Dynamic deformation of femur during medial compartment knee osteoarthritis

Autoři: Yang Lu aff001;  Zhanle Zheng aff002;  Wei Chen aff002;  Hongzhi Lv aff002;  Ji Lv aff001;  Yingze Zhang aff002
Působiště autorů: Department of Emergency Surgery, The First Hospital of Qinhuangdao Affiliated to Hebei Medical University, Haigang District, Qinhuangdao, Hebei Province, People’s Republic of China aff001;  Department of Orthopedic Surgery, The Third Hospital of Hebei Medical University, Qiaoxi District, Shijiazhuang, People’s Republic of China aff002
Vyšlo v časopise: PLoS ONE 14(12)
Kategorie: Research Article
doi: https://doi.org/10.1371/journal.pone.0226795



The aim of this study was to evaluate the morphological changes of the femur in the coronal plane in progressing varus gonarthrosis and to explore the interrelation of each component.

Patients and methods

From January to July 2017, radiographic images of 1538 knees of 883 consecutive patients were collected and analyzed. We drew the alignments and measured the orientation angles of the lower extremities and compared the results among age groups for each sex. Correlation and regression tests were used to analyze the measurements.


There were significant differences in the neck-shaft angle (NSA), femoral bowing angle (FBA) and anatomic medial distal femoral angle (aMDFA) by age group in females, whereas the differences were not significant in males. In females, a positive correlation was found between age and the FBA and aMDFA (r = 0.253, 0.141, p<0.01), and a negative correlation was found between age and the NSA while the FBA was controlled (r = -0.065, p<0.05). The FBA was positively correlated with the NSA (r = 0.312, p<0.01) and aMDFA (r = 0.233, p<0.01). The NSA, FBA, and aMDFA together affected 72.2% of the mechanical medial distal femoral angle (mMDFA) (β = 0.071, -0.528, 0.803, p<0.01).


As knee osteoarthritis (KOA) progressed, dynamic deformation of the femur was found in females, while no obvious changes were found in males. Femoral mechanical axis varus (mMDFA decrease) was the result of changes in the NSA, FBA and aMDFA. The deformation was throughout the femur rather than in a local area, as femur bowing can lead to corresponding changes in both ends of the femur. We provided a theoretical basis for TKA and knee-salvage treatment, and more attention should be paid to aging patients, especially females, in the preoperative protocol for orthomorphia.

Klíčová slova:

Age groups – Body limbs – Deformation – Knee joints – Knees – Osteoarthritis – Total knee arthroplasty


1. Chang AH, Lee SJ, Zhao H, Ren Y, Zhang LQ. Impaired varus-valgus proprioception and neuromuscular stabilization in medial knee osteoarthritis. J Biomech. 2014;47(2):360–6. doi: 10.1016/j.jbiomech.2013.11.024 24321442.

2. Roemer FW, Crema MD, Trattnig S, Guermazi A. Advances in imaging of osteoarthritis and cartilage. Radiology. 2011;260(2):332–54. doi: 10.1148/radiol.11101359 21778451.

3. Dong T, Chen W, Zhang F, Yin B, Tian Y, Zhang Y. Radiographic measures of settlement phenomenon in patients with medial compartment knee osteoarthritis. Clin Rheumatol. 2016;35(6):1573–8. doi: 10.1007/s10067-015-3146-0 26712497.

4. Issın A, Sahin V, Koçkara N, Gürsu SS, Kurtuldu A, Yıldırım T. Is proximal tibia the major problem in varus gonarthrosis? Evaluation of femur and ankle. Eklem Hastalik Cerrahisi. 2012;23(3):128–33. 23145754.

5. Cooke TD, Sled EA. Optimizing limb position for measuring knee anatomical axis alignment from standing knee radiographs. J Rheumatol. 2009;36(3):472–7. doi: 10.3899/jrheum.080732 19286859.

6. Paley D. Normal lower limb alignment and joint orientation. In: Herzenberg JE, editor. Principles of deformity correction. Baltimore: Springer, 2003;1–17. 

7. Cooke TD, Sled EA, Scudamore RA. Frontal plane knee alignment: a call for standardized measurement. J Rheumatol. 2007;34(9):1796–801. 17787049.

