ArticleKnee surgery, sports traumatology, arthroscopy : official journal of the ESSKA2022
Arithmetic hip-knee-ankle angle and stressed hip-knee-ankle angle: equivalent methods for estimating constitutional lower limb alignment in kinematically aligned total knee arthroplasty.
Article in Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA, 2022. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT07410429 (Realigning Rehab), which is not on this map. Cited by 23 papers, 1 of them a synthesis that pooled it.
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Realigning Rehab: A Randomized Controlled Trial on Specific Exercises Versus Standard Care for Medial Knee Pain and Varus Alignment
Who cites it
23 citing papers in PubMed, 1 synthesis or guideline pooled it.
- Discrepancies in CPAK classification between CT and long-leg radiography: a systematic review and meta-analysis.Skeletal radiology · 2026Pooled it
- Weight-bearing 3D morphology of valgus knees: A comparative study within a varus dominant cohort.Journal of experimental orthopaedics · 2026Article
- Medial femoral condyle restoration technique in total knee arthroplasty.Arthroplasty (London, England) · 2026Article
- Validation of the Posture Analyzing and Virtual Reconstruction (PAViR) System for Measuring the Hip-Knee-Ankle Angle Using 2D Photogrammetry and Computer Vision.Diagnostics (Basel, Switzerland) · 2026Article
- Functional alignment preserves the native Coronal Plane Alignment of the Knee phenotype while improving early clinical outcomes after robotic-assisted total knee arthroplasty.Orthopedic reviews · 2026Article
- Robotic-assisted restricted kinematic alignment in total knee arthroplasty: A multicenter retrospective assessment of coronal phenotypes and early postoperative outcomes.Journal of experimental orthopaedics · 2026Article
- Predicting postoperative coronal alignment in medial unicompartmental knee arthroplasty using the arithmetic hip-knee-ankle angle.Arthroplasty (London, England) · 2025Article
- Coronal native limb alignment: establishing reporting standards and aligning measurements of key angles.EFORT open reviews · 2025Review
- A systematic review of geographic differences in knee phenotypes based on the coronal plane alignment of the knee (CPAK) classification.Arthroplasty (London, England) · 2025Review
- Distribution of phenotypes of coronal plane alignment of the knees and functional phenotypes in the healthy young Iranian population: A cross-sectional study.Journal of experimental orthopaedics · 2025Article
- Relationship Between Coronal Plane Alignment of the Knee Phenotypes and Distal Femoral Rotation.Journal of clinical medicine · 2025Article
- Knee phenotypes distribution according to CPAK classification in Turkish population.Acta orthopaedica et traumatologica turcica · 2024Article
- Distribution and gender-specific differences of coronal plane alignment of healthy knee.Journal of orthopaedic surgery and research · 2024Article
- Gender, BMI, and Age-Related Variations in Lower Limb Alignment Parameters and CPAK Phenotypes in Chinese Patients with Knee Osteoarthritis.Orthopaedic surgery · 2024Article
- The Distribution of Coronal Plane Alignment of the Knee Classification in a Sample of Spanish Southeast Osteoarthritic Population: A Retrospective Cross-Sectional Observational Study.Medicina (Kaunas, Lithuania) · 2024Observational
- Coronal Plane Alignment Classification of Arthritic Knees in a South Indian Population and Functional Outcome Comparison Post-mechanical Alignment Total Knee Arthroplasty.Indian journal of orthopaedics · 2024Article
- Imageless robotic total knee arthroplasty determines similar coronal plane alignment of the knee (CPAK) parameters to long leg radiographs.Arthroplasty (London, England) · 2024Article
- Knees with anteromedial osteoarthritis show a substantial phenotypic variation prior and following medial unicompartmental knee arthroplasty.Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA · 2023Article
- Article
- Predicting valgus malalignment after mobile-bearing UKA using a new method: the arithmetic HKA of the arthritic knee.Archives of orthopaedic and trauma surgery · 2023Article
Corrections and comments
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Authors and funding
6 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
purposeKinematically aligned total knee arthroplasty (KA TKA) relies on precise determination of constitutional alignment to set resection targets. The arithmetic hip-knee-ankle angle (aHKA) is a radiographic method to estimate constitutional alignment following onset of arthritis. Intraoperatively, constitutional alignment may also be approximated using navigation-based angular measurements of deformity correction, termed the stressed HKA (sHKA). This study aimed to investigate the relationship between these methods of estimating constitutional alignment to better understand their utility in KA TKA.
methodsA radiological and intraoperative computer-assisted navigation study was undertaken comparing measurements of the aHKA using radiographs and computed tomography (CT-aHKA) to the sHKA in 88 TKAs meeting the inclusion criteria. The primary outcome was the difference in the paired means between the three methods to determine constitutional alignment (aHKA, CT-aHKA, sHKA). Secondary outcomes included testing agreement across measurements using Bland-Altman plots and analysis of subgroup differences based on different patterns of compartmental arthritis.
resultsThere were no statistically significant differences between any paired comparison or across groups (aHKA vs. sHKA: 0.1°, p = 0.817; aHKA vs. CT-aHKA: 0.3°, p = 0.643; CT-aHKA vs. sHKA: 0.2°, p = 0.722; ANOVA, p = 0.845). Bland-Altman plots were consistent with good agreement for all comparisons, with approximately 95% of values within limits of agreement. There was no difference in the three paired comparisons (aHKA, CT-aHKA, and sHKA) for knees with medial compartment arthritis. However, these findings were not replicated in knees with lateral compartment arthritis.
conclusionsThere was no significant difference between the arithmetic HKA (whether obtained using CT or radiographs) and the stressed HKA in this analysis. These findings further validate the preoperative arithmetic method and support use of the intraoperative stressed HKA as techniques to restore constitutional lower limb alignment in KA TKA. LEVEL OF EVIDENCE: III.
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