Iatrogenic ischiofemoral impingement due to high tibial osteotomy with overvalgization: a case report

Konrads, Christian; Ahmad, Sufian S.; Histing, Tina; Ibrahim, M Z

doi:10.1186/s13256-022-03257-2

Cited by 8 publications

(7 citation statements)

References 15 publications

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“…The changes that occur at the ankle have previously been described but this is the first study to describe the relative changes that occur at the hip [ 8 , 9 , 10 , 12 ]. Palmer et al have described the increased incidence of CAM deformities in patients with a failing medial knee compartment and Konrads et al described a case of hip impingement after an HTO [ 5 , 6 ]. Further studies would prove beneficial in assessing the clinical significance of these findings.…”

Section: Discussionmentioning

confidence: 99%

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Changes in coronal alignment of the hip joint after medial opening wedge high tibial osteotomy

Patel

Melton

2022

Eur J Orthop Surg Traumatol

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Purpose An observation was made by the senior author of this paper that patients reported changes in their hip function after a medial opening wedge high tibial osteotomy (MOHTO) for varus pattern osteoarthritis. Alignment changes at the hip after MOHTO have not been previously documented. This study assesses coronal alignment changes at the hip after MOHTO. Methods We retrospectively analysed pre- and post-operative lower limb alignment radiographs of patients who underwent MOHTO. The medial proximal tibial angle (MPTA) and mechanical axis deviation (MAD) were measured to assess the alignment changes created by the MOHTO. The coronal alignment changes at the hip were evaluated using the mechanical greater trochanter angle (MGTA). Results 29 osteotomies in 27 patients were included in this study. Results showed MOHTO created alignment changes at the hip. A positive correlation was found between the size of the correction at the knee and the subsequent changes at the hip. The change in the MGTA had a stronger correlation with the MAD than with the change in MPTA (r = 0.684 vs. 0.585). It was found that age, weight, height and BMI had no significant influence on these correlations. Conclusions Increased correction by the MOHTO lead to increased change in the coronal alignment of the hip. These changes are likely to result in an alteration in the weight bearing portion of the femoral head and the function of the abductors and we recommend assessing the hip joint as part of pre-operative planning. Level of evidence Prognostic level IV.

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Section: Discussionmentioning

confidence: 99%

“…Observations of the hip in patients with knee malalignment have been made previously [ 5 ]. The current literature on the hip after MOHTO is limited to case reports [ 6 ]. Changes in the coronal alignment of the ankle after MOHTO have been studied in the past [ 7 – 10 ].…”

Section: Introductionmentioning

confidence: 99%

Changes in coronal alignment of the hip joint after medial opening wedge high tibial osteotomy

Patel

Melton

2022

Eur J Orthop Surg Traumatol

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“…It was demonstrated earlier that the ischiofemoral distance measured on ap radiograph correlates with the real three-dimensional ischiofemoral distance measured on transverse CT slides [ 2 , 15 , 25 ]. Yet, it is reasonable to mention that therapeutic decisions and surgical indications should be based on measurements on transverse imaging slides (CT or MRI).…”

Section: Discussionmentioning

confidence: 98%

The Female Pelvis Is Associated with a Lateralized Ischium and a Reduced Ischiofemoral Space

Ahmad

Konrads

Niemann

et al. 2023

JCM

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Background: Pelvi-femoral conflicts are increasingly recognized for their explanatory role in the pathology of extra-articular hip impingement. Ischiofemoral impingement (IFI) is a type of impingement between the femur and the ischium that causes high femoral antetorsion and valgus femoral neck orientation. It is unknown whether obstetric adaptation of the female pelvis renders the female hip at a higher risk of sustaining IFI. The aim of this study was to determine the influence of the pelvic morphology on the ischiofemoral space (IFS). Methods: Plain radiographs of healthy individuals with no symptomatic hip disease were obtained in a functional standing position in a standardized manner and utilized for measurement of the interischial and ischiofemoral widths, subpubic angle, and centrum collum diaphyseal (CCD) angle. Linear regression was performed to determine the influence of morphometric measures on the ischiofemoral space. Results: Sixty-five radiographs (34 females and 31 males) were included. The cohort was stratified according to gender. Significant gender-related differences were noted regarding the ischiofemoral distance (31% increase in males, p < 0.001), pubic-arc angle (30% increased in females, p < 0.001), and the interischial space (7% increase in females, p < 0.001). CCD did not significantly differ between genders (p = 0.2). Factors influencing the IFS include the pubic-arc angle (β = −0.01 (CI −0.02–−0.00), p = 0.003), interischial distance (β = −0.11 (CI −0.23–−0.00), p = 0.049) and CCD (β = −0.06 (CI −0.09–−0.04), p < 0.001). Conclusions: Obstetric adaptation is associated with an increased subpubic angle that shifts the ischia laterally and away from the symphysis. The resultant reduction in the ischiofemoral space renders the female pelvis at a higher risk for a pelvi-femoral conflict, or more precisely, an ischiofemoral conflict, due to the reduced ischiofemoral space of the hip. The CCD angle of the femur was shown not to be gender specific. However, the CCD angle demonstrates an influence on the ischiofemoral space, rendering the proximal femur a target for corresponding osteotomies.