8. Zhao Z, Wang W, Wang S, Jiang L, Zhang S, Zhao Y. Femoral rotation influences dynamic alignment of the lower extremity in total knee arthroplasty. Int Orthop. 2015;39(1):55–60. doi: 10.1007/s00264-014-2484-x 25106671.

9. Mullaji AB, Marawar SV, Mittal V. A comparison of coronal plane axial femoral relationships in Asian patients with varus osteoarthritic knees and healthy knees. J Arthroplasty. 2009;24(6):861–7. doi: 10.1016/j.arth.2008.05.025 18701244.

10. Brouwer GM, van Tol AW, Bergink AP, Belo JN, Bernsen RM, Reijman M et al. Association between valgus and varus alignment and the development and progression of radiographic osteoarthritis of the knee. Arthritis Rheum. 2007;56(4):1204–11. doi: 10.1002/art.22515 17393449.

11. Blagojevic M, Jinks C, Jeffery A, Jordan KP. Risk factors for onset of osteoarthritis of the knee in older adults: a systematic review and meta-analysis. Osteoarthritis Cartilage. 2010;18(1):24–33. doi: 10.1016/j.joca.2009.08.010 19751691.

12. Cooke TD, Harrison L, Khan B, Scudamore A, Chaudhary MA. Analysis of limb alignment in the pathogenesis of osteoarthritis: a comparison of Saudi Arabian and Canadian cases. Rheumatol Int. 2002;22(4):160–4. doi: 10.1007/s00296-002-0218-7 12172956.

13. Prodromos CC, Amendola A, Jakob RP. High tibial osteotomy: indications, techniques, and postoperative management. Instr Course Lect. 2015;64:555–65. 25745938.

14. Luites JW, Brinkman JM, Wymenga AB, van Heerwaarden RJ. Fixation stability of opening- versus closing-wedge high tibial osteotomy: a randomised clinical trial using radiostereometry. J Bone Joint Surg Br. 2009;91(11):1459–65. doi: 10.1302/0301-620X.91B11.22614 19880890.

15. Baldini T, Roberts J, Hao J, Hunt K, Dayton M, Hogan C. Medial Compartment Decompression by Proximal Fibular Osteotomy: A Biomechanical Cadaver Study. Orthopedics. 2018;41(4):e496–e501. doi: 10.3928/01477447-20180424-05 29708573.

16. Qin D, Chen W, Wang J, Lv H, Ma W, Dong T et al. Mechanism and influencing factors of proximal fibular osteotomy for treatment of medial compartment knee osteoarthritis: A prospective study. J Int Med Res. 2018;46(8):3114–23. doi: 10.1177/0300060518772715 29848141.

17. Yang ZY, Chen W, Li CX, Wang J, Shao DC, Hou ZY et al. Medial Compartment Decompression by Fibular Osteotomy to Treat Medial Compartment Knee Osteoarthritis: A Pilot Study. Orthopedics. 2015;38(12):e1110–4. doi: 10.3928/01477447-20151120-08 26652332.

18. van der Woude JA, Spruijt S, van Ginneken BT, van Heerwaarden RJ. Distal femoral valgus osteotomy: bone healing time in single plane and biplanar technique. Strategies Trauma Limb Reconstr. 2016;11(3):177–86. doi: 10.1007/s11751-016-0266-2 27743247.

19. Saragaglia D, Blaysat M, Mercier N, Grimaldi M. Results of forty two computer-assisted double level osteotomies for severe genu varum deformity. Int Orthop. 2012;36(5):999–1003. doi: 10.1007/s00264-011-1363-y 21947287.

20. Nishida K, Matsumoto T, Takayama K, Ishida K, Nakano N, Matsushita T et al. Remaining mild varus limb alignment leads to better clinical outcome in total knee arthroplasty for varus osteoarthritis. Knee Surg Sports Traumatol Arthrosc. 2017;25(11):3488–94. doi: 10.1007/s00167-016-4260-5 27506810.

21. Slevin O, Hirschmann A, Schiapparelli FF, Amsler F, Huegli RW, Hirschmann MT. Neutral alignment leads to higher knee society scores after total knee arthroplasty in preoperatively non-varus patients: a prospective clinical study using 3D-CT. Knee Surg Sports Traumatol Arthrosc. 2018;26(6):1602–9. doi: 10.1007/s00167-017-4744-y 29026941.

