Correction of severe valgus osteoarthritis by total knee arthroplasty is associated with increased postoperative ankle symptoms

Graef, Frank; Hommel, Hagen; Falk, R.; Tsitsilonis, Serafeim; Zahn, R.; Perka, Carsten

doi:10.1007/s00167-020-06246-4

Cited by 10 publications

(14 citation statements)

References 34 publications

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“…Enough range of motion in this region might not be given in patients with an ankle arthrodesis by a nail. In patients with indication for osteotomy around the knee and primary or secondary arthritis of the ankle joints, we would recommend performing the osteotomy around the knee first and then treat the ankle afterwards-especially when indicating ankle arthrodesis [22][23][24][25][26][27]. With this sequence of surgeries, the surgeon can sustainably accomplish a correct foot position when performing the ankle arthrodesis.…”

Section: Discussionmentioning

confidence: 99%

Osteotomies around the knee lead to corresponding frontal realignment of the ankle

Konrads

Eis

Ahmad

et al. 2021

Eur J Orthop Surg Traumatol

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Introduction Despite the fact that osteotomies around the knee represent well-established treatment options for the redistribution of loads and forces within and around the knee joint, unforeseen effects of these osteotomies on the ankle are still to be better understood. It was therefore the aim of this study to determine the influence of osteotomies around the knee on the coronal alignment of the ankle. We hypothesize that osteotomies around the knee for correction of genu varum or valgum lead to a change of the ankle orientation in the frontal plane by valgisation or varisation. Materials and methods Long-leg standing radiographs of 154 consecutive patients undergoing valgisation or varisation osteotomy around the knee in 2017 were obtained and utilized for the purpose of this study. Postoperative radiographs were obtained after union at the osteotomy site. The hip knee ankle angle (HKA), the mechanical lateral distal femur angle (mLDFA), the mechanical medial proximal tibia angle (mMPTA) and five angles around the ankle were measured. Comparison between means was performed using the Wilcoxon-Mann–Whitney test. Results One hundred fifty-four patients (96 males, 58 females) underwent osteotomies around the knee for coronal realignment. The mean age was 51 ± 11 years. Correction osteotomies consisted of 73 HTO, 54 DFOs, and 27 double level osteotomies. Of all osteotomies, 118 were for valgisation and 36 for varisation. For valgisation osteotomies, the mean HKA changed from 5.8° ± 2.9° preoperatively to − 0.9° ± 2.5° postoperatively, whereas the mMPTA changed from 85.9° ± 2.7° to 90.7° ± 3.1° and the malleolar-horizontal-orientation-angle (MHA) changed from 16.4° ± 4.2° to 10.9° ± 4.2°. For varisation osteotomies, the mean HKA changed from − 4.3° ± 3.7° to 1.1° ± 2.2° postoperatively, whereas the mLDFA changed from 85.7° ± 2.2° to 89.3° ± 2.3° and the MHA changed from 8.8° ± 5.1° to 11.2° ± 3.2°. Conclusion Osteotomies around the knee for correction of coronal limb alignment not only lead to lateralization or medialization of the weight-bearing line at the knee but also lead to a coronal reorientation of the ankle. This can be measured at the ankle using the MHA. When planning an osteotomy around the knee for correction of genu varum or valgum, the ankle should also be appreciated—especially in patients with preexisting deformities, ligament instabilities, or joint degeneration around the ankle.

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Section: Discussionmentioning

confidence: 99%

Osteotomies around the knee lead to corresponding frontal realignment of the ankle

Konrads

Eis

Ahmad

et al. 2021

Eur J Orthop Surg Traumatol

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“…Other studies reported on increased pain and impaired function of the ankle joint following TKA, particularly in high-grade varus or valgus knee osteoarthritis when the mechanical axis was corrected beyond > 10-15° [5][6][7][8]. But these studies could not clarify whether TKA leads to the onset or progression of ankle pain or if the ankle pain had already been present but was masked by symptoms of knee osteoarthritis.…”

Section: Discussionmentioning

confidence: 98%

“…Mechanical corrections performed on a single joint can have vast implications for neighbouring joints, as well [4]. Recently, clinical studies reported that following total knee arthroplasty (TKA), patients may develop ankle symptoms, particularly if patients had an excessive pre-operative varus or valgus malalignment [5][6][7][8]. It is necessary to identify the mechanisms of the ankle and knee joint mutually affecting each other-both pre-operatively in knee osteoarthritis and following TKA.…”

Section: Introductionmentioning

confidence: 99%

Functional gait analysis reveals insufficient hindfoot compensation for varus and valgus osteoarthritis of the knee

