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Journal of Peking University (Health Sciences) ›› 2021, Vol. 53 ›› Issue (2): 293-297. doi: 10.19723/j.issn.1671-167X.2021.02.010

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Multivariate analysis of varus after Oxford unicompartmental knee arthroplasty

JI Song-jie,HUANG Ye,WANG Xing-shan,LIU Jian,DOU Yong,JIANG Xu,ZHOU Yi-xin()   

  1. Department of Adult Joint Reconstruction Surgery, Beijing Jishuitan Hospital, Beijing 100035, China
  • Received:2019-12-31 Online:2021-04-18 Published:2021-04-21
  • Contact: Yi-xin ZHOU E-mail:13683514672@139.com
  • Supported by:
    Beijing Jishuitan Hosptial Nova Program(XKXX2018)

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Abstract:

Objective: To analyze the preoperative influencing factors of varus after Oxford unicompartmental knee arthroplasty. Methods: A total of 660 patients (767 knees) undergoing Oxford unicompartmental knee arthroplasty in adult joint reconstruction surgery department of Beijing Jishuitan Hospital from January 2018 to December 2019 were retrospectively analyzed. Inclusive criteria: diagnosis was osteoarthritis, single compartment lesions in the medial side of the knee; preoperative flexion deformity was less than 10°, active range of motion was greater than 90°; preoperative X-ray full-length images of both lower limbs showed less than 15° varus (Noyes method); anterior cruciate ligament was well functioned, The cartilage of lateral compartment of knee joint was intact. Exclusion criteria: combined with other inflammatory arthropathy; combined with extraarticular deformity; previous knee surgery history. The average age of the patients was (64.4±8.1) years, including 153 males and 497 females. The degree of post-operative varus was measured with Noyes method. The total patients were divided into varus group (Noyes≥3 °) and normal group (Noyes<3 °). Gender, age, body mass index (BMI), range of motion (ROM), preoperative flexion deformity (FD), American Knee Society pain score (AKS) and American Knee Society function score (AKS function) were recorded. The standard anteroposterior and lateral X-ray films of knee joint and full-length lower extremity kinematic line films were taken by Sonialvision Safine Ⅱ (Shimadzu, Japan) multi-function digital tomography system. The image was measured by picture archiving and communication system (PACS). The following angles were measured preoperative Noyes angle, lateral distal femoral angle (LDFA), medial proximal tibial angle (MPTA) and joint line converge angle (JLCA) were measured and analyzed. Results: Gender(P=0.346), operative side (P=0.619), age (P=0.746), BMI (P=0.142), preoperative ROM (P=0.102), preoperative knee pain score (P=0.131) and functional score (P=0.098) were not risk factors for postoperative varus. The influencing factors of postoperative varus were preoperative MPTA<84 ° (P= 0.018, OR= 3.712, 95%CI: 1.250-11.027), preoperative Noyes > 5°(P=0.000, OR= 3.105, 95%CI: 1.835-5.254), preoperative FD > 5° (P= 0.001, OR=1.976, 95%CI: 1.326-3.234). Pre-operative LDFA (P=0.146) and preoperative JLCA (P= 0.709) had no significant effect on postoperative kinematic line. Conclusion: Patients with severe preoperative varus, especially those with varus deformity mainly from the tibial side, and those with preoperative flexion deformity are more prone to get varus lower extremity kinematic line after Oxford unicompartmental knee arthroplasty.

Key words: Unicompartmental knee arthroplasty, Alignment, Mobile-bearing, Arthroplasty, X-ray film

CLC Number: 

  • R687.4

Table 1

General information and preoperative score of patients"

Items Normal Varus χ2/Z P
Knees 669 98 - -
Gender, male/female 173/496 22/76 0.886 0.346
Side, left/right 332/337 46/52 0.247 0.619
Age/years 63.9±7.2 65.4±9.2 -0.324 0.746
BMI/(kg/m2), $\bar{x} \pm s$ 26.2±3.1 26.3±3.4 -1.467 0.142
AKS, $\bar{x} \pm s$ 57.4±14.4 55.5±14.4 -1.511 0.131
AKS function, $\bar{x} \pm s$ 65.6±11.4 63.7±11.7 -1.656 0.098
ROM/(°), $\bar{x} \pm s$ 101.7±19.1 97.7±17.3 -1.636 0.102
FD/(°), $\bar{x} \pm s$ 3.8±3.4 5.4±3.1 -4.373 <0.001

Figure 1

Several parameters on X ray of length of lower extremity and knee joint were measured A, Noyes angle, the angle between the mechanical axis of femur and tibia; B, LDFA, the angle between the joint line of distal femur and the mecha-nical axis of femur; C, MPTA, the angle between the joint line of proximal tibia and the mechanical axis of tibia; D, JLCA, the angle between the joint line of distal femur and the joint line of proximal tibia; E,Noyes angle was observed after operation."

Table 2

Preoperative measurement results of varus group and normal group ($\bar{x} \pm s$)/(°)"

Items Normal(n=669) Varus(n=98) Z P
Noyes 3.4±1.4 4.7±2.2 -5.882 <0.001
MPTA 85.9±1.5 84.9±1.6 -5.673 <0.001
LDFA 88.1±0.9 88.3±1.1 -1.293 0.196
JLCA 1.3±1.0 1.4±1.1 -0.889 0.374

Table 3

Setting of independent variables in multivariate analysisn(%)"

Dependent variable Normal Varus
FD>5° Yes 233 (34.8) 50 (51.0)
No 436 (65.2) 48 (48.9)
Noyes>5° Yes 88 (13.2) 27 (27.6)
No 581 (86.7) 71 (72.4)
LDFA>90° Yes 11 (1.6) 7 (7.1)
No 658 (98.4) 91 (92.9)
MPTA<84° Yes 16 (2.4) 25 (25.6)
No 653 (97.6) 73 (74.4)
JLCA>2° Yes 96 (14.3) 14 (14.3)
No 573 (85.7) 88 (89.8)

Table 4

Unconditional Logistic regression analysis of preoperative risk factors for varus after unicompartmental knee arthroplasty (UKA)"

Parameter B Wald OR 95%CI P
FD>5° 0.728 10.258 1.976 1.326-3.234 <0.001
Noyes>5° 1.133 17.833 3.105 1.835-5.254 <0.001
LDFA>90° 0.774 2.144 2.168 0.738-6.156 0.146
MPTA<84° 1.312 5.575 3.712 1.250-11.027 0.018
JLCA>2° -0.122 3.383 0.885 0.466-1.680 0.709
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