Evaluation of hindfoot and knee alignment by the hip-to-calcaneus view in patients with knee osteoarthritis and healthy individuals

Wanezaki, Yoshihiro; Suzuki, Akihiro; Takakubo, Yuya; Nakajima, Taku; Toyono, Shuji; Toyoshima, Sadami; Hariu, Mitsuhiro; Okada, Soichiro; Ishikawa, Hitoshi; Takagi, Michiaki

doi:10.1016/j.knee.2022.08.014

Cited by 2 publications

(1 citation statement)

References 33 publications

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“…Moreover, the hip-kneeankle (HKA) angle and hip-knee-calcaneus (HKC) angle were measured with use of hip-to-calcaneus radiographs, as previously described (Fig. 4) [20][21][22] . The preoperative degree of osteoarthritis of the knee joint was evaluated with use of the Kellgren-Lawrence grading system 23 , and that of the ankle joint was graded on standing anteroposterior radiographs of the ankle with use of the modified Takakura staging system 24,25 .…”

Section: Radiographic Assessmentmentioning

confidence: 99%

Preoperative Hindfoot Alignment and Outcomes After High Tibial Osteotomy for Varus Knee Osteoarthritis

Yang,

Kang,

Kim

et al. 2024

Journal of Bone and Joint Surgery

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Background: The hip-to-calcaneus axis, previously known as the ground mechanical axis (GA), ideally passes through the center of the knee joint in the native knee. The aim of this study was to elucidate, with use of hip-to-calcaneus radiographs, changes in knee and hindfoot alignment and changes in outcomes following high tibial osteotomy (HTO). Methods: We reviewed the records for 128 patients who underwent HTO between 2018 and 2020. Patients were stratified into 2 groups, a hindfoot valgus group (n = 94) and a hindfoot varus group (n = 34), on the basis of their preoperative hindfoot alignment. The hindfoot alignment was evaluated with use of the hindfoot alignment angle (HAA). To evaluate lower-limb alignment, full-length standing posteroanterior hip-to-calcaneus radiographs were utilized to measure 4 radiographic parameters preoperatively and 2 years postoperatively: the hip-knee-ankle (HKA) angle, hip-knee-calcaneus (HKC) angle, and the weight-bearing line (WBL) ratios of the mechanical axis (MA) and GA. Results: The mean HAA improved significantly from 5.1° valgus preoperatively to 1.9° valgus postoperatively in the hindfoot valgus group (p < 0.001). In contrast, in the hindfoot varus group, the HAA showed no meaningful improvement in the coronal alignment of the hindfoot following HTO (p = 0.236). The postoperative mean HKC angle in the hindfoot varus group was 2° more varus than that in the hindfoot valgus group (1.0° versus 3.0°; p = 0.001), and the GA in the hindfoot varus group passed across the knee 8.0% more medially than that in the hindfoot valgus group (55% versus 63% from the most medial to the most lateral part of the tibial plateau). The hindfoot varus group had worse postoperative clinical outcomes than the hindfoot valgus group in terms of the mean Knee injury and Osteoarthritis Outcome Score for pain and American Orthopaedic Foot & Ankle Society Ankle-Hindfoot Score. Conclusions: Although our findings did not provide sufficient evidence to establish clinically relevant differences between the groups, they indicated that the group with a preoperative fixed hindfoot varus deformity had a higher rate of undercorrection and worse clinical outcomes, especially pain, following HTO. Therefore, modification of the procedure to shift the GA more laterally may be required for these patients. Level of Evidence: Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.

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Section: Radiographic Assessmentmentioning

confidence: 99%

Preoperative Hindfoot Alignment and Outcomes After High Tibial Osteotomy for Varus Knee Osteoarthritis

Yang,

Kang,

Kim

et al. 2024

Journal of Bone and Joint Surgery

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Medial opening low tibial osteotomy shifts the load laterally not only at the ankle joint but also at the knee joint

Wanezaki,

Kurokawa,

Ueno

et al. 2024

J. exp. orthop.

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PurposeThe purpose of this study was to determine the effects of medial opening low tibial osteotomy (LTO) on lower limb alignment, including the knee joint, 1 year after low tibial osteotomy.MethodsThis study included 20 legs of 20 patients (mean age, 66.8 ± 5.4 years) who underwent LTO for medial ankle osteoarthritis and evaluated the changes in the hip–knee–ankle angle (HKA), percentage hip‐to‐ankle line (%HA), percentage hip‐to‐calcaneal line (%HC), medial proximal tibial angle (MPTA), knee joint line convergence angle (K‐JLCA), tibio‐calcaneal angle (TCA), tibial anterior surface angle (TAS), tibio‐plafond inclination (TPI), talar inclination (TI), ankle joint line convergence angle (A‐JLCA), mechanical ankle joint axis point (MAJAP) on radiographs and the Japanese Society for Surgery of the Foot (JSSF) ankle/hindfoot scale before and 1 year after low tibial osteotomy.ResultsThe mean preoperative/postoperative measured values showed the following: HKA (degrees) of 1.0 ± 3.7/−0.8 ± 3.7; %HC of 38.8 ± 10.0/53.8 ± 16.1; MPTA (degrees) of 85.6 ± 2.4/87.6 ± 2.1; and A‐JLCA (degrees) of 4.2 ± 2.9/1.1 ± 2.3 respectively. Including other measurements, a significant increase in the %HA, %HC, MPTA, TCA, TAS, MAJAP and JSSF ankle/hindfoot scale was observed postoperatively, whereas a significant decrease in the HKA, TPA, TI and A‐JLCA was observed postoperatively (p < 0.05). With the numbers available, no significant differences were observed between the preoperative and postoperative values of K‐JLCA (n.s.).ConclusionAfter LTO, the entire lower limb alignment became valgus, and the loading points of the knee and ankle joints shifted laterally. These changes must be considered when performing LTO, especially in patients with lateral knee OA.Level of EvidenceⅣ

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Evaluation of hindfoot and knee alignment by the hip-to-calcaneus view in patients with knee osteoarthritis and healthy individuals

Cited by 2 publications

References 33 publications

Preoperative Hindfoot Alignment and Outcomes After High Tibial Osteotomy for Varus Knee Osteoarthritis

Preoperative Hindfoot Alignment and Outcomes After High Tibial Osteotomy for Varus Knee Osteoarthritis

Medial opening low tibial osteotomy shifts the load laterally not only at the ankle joint but also at the knee joint

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