Rühling

Kirschbaum

Perka

et al. 2023

International Orthopaedics (SICOT)

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Purpose The hindfoot is believed to compensate varus and valgus deformities of the knee by eversion and inversion movements. But these mechanisms were merely found in static radiologic measurements. The aim of this study was, therefore, to assess dynamic foot posture during gait using pressure-sensitive wireless insoles in patients with osteoarthritis of the knee and frontal knee deformities. Methods Patients with osteoarthritis of the knee were prospectively included in this study. Patients were clinically and radiologically (mechanical tibiofemoral angle (mTFA), hindfoot alignment view angle (HAVA), and talar tilt (TT)) exa mined. Gait line analysis was conducted using pressure-sensitive digital shoe insoles. Results Eighty-two patients (varus n = 52, valgus n = 30) were included in this prospective clinical study. Radiologically, the mTFA significantly correlated with the HAVA (cor = −0.72, p < 0.001) and with the TT (Pearson’s cor = 0.32, p < 0.006). Gait analysis revealed that the gait lines in varus knee osteoarthritis were lateralized, despite the hindfoot valgus. In valgus knee osteoarthritis, gait lines were medialized, although the hindfoot compensated by varization. Conclusions Functional dynamic gait analysis could demonstrate that the hindfoot is not able to sufficiently compensate for frontal malalignments of the knee joint, contrary to static radiologic findings. This led to a narrowing of the joint space of the ankle medially in varus and laterally in valgus knee osteoarthritis.

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“… 1 , 8 This is also relevant in the field of joint arthroplasty that involves alteration of the alignment of the knee. 19 , 20 …”

Section: Discussionmentioning

confidence: 99%

Frontal knee alignment influences the vertical orientation of the femoral neck in standing position

et al. 2021

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Aims The aim of this study was to determine the association between knee alignment and the vertical orientation of the femoral neck in relation to the floor. This could be clinically important because changes of femoral neck orientation might alter chondral joint contact zones and joint reaction forces, potentially inducing problems like pain in pre-existing chondral degeneration. Further, the femoral neck orientation influences the ischiofemoral space and a small ischiofemoral distance can lead to impingement. We hypothesized that a valgus knee alignment is associated with a more vertical orientation of the femoral neck in standing position, compared to a varus knee. We further hypothesized that realignment surgery around the knee alters the vertical orientation of the femoral neck. Methods Long-leg standing radiographs of patients undergoing realignment surgery around the knee were used. The hip-knee-ankle angle (HKA) and the vertical orientation of the femoral neck in relation to the floor were measured, prior to surgery and after osteotomy-site-union. Linear regression was performed to determine the influence of knee alignment on the vertical orientation of the femoral neck. Results The cohort included 147 patients who underwent knee realignment-surgery. The mean age was 51.5 years (SD 11). Overall, 106 patients underwent a valgisation-osteotomy, while 41 underwent varisation osteotomy. There was a significant association between the orientation of the knee and the coronal neck-orientation. In the varus group, the median orientation of the femoral neck was 46.5° (interquartile range (IQR) 49.7° to 50.0°), while in the valgus group, the orientation was 52.0° (IQR 46.5° to 56.7°; p < 0.001). Linear regression analysis revealed that HKA demonstrated a direct influence on the coronal neck-orientation ( β = 0.5 (95% confidence interval (CI) 0.2 to 0.7); p = 0.002). Linear regression also showed that realignment surgery was associated with a significant influence on the change in the coronal femoral neck orientation ( β = 5.6 (95% CI 1.5 to 9.8); p = 0.008). Conclusion Varus or valgus knee alignment is associated with either a more horizontal or a more vertical femoral neck orientation in standing position, respectively. Subsequently, osteotomies around the knee alter the vertical orientation of the femoral neck. These aspects are of importance when planning osteotomies around the knee in order to appreciate the effects on the adjacent hip joint. The concept may be of even more relevance in dysplastic hips. Cite this article: Bone Jt Open 2021;2(12):1057–1061.

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Correction of severe valgus osteoarthritis by total knee arthroplasty is associated with increased postoperative ankle symptoms

Cited by 10 publications

References 34 publications

Osteotomies around the knee lead to corresponding frontal realignment of the ankle

Osteotomies around the knee lead to corresponding frontal realignment of the ankle

Functional gait analysis reveals insufficient hindfoot compensation for varus and valgus osteoarthritis of the knee

Frontal knee alignment influences the vertical orientation of the femoral neck in standing position

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