ArticleArchives of orthopaedic and trauma surgery2023
Predicting valgus malalignment after mobile-bearing UKA using a new method: the arithmetic HKA of the arthritic knee.
Article in Archives of orthopaedic and trauma surgery, 2023. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 6 papers, 1 of them a synthesis that pooled it.
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Who cites it
6 citing papers in PubMed, 1 synthesis or guideline pooled it.
- There is no standardised measurement approach for medial proximal tibial angle after unicompartmental knee arthroplasty: A systematic review.Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA · 2026Pooled it
- Predicting postoperative coronal alignment in medial unicompartmental knee arthroplasty using the arithmetic hip-knee-ankle angle.Arthroplasty (London, England) · 2025Article
- Optimizing uni-compartmental knee arthroplasty: the impact of preoperative planning and arithmetic hip-knee-ankle angle.BMC musculoskeletal disorders · 2025Article
- Preoperative difference between 2D and 3D planning correlates with difference between planned and achieved surgical correction in patient-specific instrumented total knee arthroplasty.Journal of experimental orthopaedics · 2025Article
- Predicting postoperative coronal alignment after fixed-bearing unicompartmental knee arthroplasty using a new morphological assessment method: the arithmetic hip-knee-ankle angle.International orthopaedics · 2024Article
- The Coronal Plane Alignment of the Knee Classification: How It Works, How to Apply It, and How It can Affect Outcomes in Knee Reconstruction Surgery.JB & JS open accessReview
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6 authors.
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Abstract
backgroundValgus malalignment is one of the most common reasons for the progression of osteoarthritis in the lateral compartment of the knee after mobile-bearing unicompartmental knee arthroplasty (UKA). The arithmetic hip-knee-ankle angle (aHKA) of the Coronal Plane Alignment of the Knee (CPAK) classification could reflect the constitutional alignment of the arthritic knee. The purpose of this study was to observe the relationship between the aHKA and valgus malalignment after mobile-bearing UKA.
methodsThis retrospective study was conducted using 200 knees undergoing UKA from January 1, 2019, to August 1, 2022. These radiographic signs, including preoperative hip-knee-ankle angle (HKA), mechanical proximal tibial angle (MPTA), mechanical lateral distal femoral angle (LDFA), and postoperative HKA, were measured using standardized weight-bearing long-leg radiographs. Patients with postoperative HKA > 180° and postoperative HKA ≤ 180° were classified as the valgus group and non-valgus group, respectively. The aHKA was calculated as 180° + MPTA - LDFA in this study, which had the same meaning as that (aHKA = MPTA - LDFA) in the CPAK classification. The Spearman correlation analysis, the Mann-Whitney U test, the chi-square test, the Fisher's exact test, and multiple logistic regression were used in the study.
resultsOf the 200 knees included in our study, 28 knees were classified as the valgus group, while 172 knees were in the non-valgus group. The mean ± standard deviation (SD) of aHKA (all groups) was 177.04 ± 2.58°. In the valgus group, 11 knees (39.3%) had a value of aHKA > 180°, while 17 knees (60.7%) had a value of aHKA ≤ 180°. In the non-valgus group, 12 knees (7.0%) had a value of aHKA > 180°, while 160 knees (93.0%) had a value of aHKA ≤ 180°. In Spearman correlation analysis, aHKA was positively correlated with postoperative HKA (r = 0.693, p < 0.001). In univariate analysis, preoperative HKA (p < 0.001), LDFA (p = 0.02), MPTA (p < 0.001), and aHKA (p < 0.001) showed significant differences between the valgus and non-valgus groups. Variables with p < 0.1 in univariate analysis were further analyzed using multiple logistic regression analysis, and the variable-aHKA (> 180° vs ≤ 180°, odds ratio (OR) = 5.899, 95% confidence interval (CI) = 1.213 to 28.686, and p = 0.028) was expressed as the risk factor of postoperative valgus malalignment.
conclusionThe aHKA is correlated with the postoperative alignment of mobile-bearing UKA and a high aHKA (> 180°) will increase the risk of postoperative valgus malalignment. Therefore, mobile-bearing UKA should be performed with caution in patients with preoperative aHKA > 180°.
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