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“…E.g., Ahmad et al demonstrated a correlation between the ischiofemoral distance (IFD) and the frontal alignment of the knee. Varisation osteotomy around the knee increases the hip abduction angle and thus the ischiofemoral space, which could correlate with extraarticular hip pain due to ischiofemoral impingement [1, 21]. Freiling et al described a correction of the mechanical femorotibial axis to a target between 0 and 3° depending on the extent of degenerative changes in the lateral compartment [15].…”

Section: Discussionmentioning

confidence: 99%

In closed wedge distal femur osteotomies for correction of valgus malalignment overcorrection of mLDFA should be avoided

Schröter

Konrads

Maiotti³

et al. 2023

Knee Surg Sports Traumatol Arthrosc

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PurposeThe purpose of the study was to investigate the inluence of the mLDFA (mechanical lateral distal femur angle) as a parameter in varus realignment osteotomies for valgus deformities of the knee. We hypothesized that joint line obliquity with mLDFA > 90° after distal femur osteotomy (DFO) is associated with inferior clinical outcome. Methods In a retrospective study, a total of 52 patients with isolated femoral valgus deformities were included in the study. The mean postoperative follow-up was 70.5 (SD 33.3) months (standard deviation SD±33.3). In all patients, a distal femur osteotomy was performed. A clinical examination and survey of questionnaires was conducted with the HSS (Hospital for Special Surgery), LG (Lysholm-Gilquist), and KOOS (Knee Injury and Osteoarthritis Outcome Score) scores. Several radiological parameters were assessed on long-standing x-rays: mechanical tibio-femoral angle (mTFA), mLDFA, mechanical medial proximal tibia angle (mMPTA), joint-line convergence angle (JLCA). The t test was used for normally distributed data. The Mann-Whitney U test was performed in non-normally distributed data. ResultsThe mLDFA was 84.9° (SD±2.3) preop and changed to 91.9° (SD±3, 22.9) postop. The mTFA (mechanical tibiofemoral angle) was 5.2° (SD±2.9°) preop and − 1.8° (SD±2.9) postop demonstrating a diference of 6.7°. For analysis, the data was divided into two groups based on postop mLDFA. Group 1: mLDFA ≤ 90°; Group 2: > 90°. Postoperatively, a mean mLDFA of 88.6° (SD±1.4°) was measured in group 1 and 93.9° (SD±2.1) in group 2. The change in mLDFA was 4.7° (SD±1.6) in group 1 and 8.4° (SD±2.8) in group 2. Preoperatively, the mTFA was 4.8° (SD±1.9) in group 1 and 5.5° (SD±3.3) in group 2. Postoperatively, the mTFA decreased in group 1 by 4.8° (SD±2.3) to − 0.1° (SD±2.1). In group 2, the mTFA decreased by 8.2° (SD±3.8) to − 2.8° (SD±2.9). Regarding the HSS, group 1 showed a 10.4 points better score than group 2 (p<0.01). Also, regarding the Lysholm, a signiicant diference of 16.9 points was found (p<0.01). Conclusion Correction of valgus knees using closed wedge DFO leads to good clinical results. A postoperative mLDFA of 85-90° results in superior clinical outcome compared to mLDFA > 90°. Joint-line obliquity should be avoided using double level osteotomy, if needed. Level of evidence III.

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Iatrogenic ischiofemoral impingement due to high tibial osteotomy with overvalgization: a case report

Cited by 8 publications

References 15 publications

Changes in coronal alignment of the hip joint after medial opening wedge high tibial osteotomy

Changes in coronal alignment of the hip joint after medial opening wedge high tibial osteotomy

The Female Pelvis Is Associated with a Lateralized Ischium and a Reduced Ischiofemoral Space

In closed wedge distal femur osteotomies for correction of valgus malalignment overcorrection of mLDFA should be avoided

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