22. Yau WP, Chiu KY, Tang WM, Ng TP. Coronal bowing of the femur and tibia in Chinese: its incidence and effects on total knee arthroplasty planning. J Orthop Surg (Hong Kong). 2007;15(1):32–6. doi: 10.1177/230949900701500108 17429114.

23. Shi X, Li H, Zhou Z, Shen B, Yang J, Pei F. Comparison of Postoperative Alignment Using Fixed vs Individual Valgus Correction Angle in Primary Total Knee Arthroplasty With Lateral Bowing Femur. J Arthroplasty. 2016;31(5):976–83. doi: 10.1016/j.arth.2015.10.040 26787012.

24. Bardakos N, Cil A, Thompson B, Stocks G. Mechanical axis cannot be restored in total knee arthroplasty with a fixed valgus resection angle: a radiographic study. J Arthroplasty. 2007;22(6 Suppl 2):85–9. doi: 10.1016/j.arth.2007.04.018 17823023.

25. Kinzel V, Scaddan M, Bradley B, Shakespeare D. Varus/valgus alignment of the femur in total knee arthroplasty. Can accuracy be improved by pre-operative CT scanning? The Knee. 2004;11(3):197–201. doi: 10.1016/S0968-0160(03)00106-6 15194095

26. Nagamine R, Miura H, Bravo CV, Urabe K, Matsuda S, Miyanishi K et al. Anatomic variations should be considered in total knee arthroplasty. J Orthop Sci. 2000;5(3):232–7. doi: 10.1007/s007760050157 10982663.

27. Yin Y, Zhang R, Jin L, Li S, Hou Z, Zhang Y. The Hip Morphology Changes with Ageing in Asian Population. Biomed Res Int. 2018;2018:1507979. doi: 10.1155/2018/1507979 30363710.

28. Anderson AE. CORR Insights((R)): Increased Hip Stresses Resulting From a Cam Deformity and Decreased Femoral Neck-Shaft Angle During Level Walking. Clin Orthop Relat Res. 2017;475(4):1009–12. doi: 10.1007/s11999-016-5126-3 27785672.

29. Jones CD. Gender differences in patellofemoral joint biomechanics. Clin Orthop Relat Res. 2004;(419):317; author -8. doi: 10.1097/00003086-200402000-00051 15021173.

30. Kurtz S, Mowat F, Ong K, Chan N, Lau E, Halpern M. Prevalence of primary and revision total hip and knee arthroplasty in the United States from 1990 through 2002. J Bone Joint Surg Am. 2005;87(7):1487–97. 15995115.

31. Poilvache PL, Insall JN, Scuderi GR, Font-Rodriguez DE. Rotational landmarks and sizing of the distal femur in total knee arthroplasty. Clin Orthop Relat Res. 1996;(331):35–46. doi: 10.1097/00003086-199610000-00006 8895617.

32. Ritter MA, Harty LD, Davis KE, Meding JB, Berend ME. Predicting range of motion after total knee arthroplasty. Clustering, log-linear regression, and regression tree analysis. J Bone Joint Surg Am. 2003;85-a(7):1278–85. doi: 10.2106/00004623-200307000-00014 12851353.

33. Tosi LL, Boyan BD, Boskey AL. Does sex matter in musculoskeletal health? The influence of sex and gender on musculoskeletal health. J Bone Joint Surg Am. 2005;87(7):1631–47. 15995134.

34. Spector TD, Nandra D, Hart DJ, Doyle DV. Is hormone replacement therapy protective for hand and knee osteoarthritis in women?: The Chingford Study. Ann Rheum Dis. 1997;56(7):432–4. doi: 10.1136/ard.56.7.432 9486006.

35. Font-Rodriguez DE, Scuderi GR, Insall JN. Survivorship of cemented total knee arthroplasty. Clin Orthop Relat Res. 1997;(345):79–86. 9418624.

36. Morgan MC, Gillespie B, Dedrick D. Survivorship analysis of total knee arthroplasty. Cumulative rates of survival of 9200 total knee arthroplasties. J Bone Joint Surg Am. 1992;74(2):308–9. 1541629.

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