Contralateral preoperative templating of lower limbs' mechanical angles is a reasonable option

Abstract

Purpose: In cases where the femur or tibia exhibits abnormal mechanical angulation due to degenerative changes or fracture, the contralateral leg is often used to complete preoperative templating. The aim of this study was to determine the degree of asymmetry between knee joints in healthy individuals and to determine whether it is affected by differing demographic parameters.

Methods: A CT scan-based modelling and analysis system was used to examine the lower limb of 233 patients (102 males, 131 women; mean age 61.2 ± 15.2 years, mean body mass index 24.9 ± 4.4 kg/m²) The hip-knee angle (HKA), lateral distal femoral angle (LDFA), medial proximal tibial angle (MPTA), posterior proximal tibial angle (ppta) and posterior distal femoral angle (PDFA) were then calculated for each patient. Results were then analysed to calculate femoral symmetry based on absolute differences (AD) and percentage asymmetry (%AS) using a previously validated method.

Results: Our results do not demonstrate any considerable asymmetry (percentage of asymmetry > 2%) for all the anatomical parameters analysed: HKA (mean AD = 1.5°; mean AS % = 0.8, n.s), MPTA (AD = 1.1°; AS % = 1.3, n.s), PPTA (AD = 1.4°; AS % = 1.0, n.s), LDFA (AD = 1.2 mm; AS % = 1.4, n.s) and PDFA (AD = 0.9°; AS % = 1.0, n.s). Gender and ethnicity were not associated with significantly higher AD asymmetry. A significant correlation of AD asymmetry was observed between BMI and HKA, BMI and MPTA, and between patients' age and the MPTA.

Conclusion: This data demonstrate that there is a non-statistically significant mechanical angle asymmetry between the two lower limbs. In cases where contralateral templating is used, such asymmetry will induce minimal (if any) clinical differences.

Level of evidence: IV.

Keywords: Asymmetry; Contralateral templating; Lower limb; Mechanical axis.