Association of Osteoporosis and Varus Inclination of the Tibial Plateau in Postmenopausal Women with Advanced Osteoarthritis of the Knee

Overview

Journal BMC Musculoskelet Disord

Publisher Biomed Central

Specialties Orthopedics
Physiology

Date 2021 Feb 26

PMID 33632177

Citations 9

Authors

Shun-Ping Wang

Po-Kuan Wu

Cheng-Hung Lee

Cheng-Min Shih

Yung-Cheng Chiu

Cheng-En Hsu

Affiliations

Soon will be listed here.

Abstract

Background: Although varus inclination of the tibial plateau has increasingly been recognized as a major risk factor in the progression of Osteoarthritis of the knee (OA knee), little attention has been placed on the development of the varus inclination of the tibial plateau. Osteoporosis is a disease characterized by low bone mass and may increase the risk of a stress fracture in the proximal tibia. To date, risk factors for varus inclination of the tibial plateau are rarely reported. In this study, we investigated Bone Mineral Density (BMD) as a risk factor of varus inclination of the tibial plateau in postmenopausal women with advanced OA knee.

Methods: A total of 90 postmenopausal women with varus OA knee who had received a total knee arthroplasty in our department between January 2016 and December 2019 were reviewed. Certain factors may correlate to inclination of the tibial plateau (Medial Tibial Plateau Angle, MTPA), including age, operation side, Kellgren-Lawrence grade of OA knee, BMD, Body Mass Index (BMI), Lateral Distal Femur Angle (LDFA), lower extremity alignment (Hip-Knee-Ankle angle, HKAA), and history of both spinal compression fracture and hip fracture were collected and analyzed.

Results: Osteoporosis, lower extremity varus malalignment and age were significantly associated with varus inclination of the tibial plateau (MTPA) (P = 0.15, 0.013 and 0.033 respectively). For patients with a lower extremity varus malalignment (HKAA < 175°), osteoporosis (T-score ≤ -2.5) was significantly associated with inclination of the tibial plateau. For patients with a normal lower extremity alignment (HKAA ≥ 175°), no significant association was found between osteoporosis (T-score ≤ -2.5) and varus inclination of the tibial plateau.

Conclusions: Osteoporosis, lower extremity varus malalignment and age are major risk factors for inclination of the tibial plateau in postmenopausal women with OA knee. More attention needs to be given to the progression of varus OA knee in postmenopausal women who simultaneously has osteoporosis and lower extremity varus malalignment.

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References

Zaremski J, Vincent K . Spontaneous Osteonecrosis of the Knee. Curr Sports Med Rep. 2016; 15(4):228-9. DOI: 10.1249/JSR.0000000000000271. View

Sharma L, Song J, Felson D, Cahue S, Shamiyeh E, Dunlop D . The role of knee alignment in disease progression and functional decline in knee osteoarthritis. JAMA. 2001; 286(2):188-95. DOI: 10.1001/jama.286.2.188. View

Hannan M, Anderson J, Zhang Y, Levy D, Felson D . Bone mineral density and knee osteoarthritis in elderly men and women. The Framingham Study. Arthritis Rheum. 1993; 36(12):1671-80. DOI: 10.1002/art.1780361205. View

Arokoski J, Arokoski M, Jurvelin J, Helminen H, Niemitukia L, Kroger H . Increased bone mineral content and bone size in the femoral neck of men with hip osteoarthritis. Ann Rheum Dis. 2002; 61(2):145-50. PMC: 1753998. DOI: 10.1136/ard.61.2.145. View

Skytta E, Haapamaki V, Koivikko M, Huhtala H, Remes V . Reliability of the hip-to-ankle radiograph in determining the knee and implant alignment after total knee arthroplasty. Acta Orthop Belg. 2011; 77(3):329-35. View

. Consensus development conference: prophylaxis and treatment of osteoporosis. Am J Med. 1991; 90(1):107-10. DOI: 10.1016/0002-9343(91)90512-v. View

Tanamas S, Hanna F, Cicuttini F, Wluka A, Berry P, Urquhart D . Does knee malalignment increase the risk of development and progression of knee osteoarthritis? A systematic review. Arthritis Rheum. 2009; 61(4):459-67. DOI: 10.1002/art.24336. View

Atalar H, Yanik B, Ozcakar B, Atalar E, Koktener A . Bone mineral density is not related to severity of osteoarthritis in the knee in postmenopausal women. Rheumatol Int. 2007; 28(3):233-6. DOI: 10.1007/s00296-007-0416-4. View

Teichtahl A, Cicuttini F, Janakiramanan N, Davis S, Wluka A . Static knee alignment and its association with radiographic knee osteoarthritis. Osteoarthritis Cartilage. 2006; 14(9):958-62. DOI: 10.1016/j.joca.2006.04.014. View

10.

Murthy N . Imaging of stress fractures of the spine. Radiol Clin North Am. 2012; 50(4):799-821. DOI: 10.1016/j.rcl.2012.04.009. View

11.

Martin L, Bourne R, Rorabeck C . Stress fractures associated with osteoarthritis of the knee. A report of three cases. J Bone Joint Surg Am. 1988; 70(5):771-4. View

12.

Sezer I, Illeez O, Tuna S, Balci N . The relationship between knee osteoarthritis and osteoporosis. Eurasian J Med. 2015; 42(3):124-7. PMC: 4261263. DOI: 10.5152/eajm.2010.35. View

13.

Hunter D, Zhang Y, Tu X, Lavalley M, Niu J, Amin S . Change in joint space width: hyaline articular cartilage loss or alteration in meniscus?. Arthritis Rheum. 2006; 54(8):2488-95. DOI: 10.1002/art.22016. View

14.

Sharma L, Song J, Dunlop D, Felson D, Lewis C, Segal N . Varus and valgus alignment and incident and progressive knee osteoarthritis. Ann Rheum Dis. 2010; 69(11):1940-5. PMC: 2994600. DOI: 10.1136/ard.2010.129742. View

15.

Siris E, Adler R, Bilezikian J, Bolognese M, Dawson-Hughes B, Favus M . The clinical diagnosis of osteoporosis: a position statement from the National Bone Health Alliance Working Group. Osteoporos Int. 2014; 25(5):1439-43. PMC: 3988515. DOI: 10.1007/s00198-014-2655-z. View

16.

Terauchi M, Shirakura K, Katayama M, Higuchi H, Takagishi K . The influence of osteoporosis on varus osteoarthritis of the knee. J Bone Joint Surg Br. 1998; 80(3):432-6. DOI: 10.1302/0301-620x.80b3.8408. View

17.

Akamatsu Y, Mitsugi N, Taki N, Takeuchi R, Saito T . Relationship between low bone mineral density and varus deformity in postmenopausal women with knee osteoarthritis. J Rheumatol. 2009; 36(3):592-7. DOI: 10.3899/jrheum.080699. View

18.

Sabharwal S . Blount disease: an update. Orthop Clin North Am. 2014; 46(1):37-47. DOI: 10.1016/j.ocl.2014.09.002. View

19.

Akamatsu Y, Mitsugi N, Hayashi T, Kobayashi H, Saito T . Low bone mineral density is associated with the onset of spontaneous osteonecrosis of the knee. Acta Orthop. 2012; 83(3):249-55. PMC: 3369150. DOI: 10.3109/17453674.2012.684139. View

20.

Nabors E, Kremchek T, BURKE D . Stress fracture of the proximal tibia associated with severe osteoarthritis. Am J Knee Surg. 1995; 8(4):141-3. View