We are looking for a publication that supports or refutes this question (see attached article by White) that shows that weight-bearing on a varus OA knee causes a large varus deformity but does not describe that the varus could be more apparent than real due to ER of the femur on the tibia.
Hi Stephen,
I cannot find papers that demonstrate that rotation misleads the assessor into exaggerating the angle of varus.
However, one paper has demonstrated an association between increased varus and increased rotation. This is also correlated positively with increasing degeneration.
Matsui, Y., Kadoya, Y., Uehara, K., Kobayashi, A., & Takaoka, K. (2005). Rotational deformity in varus osteoarthritis of the knee: analysis with computed tomography. Clinical orthopaedics and related research, 433, 147-151.
Most papers looking at varus and valgus simply measure the angle on an antero-posterior view, and cannot include adjustment for rotation due to the two-dimensional measurement techniques. E.g.
Sharma, L., Song, J., Felson, D. T., Shamiyeh, E., & Dunlop, D. D. (2001). The role of knee alignment in disease progression and functional decline in knee osteoarthritis. JAMA, 286(2), 188-195.
I hope this helps,
Jeremy
I have the impression that in varus knee deformity the tibia is rotating externally so the defect is mainly on the posteromedial aspect of the tibial plateaux. This can be demonstrated as extreme varus angle in AP views. Usually the femora condyle is OK. Literature supporting this
Takashi Tsujimoto and Yoshinori Kadoya (2013). Rotational Deformity After Total Knee Arthroplasty for Varus Osteoarthritis of the Knee. Bone Joint Journal . 95-B SUPP 34, 562
Shuichi Matsuda , Hiromasa Miura, Ryuji Nagamine, Taro Mawatari, Masami Tokunaga, Ryotaro Nabeyama, Yukihide Iwamoto (2004). Anatomical analysis of the femoral condyle in normal and osteoarthritic knees. Journal of Orthopaedic Research 22, 104-109.
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