Difference in joint line convergence angle between the supine and standing positions is the most important predictive factor of coronal correction error after medial opening wedge high tibial osteotomy

S, So; Lee, Sung-Sahn; Jung, Eun Jin; Kim, Joo Hwan; Wang, Joon Ho

doi:10.1007/s00167-019-05555-7

Cited by 48 publications

(65 citation statements)

References 42 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…The effect of WB on the JLCA was less frequently investigated so far. However, So et al showed a mean difference of 1.8°between WB and NWB conditions for the measurement of JLCA [32], which is comparable to the results of this study. At the same time, they found it to be the most important predicting factor for coronal correction discrepancy after medial opening-wedge high tibial osteotomy.…”

Section: Discussionsupporting

confidence: 91%

“…Besides the need for 3D preoperative planning, it is important to incorporate WB into the surgical planning workflow, not to neglect the resulting differences in measuring lower limb parameters caused by limb loading [4,28,32]. Correctly estimating the HKA is mandatory, as precise axis correction in coronal realignment surgery is crucial for a successful postoperative result, and under-or overcorrection, probably partly as a result of the measurement discrepancies, was shown to be the main reason for clinical failure [3,11].…”

Section: Discussionmentioning

confidence: 99%

“…The goal of this study was to perform a systematic analysis of the impact of limb loading (WB versus NWB) and the measurement modality (2D versus 3D) on common limb loading-dependent lower extremity parameters. As the joint line convergence angle (JLCA) was shown to be the most important preoperative factor that predicts realignment discrepancy after high tibial osteotomy [32], JLCA was investigated as the second parameter besides the most used parameter in realignment surgery in daily practice, the HKA. We hypothesize that HKA and JLCA measurements are significantly different depending on limb loading (WB versus NWB) and the applied measurement modality (2D versus 3D).…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

The impact of limb loading and the measurement modality (2D versus 3D) on the measurement of the limb loading dependent lower extremity parameters

Jud

Roth

Fürnstahl

et al. 2020

BMC Musculoskelet Disord

View full text Add to dashboard Cite

Background: Deformity assessment and preoperative planning of realignment surgery are conventionally based on weight-bearing (WB) radiographs. However, newer technologies such as three-dimensional (3D) preoperative planning and surgical navigation with patient-specific instruments (PSI) rely on non-weight bearing (NWB) computed tomography (CT) data. Additionally, differences between conventional two-dimensional (2D) and 3D measurements are known. The goal of the present study was to systematically analyse the influence of WB and the measurement modality (2D versus 3D) on common WB-dependent measurements used for deformity assessment. Methods: 85 lower limbs could be included. Two readers measured the hip-knee-ankle angle (HKA) and the joint line convergence angle (JLCA) in 2D WB and 2D NWB radiographs, as well as in CT-reconstructed 3D models using an already established 3D measurement method for HKA, and a newly developed 3D measurement method for JLCA, respectively. Interrater and intermodality reliability was assessed. Results: Significant differences between WB and NWB measurements were found for HKA (p < 0.001) and JLCA (p < 0.001). No significant difference could be observed between 2D HKA NWB and 3D HKA (p = 0.09). The difference between 2D JLCA NWB and 3D JLCA was significant (p < 0.001). The intraclass correlation coefficient (ICC) for the interrater agreement was almost perfect for all HKA and 3D JLCA measurements and substantial for 2D JLCA WB and 2D JLCA NWB. ICC for the intermodality agreement was almost perfect between 2D HKA WB and 2D HKA NWB as well as between 2D HKA NWB and 3D HKA, whereas it was moderate between 2D JLCA WB and 2D JLCA NWB and between 2D JLCA NWB and 3D JLCA. Conclusion: Limb loading results in significant differences for both HKA and JLCA measurements. Furthermore, 2D projections were found to be insufficient to represent 3D joint anatomy in complex cases. With an increasing number of surgical approaches based on NWB CT-reconstructed models, research should focus on the development of 3D planning methods that consider the effects of WB on leg alignment.

show abstract

Section: Discussionsupporting

confidence: 91%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

The impact of limb loading and the measurement modality (2D versus 3D) on the measurement of the limb loading dependent lower extremity parameters

Jud

Roth

Fürnstahl

et al. 2020

BMC Musculoskelet Disord

View full text Add to dashboard Cite

show abstract

“…Finally, JLCA changes can be anticipated [4,19,45] as well as accounting for the changes in soft tissue correction [27,44]. An equation has been proposed to define the acceptable intra-articular correction with the aim of achieving a more anatomic osteotomy while considering JLCA.…”

