Discrepancy of Alignment in Different Weight Bearing Conditions Before and After High Tibial Osteotomy

Overview

Journal Int Orthop

Specialty Orthopedics

Date 2016 Aug 19

PMID 27535554

Citations 14

Authors

Joon Ho Wang

Jung Min Shin

Hyun Ho Kim

Seung-Hoon Kang

Byung Hoon Lee

Affiliations

Soon will be listed here.

Abstract

Purpose: To evaluate the differences in the amount of varus malalignment and valgus (over) correction in relation to three different weight bearing conditions from whole leg AP radiographs (single-limb (SL) stance, double-limb (DL) stance, supine position (S)) before and after high tibial osteotomy (HTO), and to evaluate which alignment parameters affect the changes for patients in three different weight bearing conditions.

Methods: A total of 40 consecutive patients (43 knees) with varus osteoarthritis underwent navigation assisted open wedge HTO. Mechanical axis angle (MA) was measured before and after surgery from hip-to-ankle radiographs taken with patients in three different weight bearing conditions. To find significant factors that affect the alignment differences, several variables including patient demographics, soft tissue laxity, pelvic obliquity, and ground mechanical axis deviation of tibia (calculated by the angle between two lines, tibial anatomical axis and weight-bearing line) were evaluated.

Results: Pre-operatively, mean MA measured on SL stance radiographs was significantly more varus than on DL stance (10.1° ± 2.4° and 8.0° ± 2.6°, respectively, p < 0.001), which was significantly more varus than on supine position (6.6° ± 2.6°, p < 0.001). Meanwhile, in patients with post-operatively valgus corrected knee, MA did not show the same pattern of change as with pre-operative varus knee. Mean MA measured on DL stance radiographs was more valgus than in supine position (-3.0 ± 2.4 and -2.6 ± 3.1, p = 0.455), while mean MA on SL stance radiographs (-2.0 ± 2.1) was significantly less valgus than on DL stance (p = 0.002). The ground mechanical axis deviation of tibia showed a significant correlation with MA difference between SL and DL stance radiographs before (β = -0.341, p = 0.045) and after surgery (β = -0.536, p = 0.001).

Conclusion: In pre-operative varus knee, the mean MA on SL stance was changed to more varus than on DL stance, which changed to less valgus in post-operative valgus knee. The understanding in discrepancy of alignment in different weight bearing conditions before and after HTO should be considered for the appropriate realignment of the limb.

Study Design: Level II Prospective comparative study.

Citing Articles

Influence of different standing positions on anatomical parameters of coronal whole-leg weight-bearing radiographs in preoperative planning for high tibial osteotomy.

Kamiya T, Hamaoka K, Ono A, Okada Y, Emori M, Teramoto A J Exp Orthop. 2024; 11(3):e12085.

PMID: 38974048 PMC: 11227596. DOI: 10.1002/jeo2.12085.

Postoperative full leg radiographs exhibit less residual coronal varus deformity compared to intraoperative measurements in robotic arm-assisted total knee arthroplasty with the MAKO™ system.

Glowalla C, Langer S, Lenze U, Lazic I, Hirschmann M, Hinterwimmer F Knee Surg Sports Traumatol Arthrosc. 2023; 31(9):3912-3918.

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Key-Point Detection Algorithm of Deep Learning Can Predict Lower Limb Alignment with Simple Knee Radiographs.

Nam H, Park S, Ho J, Park S, Cho J, Lee Y J Clin Med. 2023; 12(4).

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[Effectiveness of intraoperative tibia fibular angle and femoral fibular angle in predicting coronal lower limb alignment after medial open-wedge high tibial osteotomy].

Mao Y, He A, Zhou Y, Chen Y, Liu Y, Yu X Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. 2022; 36(1):58-64.

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Influence of axial limb rotation on radiographic lower limb alignment: a systematic review.

Ahrend M, Baumgartner H, Ihle C, Histing T, Schroter S, Finger F Arch Orthop Trauma Surg. 2021; 142(11):3349-3366.

PMID: 34596760 PMC: 9522705. DOI: 10.1007/s00402-021-04163-w.

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