Joint line obliquity was maintained after double-level osteotomy, but was increased after open-wedge high tibial osteotomy

Akamatsu, Yasushi; Nejima, Shuntaro; Tsuji, Masaki; Kobayashi, Hideo; Muramatsu, Shuntaro

doi:10.1007/s00167-020-06430-6

Cited by 46 publications

(44 citation statements)

References 24 publications

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“…Slight overvalgization is accepted in cases with medial gonarthritis, but no unphysiological bony angles or oblique JLCA should be created. To avoid this, often double-level osteotomy of the proximal tibia and the distal femur is indicated in cases with bony malalignment [ 4 , 13 , 14 ]. It was demonstrated earlier that joint-line obliquity (JLO) of more than 3° is associated with worse clinical outcomes after medial owHTO [ 15 ].…”

Section: Discussionmentioning

confidence: 99%

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

et al. 2022

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Background Open wedge high tibial osteotomy is a standard procedure for frontal realignment. It is indicated in varus knee with reduced mechanical medial proximal tibia angle. Overcorrection producing a mechanical medial proximal tibia angle out of the normal range (85–90°) is not recommended because this would lead to unphysiological joint-line orientation. Osteotomies around the knee also influence the adjacent ankle and hip joints. For the hip, it is known that frontal alignment of the leg influences the ischiofemoral space. A decreased ischiofemoral space can lead to painful impingement between the ischial bone and the lesser trochanter. Case presentation A 53-year-old German woman presented with severe ischiofemoral impingement symptoms and valgus malalignment of the left leg after open wedge high tibial osteotomy, which was indicated and performed by an orthopedic surgeon with intention to treat medial knee pain due to degenerative arthritis of the medial compartment years after medial meniscectomy. The mechanical medial proximal tibia angle was 100.5°. We performed closed wedge high tibial osteotomy producing a mechanical medial proximal tibia angle of 90.0° and normal joint-line orientation. The hip pain was gone immediately after the surgery, and the patient had no signs of ischiofemoral impingement or hip pain at last follow-up 12 months after closed wedge high tibial osteotomy. Conclusions Frontal realignment osteotomy around the knee can create problems at adjacent joints. Overvalgization of the proximal tibia made the patient compensate by hyperadduction of the hip to enable full foot sole contact with the floor. Hyperadduction of the hip decreased the ischiofemoral space, leading to severe impingement. Therefore, meticulous planning of osteotomies is important not to produce unphysiological situations or unwanted negative effects at the level of an adjacent joint.

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Section: Discussionmentioning

confidence: 99%

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

et al. 2022

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“…It is of upmost importance to appreciate the influence of the correction on the adjacent hip joint to prevent the occurrence of an unwanted effect. Given that pain disorders of the ankle have also been reported as a result of realignment of the knee, it can only be underlined that there is a true need of deepening the understanding of limb realignment with particular emphasis on further developing planning tools [1,5,10]. Figure 5 represents an example of the above concept in a patient who was referred to the outpatient clinic with severe hip pain that has occured after having undergone a high tibial osteotomy for the treatment of medial knee gonalgia.…”