Section: Discussionmentioning

confidence: 99%

Managing intra-articular deformity in high Tibial osteotomy: a narrative review

et al. 2020

View full text Add to dashboard Cite

The joint line convergence angle (JLCA) has a normal range between 0° to 2°, which increases in magnitude depending on the severity and stage of osteoarthritis in the knee. The JLCA represents the interaction of the intra-articular deformity arising from the osteoarthritis and the surrounding soft tissue laxity. Therefore, the JLCA has become a vital parameter in analysing the long leg alignment views for corrective planning before osteotomy surgery. Recent studies have considered the influence on how the preoperative JLCA is measured and its influence on achieving accurate postoperative desired correction in high tibial osteotomy surgery. The JLCA also reflects the influence of soft tissue laxity in a lower limb malalignment and many surgeons encourage it to be taken into account to avoid non physiological correction and/or overcorrection with negatively impacted postoperative patient outcome. This present review addressed how to obtain an accurate preoperative measurement of the JLCA, its influence on postoperative deformity analysis and how to reduce errors arising from an elevated preoperative JLCA. We have proposed a formula to help determine the value to subtract from the planned correction in order to avoid an overcorrection when performing a corrective osteotomy. Level of clinical evidence IV, narrative review.

show abstract

“…The effect of overcorrection due to a change in JLCA after OWHTO can explain this difference. 8,16,19,22 Whereas several studies 8,19 have proposed a method to predict overcorrection due to soft tissue effects after OWHTO, there are some limitations to accurately predicting this soft tissue effect preoperatively. Although postoperative knee JLO may increase due to an increase in limb adduction by overcorrecting the overall alignment, the local effect of the decrease in JLO caused by the decrease in JLCA compensates for the increase in JLO due to overcorrection.…”

Section: Discussionmentioning

confidence: 99%

Using the Lower Limb Adduction Angle to Predict Postoperative Knee Joint-Line Obliquity After Open-Wedge High Tibial Osteotomy

Park

Bin

Kim

et al. 2021

Orthopaedic Journal of Sports Medicine

View full text Add to dashboard Cite

Background: Knee joint-line orientation is altered after open-wedge high tibial osteotomy (OWHTO), and excessive joint-line obliquity (JLO) can adversely affect outcomes. Little is known regarding preoperative prediction of postoperative knee JLO. Purpose/Hypothesis: The purpose of this study was to assess the correlation between the amount of lower limb adduction and changes in knee JLO after OWHTO. The hypothesis was that postoperative knee JLO could be predicted using the amount of lower limb adduction after OWHTO. Study Design: Case series; Level of evidence, 4. Methods: The records of 67 patients (77 knees) who underwent OWHTO for medial compartment osteoarthritis were retrospectively reviewed. The mechanical hip-knee-ankle (HKA) axis, lateral distal femoral angle, medial proximal tibial angle (MPTA), knee JLO, ankle JLO, and joint-line convergence angle were measured on standing whole-leg plain radiographs preoperatively and at 1 year postoperatively. The limb adduction angle was defined as the angle between the native weightbearing line (WBL) and the planned WBL on preoperative standing whole-leg plain radiographs. The predicted knee JLO was calculated as the sum of the preoperative knee JLO and the limb adduction angle. Multivariable linear regression analysis was used to identify the preoperative radiologic factors associated with the postoperative knee JLO. The agreement between postoperative and predicted values was determined using intraclass correlation coefficients (ICCs). Results: The estimated limb adduction angle was 4.2° ± 1.3°, and the predicted knee JLO was 4.9° ± 3.0°. The actual postoperative knee JLO was 4.5° ± 2.4°, which was a significant increase from 0.7° ± 2.4° preoperatively ( P < .001). Excellent agreement was found between the predicted knee JLO and postoperative knee JLO (ICC = 0.928; P < .001). Limb adduction angle and changes in preoperative MPTA were significantly associated with changes in knee JLO ( P < .001). On multivariable linear regression analysis, preoperative knee JLO and limb adduction angle were significantly associated with postoperative knee JLO ( P < .001; R 2 = 0.83). Conclusion: Changes in knee JLO after OWHTO were associated with adduction of the lower limb after OWHTO. During preoperative planning, postoperative knee JLO can be predicted as the sum of the preoperative knee JLO and the limb adduction angle between the preoperative WBL and planned WBL.

show abstract

Difference in joint line convergence angle between the supine and standing positions is the most important predictive factor of coronal correction error after medial opening wedge high tibial osteotomy

Cited by 48 publications

References 42 publications

The impact of limb loading and the measurement modality (2D versus 3D) on the measurement of the limb loading dependent lower extremity parameters

The impact of limb loading and the measurement modality (2D versus 3D) on the measurement of the limb loading dependent lower extremity parameters

Managing intra-articular deformity in high Tibial osteotomy: a narrative review

Using the Lower Limb Adduction Angle to Predict Postoperative Knee Joint-Line Obliquity After Open-Wedge High Tibial Osteotomy

Contact Info

Product

Resources

About