Is lateral femoral condyle hypoplasia a feature of genu valgum? A morphological computed tomography study of 200 knees

Background: Young surgeons are taught that genu valgum deformity is associated with hypoplasia of the lateral femoral condyle, despite the absence of supporting evidence. The objective of this study was to determine whether the lateral condyle was hypoplastic in genu valgum, by assessing the morphological features of the distal femur and their variations according to the severity of the coronal deformity. Hypothesis: The lateral femoral condyle is not hypoplastic in genu valgum deformity. Material and methods: The 200 included patients treated by unilateral total knee arthroplasty were divided into five groups based on their preoperative hip-knee-ankle (HKA) angle. The HKA angle, valgus cut angle (VCA), and anatomical lateral distal femoral angle (aLDFA) were measured on long-leg radiographs. Computed tomography images were then used to measure the medial and lateral anterior-posterior condylar lengths (mAPCL and lAPCL) and condylar thicknesses (mCT and lCT), distal femoral torsion (DFT), medial and lateral posterior condylar heights (mPCH and lPCH), and medial and lateral condylar volumes (mCV and lCV). Results: No significant differences were demonstrated across the five mechanical-axis groups for mAPCL, lAPCL, mCT, lCT, mPCH, or lPCH. The groups differed significantly regarding the VCA (p<0.0001), aLDFA (p<0.0001), DFT (p<0.0001), and mCV/lCV ratio (p<0.0001). VCA and aLDFA were smaller when the valgus exceeded 10 degrees. DFT was similar in all varus knees (2.2 degrees-2.6 degrees) but significantly greater for knees with moderate (4.0 degrees) or severe (6.2 degrees) valgus. Finally, lCV was greater than mCV in valgus knees compared to varus knees. Conclusion: The presence of lateral condyle hypoplasia in knees with genu valgum seems open to question. Apparent hypoplasia noted during the standard physical examination may be chiefly ascribable to distal valgus of the femoral epiphysis in the coronal plane and, with the knee flexed, to distal epiphyseal torsion, whose severity increases with the degree of valgus deformity. These considerations should be taken into account when performing distal femoral cuts for TKA, to ensure the restoration of normal anatomy in patients with genu valgus. (C) 2023 Elsevier Masson SAS. All rights reserved.

Automated summary

This study aimed to determine whether the lateral femoral condyle is hypoplastic in genu valgum by evaluating the severity of the coronal deformity. The results showed no significant differences in mAPCL, lAPCL, mCT, lCT, mPCH, or lPCH across different mechanical-axis groups. VCA, aLDFA, DFT, and mCV/lCV differed significantly, with smaller VCA and aLDFA when valgus exceeded 10 degrees. In conclusion, genu valgum does not seem to be associated with hypoplasia of the lateral condyle.