Section: Discussionmentioning

confidence: 99%

The ischiofemoral space of the hip is influenced by the frontal knee alignment

Ahmad

Kerber

Konrads

et al. 2021

Knee Surg Sports Traumatol Arthrosc

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Purpose The ischiofemoral distance (IFD), defined as the distance between the ischial tuberosity and the lesser trochanter of the femur, is gaining recognition as an extra-articular cause of hip pain. It is unknown whether the IFD is influenced by the frontal knee alignment. The aim of this study was to determine the influence of realignment surgery around the knee on the IFD. It was hypothesized that valgisation osteotomy around the knee is associated with reduction of the IFD. Methods A consecutive series of 154 patients undergoing frontal realignment procedures around the knee in 2017 were included in this study. Long-leg standing radiographs were obtained before surgery and postoperatively. The IFD was measured between the ischium and the lesser trochanter at three different levels (proximal, middle and distal margins of the lesser trochanter parallel to the horizontal orientation of the pelvis) on standardized long-leg radiographs with the patient in upright standing position. The knee alignment was determined by measuring the hip knee ankle angle, mechanical lateral distal femur angle and the medial mechanical proximal tibia angle. Linear regression was performed to determine the influence of the change of frontal knee alignment on the IFD. Results Linear regression showed a direct influence of the overall change in frontal knee alignment on the IFD of the hip, regardless of the site of the osteotomy (β-0.4, confidence-interval − 0.5 to − 0.3, p < 0.001). Valgisation osteotomy around the knee induced a significant reduction of the ipsilateral IFD (p < 0.001), while varisation osteotomy induced a significant increase (p < 0.001). The amount of ISD change was 0.4 mm per corresponding degree of change in frontal knee alignment. Conclusion These findings are relevant to both the hip and knee surgeons when planning an osteotomy or arthroplasty procedure. Correction of a malalignment of the knee may resolve an ischiofemoral conflict in the hip. The concept deserves inclusion in the diagnostic workup of both the hip and knee joints. Level of evidence IV.

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“…Therefore, the postoperative KAJA should be below 9.6° for postoperative KJLO to remain below 5 degrees. Double-level osteotomy may be a solution if optimal alignment cannot be achieved [ 24 ].…”

Section: Discussionmentioning

confidence: 99%

Knee-ankle joint line angle: a significant contributor to high-degree knee joint line obliquity in medial opening wedge high tibial osteotomy

et al. 2022

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Background Medial opening wedge high tibial osteotomy (MOWHTO) changes the knee joint inclination in the coronal plane, which can be compensated by the ankle joint. Once there is a decompensated knee joint obliquity, it can induce excessive shear force on the articular cartilage. This study aimed to investigate the capacity of the compensation by analyzing the correlation of the knee-ankle joint line angle (KAJA) and the knee joint line obliquity (KJLO). Patients and Methods Ninety-six patients undergoing MOWHTO were included. We measured potential predictors including preoperative or postoperative body mass index (BMI), weight-bearing line (WBL) ratio/correction amount, knee-ankle joint line angle(KAJA), mechanical lateral distal femoral angle (mLDFA), medial proximal tibia angle (MPTA), ankle joint line obliquity (AJLO), mechanical hip-knee-ankle angle (mHKA) and joint line convergence angle (JLCA). The correlations of these predictors and postoperative KJLO were determined using Pearson correlation coefficient. The contribution of significant predictors was further analyzed using multiple linear regression. Finally, the cutoff value of the most contributing factor resulting in decompensated KJLO was derived with receiver operating characteristic (ROC) curve analysis. Results Preoperative AJLO, JLCA, MPTA, mHKA and KJLO and postoperative KAJA and MPTA correlated with postoperative KJLO. After multiple linear regression, only preoperative AJLO and JLCA and postoperative KAJA still showed significant contribution to postoperative KJLO. Postoperative KAJA made the greatest contribution. The cutoff value of postoperative KAJA was at 9.6° after ROC analysis. The incidence rate of high-grade KJLO was 69.6% when postoperative KAJA exceeded 9.6°. Conclusions Postoperative KAJA is a significant contributor to high-grade KJLO after MOWHTO. The incidence was increased at angles greater than 9.6°. The results suggest that KAJA should be carefully assessed during preoperative planning or intraoperative evaluation. Postoperative KAJA < 9.6° can lower the rate of early high-degree KJLO.

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Joint line obliquity was maintained after double-level osteotomy, but was increased after open-wedge high tibial osteotomy

Cited by 46 publications

References 24 publications

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

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

The ischiofemoral space of the hip is influenced by the frontal knee alignment

Knee-ankle joint line angle: a significant contributor to high-degree knee joint line obliquity in medial opening wedge high tibial osteotomy

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