Clinical Measurement of the Tibio-femoral Angle in Malay Children

Background: This study was conducted to find out the age when tibiofemoral angle starts to be in valgus and reaches maximum angle. The differences of the angles between genders were also studied. Methodology: This cross sectional study on tibiofemoral angle was conducted among 160 normal healthy children using clinical measurement method. The children between 2 18 months to 6 years old were assigned to 5 specific age groups of 32 children with equal sex distribution. Result: This study had shown a good inter-observer reliability of tibiofemoral angle measurement with intraclass correlation coefficient (ICC) of 0.87 with narrow margin of 95% confident interval (95% CI: 0.73, 0.94). The mean tibiofemoral angle for children at 2 , 3 , 4 , 5 and 6 years old were 2.25o (SD=0.53), 8.73o (SD=0.95), 7.53o (SD=1.40), 7.27o (SD=1.14) and 6.72o (SD=0.98) respectively. The age when they achieved maximum valgus tibiofemoral angle was 3 years old. The maximum mean (SD) tibiofemoral angle for boys, girls and all children were 8.91o (SD=1.17) , 8.56o (SD=0.62) and 8.73o (SD=0.95) respectively. The mean tibiofemoral angle showed no statistically significant difference between girls and boys except for the 5-year-old group, in which the mean TF angle for girls was 7.560 (SD=0.95) and for the boys was 6.970 (SD=1.26) with p-value of 0.037. Conclusion: Measurement of tibiofemoral angle using the clinical method had a very good inter-observer reliability. The tibiofemoral angle in Malay population was valgus since the age of 2 years with maximum angle of 8.730 (SD=0.95) achieved at the age of 3 years.

The Influence of Postoperative Tibiofemoral Alignment on the Clinical Results of Unicompartmental Knee Arthroplasty

PURPOSE: To evaluate the influence of postoperative tibiofemoral alignment on the clinical results and failure in patients who underwent unicompartmental knee athroplasty (UKA). MATERIALS AND METHODS: We reviewed 246 cases of medial UKA which were followed up for at least 5 years after the operation. The clinical results were compared between 5 groups classified according to the tibiofemoral angle that was measured at 3 months after surgery. We analyzed the relationship between the tibiofemoral alignment and the failure after UKA. RESULTS: The preoperative tibiofemoral angle was changed from 0.4degrees of varus to 5.4degrees of valgus after surgery and the average correction angle was 5.8degrees. During the follow-up, which averaged 7 years and 5 months, the knee score and function score were improved significantly in all groups regardless of the tibiofemoral angle (p0.05). However, there were significant differences in the cumulative survival rate of implants between the groups and the highest rate was found in the group with a tibiofemoral angle of 4degrees to 6degrees of valgus (p<0.01). CONCLUSIONS: The tibiofemoral angle after UKA had no significant influence on the midterm clinical scores, but there was a significant relationship between the postoperative tibiofemoral angle and failure rate of implant.

Factors Affecting the Tibiofemoral Alignment in Minimally Invasive Unicompartmental Knee Arthroplasty / 대한정형외과학회잡지

PURPOSE: We analyzed affecting factors associated with the tibiofemoral alignment after minimally invasive unicompartmental knee arthroplasty (UKA) used to treat medial compartmental osteoarthritis of the knee. MATERIALS AND METHODS: From January 2003 to December 2003, 128 UKA were performed in 114 patients with minimally invasive surgery. The revealed tibiofemoral angle, tibial translation, posterior slope and the coronary orientation of the tibial and femoral component were measured using the preoperative and postoperative weight-bearing radiographs. The possible factors associated with the corrective tibiofemoral angle were analyzed statistically. RESULTS: The average corrective angle of the tibiofemoral axis was 5.8 degrees from varus 0.6 degrees preoperatively to valgus 5.2 degrees postoperatively. The average corrective angle of the tibiofemoral axis was 6.1 degrees in the mobile bearing group and 3.6 degrees in the fixed bearing group. There was significantly more corrective tibiofemoral angle postoperatively with a larger varus deformity of the knee preoperatively (p<0.0001). The corrective tibiofemoral angle had an increasing tendency with increasing bearing size but this was not statistically significant. Surgeons, the age of the patients, tibial translation, posterior slope of the tibial component, and coronary orientation of the tibial component and femoral component did not affect the degree of the corrective tibiofemoral angle. CONCLUSION: The average corrective angle of the tibiofemoral axis after minimally invasive UKA was 5.8 degrees. The preoperative tibiofemoral angle and the types of implants affected the postoperative tibiofemoral axis after minimally invasive UKA.

