Under-correction of preoperative varus alignment does not lead to a difference in in-vivo bone loading in 3D-SPECT/CT compared to neutral alignment |
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| Institution: | 1. Department of Orthopaedic Surgery and Traumatology, Kantonsspital Baselland (Bruderholz, Liestal, Laufen), CH-4101 Bruderholz, Switzerland;2. University of Basel, Basel, Switzerland;3. Amsler Consulting, Basel, Switzerland;4. Institute of Radiology and Nuclear Medicine, Kantonsspital Baselland (Bruderholz, Liestal, Laufen), CH-4101 Bruderholz, Switzerland |
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| Abstract: | BackgroundThe aim was to investigate the correlation of bone tracer uptake (BTU) in SPECT/CT and changes in coronal knee alignment after total knee arthroplasty (TKA). We questioned if undercorrection of preoperative varus alignment leads to a difference in BTU compared to neutral alignment.MethodsConsecutive 66 patients who received SPECT/CT before and after TKA were retrospectively included. Adjusted mechanical alignment was the alignment target. The alignment of the knee was measured on 3D-CT by selecting standardized landmarks. Maximum (mean ± SD) and relative BTU (ratio to the reference) were recorded using a previously validated localization scheme (p < 0.05).ResultsIn the native group, 20 knees were aligned (30.3%) in valgus (HKA > 181.5°), 12 (18.2%) in neutral (178.5°-181.5°) and 34 (51.5%) in varus (HKA < 178°). Overall TKA changed the alignment towards neutral. 48.5% remained in the same groups, whereas 50% of native valgus and 33% of varus knees changed to neutral after TKA. In native varus alignment mean BTU was significantly higher in some medial tibial and femoral regions (fem1ia (p = 0.010), fem1ip (p = 0.002), tib1a.mid (p = 0.005), tib1a.tray (p = 0.000), tib1p.tray (p = 0.000)); in native valgus alignment mean BTU was higher in the corresponding lateral tibial and femoral regions (fem2ip (p = 0.001), tib2a.tray (p = 0.011), tib2p.tray (p = 0.002)). After TKA, a significant decrease in femoral and tibial BTU (femoral preoperative BTU 1.64 +/-0.69; femoral postoperative BTU 0.95 +/-0.42; p = 0.000// tibial preoperative BTU 1.65 +/- 0.93; tibial postoperative BTU 1.16 +/- 0.48; p = 0.000) and an increase in patellar BTU was observed (p = 0.025). Native varus alignment correlated with a higher medial BTU decrease medially. Undercorrection of preoperative varus alignment showed no higher BTU after TKA.ConclusionPreoperative varus alignment correlated with a higher decrease in BTU in specific femoral and tibial medial regions. Preoperative valgus alignment correlated with a higher decrease in the corresponding lateral regions. Undercorrection of preoperative varus alignment did not lead to higher bone loading reflected by BTU after TKA. |
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| Keywords: | SPECT/CT Knee TKA BTU Alignment In-vivo bone loading Varus Valgus Neutral SPECT/CT"} {"#name":"keyword" "$":{"id":"k0055"} "$$":[{"#name":"text" "_":"Single Photon Emission Tomography/ Computerized Tomography HTO"} {"#name":"keyword" "$":{"id":"k0065"} "$$":[{"#name":"text" "_":"High Tibial Osteotomy BTU"} {"#name":"keyword" "$":{"id":"k0075"} "$$":[{"#name":"text" "_":"Bone Tracer Uptake TKA"} {"#name":"keyword" "$":{"id":"k0085"} "$$":[{"#name":"text" "_":"Total Knee Arthroplasty OA"} {"#name":"keyword" "$":{"id":"k0095"} "$$":[{"#name":"text" "_":"Osteoarthritis HKA"} {"#name":"keyword" "$":{"id":"k0105"} "$$":[{"#name":"text" "_":"Hip-Knee-Ankle angle FMA"} {"#name":"keyword" "$":{"id":"k0115"} "$$":[{"#name":"text" "_":"Femoral-Mechanical Anatomical TMA"} {"#name":"keyword" "$":{"id":"k0125"} "$$":[{"#name":"text" "_":"Tibial-Mechanical Anatomical Val"} {"#name":"keyword" "$":{"id":"k0135"} "$$":[{"#name":"text" "_":"Valgus Var"} {"#name":"keyword" "$":{"id":"k0145"} "$$":[{"#name":"text" "_":"Varus Neu"} {"#name":"keyword" "$":{"id":"k0155"} "$$":[{"#name":"text" "_":"Neutral TbFm"} {"#name":"keyword" "$":{"id":"k0165"} "$$":[{"#name":"text" "_":"TibioFemoral tib"} {"#name":"keyword" "$":{"id":"k0175"} "$$":[{"#name":"text" "_":"tibial pat"} {"#name":"keyword" "$":{"id":"k0185"} "$$":[{"#name":"text" "_":"patellar fem"} {"#name":"keyword" "$":{"id":"k0195"} "$$":[{"#name":"text" "_":"femoral WOMAC"} {"#name":"keyword" "$":{"id":"k0205"} "$$":[{"#name":"text" "_":"Western Ontario and McMaster Universities Osteoarthritis Index |
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