valgus and varusalignment (mechanical Lateral Distal Femoral Angle, Medial Proximal Tibial Angle andmechanical Lateral Distal Tibial Angle). Only the Medial Proximal Tibial Angle wassignificantly associated with structural progression and none of the variables wasassociated with symptom progression. The odds of joint space narrowing progressionin the medial compartment occurring at 24 months increased by 21% for every onedegree decrease (more varus) in Medial Proximal Tibial Angle (p < 0.001) Conclusions Our results suggest that the risk of structural progression in the medialcompartment is associated with greater varus alignment of the proximal tibia. Level of evidence Level III, retrospective cohort study. Keywords Osteoarthritis · Knee · Mechanical alignment · Coronal · Proximal tibial angle · MPTA
Introduction
* Andrew J. Price [email protected] 1
Orthopaedic Department, Dorset County Hospital, Dorchester DT1 2JY, UK
2
Orthopaedic Department, Chelsea and Westminster Hospital, London SW10 9NH, UK
3
Auckland Bioengineering Institute, University of Auckland, Auckland 1142, New Zealand
4
San Francisco Coordinating Center, University of California, San Francisco, USA
5
Nuffield Department of Orthopaedics Rheumatology and Musculoskeletal Sciences, University of Oxford, Old Rd, Oxford OX3 7LD, UK
Early to moderate knee osteoarthritis (OA) is common, hard to treat and can be debilitating for symptomatic individuals [13]. These patients are said to be in a “treatment gap” [14] where effective therapeutic interventions are limited. A clear understanding of the predictors that cause structural progression, sympto
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