The Effect of Tibiofemoral Alignment on the Results of Total Knee Arthroplasty / 대한정형외과학회잡지

There have been several reports that total knee arthroplasty(TKA) was most likely to survive successfully if the coronal tibiofemoral angle was close to 7 degree of valgus, the accepted normal. In order to know whether the postoperative coronal tibiofemoral angle influences the result of total knee arthroplasty, we examined the 152 TKA cases in 106 patients which had been performed at Department of Orthopaedic Surgery, Seoul National University Hospital from Jan. 1987 to Dec. 1991. In our series the average follow-up period was 31 months(range, 13 months to 75 months). Coronal tibiofemoral angles of all cases were checked on weight bearing anteroposterior plain X-rays and were divided into three groups(less than valgus 2° ; valgus 3° to 7° ; greater than valgus 8°). All cases were analyzed on the knee score of Hospital for Special Surgery and the American Knee Society total knee arthroplasty roentgenographic evaluation and scoring system and the cases with radiolucent lines wider than 2mm were checked. Three groups were analyzed comparatively with statistical means(Wilcoxon signed rank test, X² test). There were no significant differences in the clinical results of total knee arthroplasty according to the postoperative coronal tibiofemoral angle. Lateral subluxation of the patella occurred more frequently when the postoperative coronal tibiofemoral angle was above valgus 8°. In the tibial components of group lesser than valgus 2°, the frequency of radiolucent lines wider than 2mm was higher than those of other groups, but its significance should be examined through long term follow-up.

A New Method in the Measurement of Tibiofemoral Angle / 대한정형외과학회잡지

The tibiofemoral angle is widely used for the diagnosis and treatment of knee problems, especially in degenerative joint disease of the knee. Among the various methods of measurement of tibiofemoral angle, Bauers method is being used most frequently. But measurement by Bauers method has seemed to show wide individual differences. Therefore we designed a ruler which can be used very easily for the measurement of the tibiofemoral angle with little differences between persons who measure the angle. To testify the advantages of our method, we selected 4 orthopedic surgeons and let them measure the tibiofemoral angles of 60 knees of 30 patients by Bauers method and by our method using the ruler. And 20 orthopedic surgeons measured tibiofemoval angles of 2 left knees by Bauers method and by our method using the ruler. The values of the tibiofemoral angle by two methods were compared and analyzed statistically. There was no significant differences between mean values. But, the tibiofemoral angles by our new method showed little differences among measurers. (P < 0.05)

A Clinical Analysis of Suparacondylar Fracture of the Femur in Adult / 대한정형외과학회잡지

The treatment of supracondylar fracture of the femur remains a difficult problem because of the wide range of portential complications. In the past, authors thought conservative treatment was superior to operative treatment of supracondylar fracture of the femur. In addition, the advent of the Cast-Brace introduced the change in concept of the conservative treatment. Recently, however, the advances in the techniques and in the devices used in intemal fixation have encouraged the operative treatment. Tibiofemoral angle, gap or stepping of the articular surface of the distal femur, range of motion of the knee, and pains in the knee were used to evaluate the following results investigated by statistical study(T-test). These clinical results were shown by analyzing 49 cases of supracondylar fracture of the femur trea ted in the Department of Orthopedic Surgery, Hallym College of Medicine, from Jan. 1980 to Dec. 1983 1. We end result of each patient was evaluated by scaled score value calculated from above mentioned criteria. 2. The mean value of the operative treatment(35 cases) was 31.03±5.52, while that of the conservative treatment(14 cases) was 27.71±4.56. 3. The mean value of the group which began the exercise of the knee joint within 2 weeks (33 cases) was 32.24±4.43. The mean value of the other group which began the exercise of the knee joint after 2 weeks(16 cases) was 25.78±4.56. This difference of means between two groups was statistically significant. Beginning the knee joint exercise within 2 weeks has large effect on the result of the treatment. 4.The results of treatment in patient over age of 50 were graded as fair irrespective of methods of treatment. 5. Various devices were used in intemal fixation but there was no difference in the results. 6. We mean value of the Tibiofemoral angle(difference from normal angle) in the operative treatment was 2.37±6.25 and that of the conservative treatment was 8.04±4.62. Both of the above method of treatment showed a varus trend, especially in the conservative treatment. In statistical study, through, there was no significance in two methods.