Tibia vara in Asians: Myth or fact? Verification with three-dimensional computed tomography

Ho, Jade Pei Yuik and Merican, Azhar Mahmood and Ayob, Khairul Anwar and Sulaiman, Shahrul-Hisham and Hashim, Muhammad Sufian (2021) Tibia vara in Asians: Myth or fact? Verification with three-dimensional computed tomography. Journal of orthopaedic surgery (Hong Kong), 29 (1). ISSN 1022-5536, DOI https://doi.org/10.1177/2309499021992618.

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Background: There is a common perception among surgeons that Asian tibiae are significantly more varus compared to non-Asians, contributed both by an acute medial tibial proximal angle (MPTA) and diaphyseal bowing. Insight into the normative morphology of the tibia allows generation of knowledge towards disease processes and subsequently planning for corrective surgeries. Methods: Computed tomography (CT) scans of 100 normal adult knees, aged 18 years and above, were analysed using a 3-dimensional (3D) analysis software. All tibiae were first aligned to a standard frame of reference and then rotationally aligned to the tibial centroid axis (TCAx) and the transmalleolar axis (tmAx). MPTA was measured from best-fit planes on the surface of the proximal tibia for each rotational alignment. Diaphyseal bowing was assessed by dividing the shaft to three equal portions and establishing the angle between the proximal and distal segments. Results: The mean MPTA was 87.0 degrees +/- 2.2 degrees (mean +/- SD) when rotationally aligned to TCAx and 91.6 degrees +/- 2.7 degrees when aligned to tmAx. The mean diaphyseal bowing was 0.1 degrees +/- 1.9 degrees varus when rotationally aligned to TCAx and 0.3 degrees +/- 1.6 degrees valgus when aligned to tmAx. The mean difference when the MPTA was measured with two different rotational alignments (TCAx and tmAx) was 4.6 degrees +/- 2.3 degrees. No statistically significant differences were observed between males and females. Post hoc tests revealed statistically significant difference in MPTA between different ethnic sub-groups. Conclusion: The morphology of the proximal tibiae in the disease-free Asian knee is inherently varus but not more so than other reported populations. The varus profile is contributed by the MPTA, with negligible diaphyseal bowing. These implications are relevant to surgical planning and prosthesis design.

Item Type: Article
Funders: Universiti Malaya [RG476-12HTM]
Uncontrolled Keywords: 3D computed tomography; Arthroplasty; Asians; Diaphyseal bowing; Knee; Osteoarthritis; Tibia vara
Subjects: R Medicine > R Medicine (General)
R Medicine > RD Surgery
Divisions: Faculty of Medicine > Orthopaedic Surgey Department
Depositing User: Ms Zaharah Ramly
Date Deposited: 02 Aug 2022 01:26
Last Modified: 02 Aug 2022 01:26
URI: http://eprints.um.edu.my/id/eprint/28150

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