Supracondylar rotation osteotomy of the femur influences the coronal alignment of the ankle

Konrads, Christian; Ahrend, Marc-Daniel; Beyer, Myriam R; Stöckle, Ulrich; Ahmad, Sufian S.

doi:10.1186/s40634-021-00340-3

Cited by 8 publications

(12 citation statements)

References 21 publications

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“…Osteotomies around the knee also influence the adjacent joints—ankle and hip [ 6 – 9 ]. For the hip, it was demonstrated earlier that frontal alignment of the leg influences the ischiofemoral space [ 9 ], but this has not become common knowledge yet.…”

Section: Introductionmentioning

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: Introductionmentioning

confidence: 99%

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

et al. 2022

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“…By using this method, we've been able to quantitatively correlate degrees of pelvic and femoral Four levels of coronal PO were assessed in our study: 0°, 5°, 10°, and 15°. These were chosen based on previously published works demonstrating the range of obliquities most commonly seen clinically in THA [28,29]. Categorically, PO can be classified as suprapelvic, intrapelvic, and infrapelvic, depending on its origin.…”

Section: Discussionmentioning

confidence: 99%

Effects of pelvic obliquity and limb position on radiographic leg length discrepancy measurement: a Sawbones model

Hamad¹,

Livshetz

Sood³

et al. 2022

J EXP ORTOP

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Purpose Potential sources of inaccuracy in leg length discrepancy (LLD) measurements commonly arise due to postural malalignment during radiograph acquisition. Preoperative planning techniques for total hip arthroplasty (THA) are particularly susceptible to this inaccuracy, as they often rely solely on radiographic assessments. Owing to the extensive variety of pathologies that are associated with LLD, an understanding of the influence of malpositioning on LLD measurement is crucial. In the present study, we sought to characterize the effects of varying degrees of lateral pelvic obliquity (PO) and mediolateral limb movement in the coronal plane on LLD measurement error (ME). Methods A 3-D sawbones model of the pelvis with bilateral femurs of equal-length was assembled. Anteroposterior pelvic radiographs were captured at various levels of PO: 0°, 5°, 10°, and 15°. At each level of PO, femurs were individually rotated medio-laterally to produce 0°, 5°, 10°, and 15° of abduction/adduction. LLD was measured radiographically at each position combination. For all cases of PO, the right-side of the pelvis was designated as the higher-side, and the left as the lower-side. Results At 0° PO, 71% of tested variations in femoral abduction/adduction resulted in LLD ME < 0.5-cm, while 29% were ≥ 0.5-cm, but < 1-cm. ME increased progressively as one limb was further abducted while the contralateral limb was simultaneously further adducted. The highest ME occurred with one femur abducted 15° and the other adducted 15°. Similar magnitudes of ME were seen in 98% of tested femoral positions at 5° of PO. The greatest ME (~ 1 cm) occurred at the extremes of right-femur abduction and left-femur adduction. At 10° of PO, a higher prevalence of cases exhibited LLD ME > 0.5-cm (39%) and ≥ 1-cm (8%). The greatest errors occurred at femoral positions similar to those seen at 5° of PO. At 15° of PO, half of tested variations in femoral position resulted in LLD ME > 1-cm, while 22% of cases produced errors > 1.5-cm. These clinically significant errors occurred at all tested variations of right-femur abduction, with the left-femur in either neutral position, abduction, or adduction. Conclusion This study aids surgeons in understanding the magnitude of radiographic LLD ME produced by varying degrees of PO and femoral abduction/adduction. At a PO of ≤5°, variations in femoral abduction/adduction of up to 15° produce errors of marginal clinical significance. At PO of 10° or 15°, even small changes in mediolateral limb position led to clinically significant ME (> 1-cm). This study also highlights the importance of proper patient positioning during radiograph acquisition, demonstrating the need for surgeons to assess the quality of their radiographs before performing preoperative templating for THA, and accounting for PO (> 5°) when considering the validity of LLD measurements.

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“…These limitations were minimized by selecting the degree of opening based on the protocols used in other studies that analyse the PTS when performing an OWHTO [ 13 ]. In addition, because the specimens did not include the ankle joint, the PTS was measured on a lateral radiograph of the knee according to the proximal anatomic axis of the tibia [ 41 ]. However, with this methodology, no significant differences in the PTS should be observed if it is measured according to the complete anatomical axis of the tibia on full-length lateral radiographs [ 42 ].…”

Section: Discussionmentioning

confidence: 99%

A lower starting point for the medial cut increases the posterior slope in opening-wedge high tibial osteotomy: a cadaveric study

et al. 2022

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Purpose The objective of this study was to evaluate the effects on the posterior tibial slope of different distances from the joint line to start the osteotomy and of varying the placement of the opening wedge in high tibial osteotomy. Starting the osteotomy more distally and an incorrect location for the tibial opening wedge were hypothesized to increase the posterior tibial slope. Methods A cadaveric study was conducted using 12 knees divided into two groups based on the distance from the joint line to the start of the osteotomy: 3 and 4 cm. The preintervention posterior tibial slope was measured radiologically. Once the osteotomy was performed, the medial cortex of the tibia was divided into anteromedial, medial, and posteromedial thirds. A 10° opening wedge was sequentially placed in each third, and the effect on the posterior tibial slope was evaluated radiographically. Results: Significant changes were observed only in the 3-cm group (p = 0.02) when the wedge was placed in the anteromedial zone. In contrast, in the 4-cm group, significant differences were observed when the opening wedge was placed at both the medial (p = 0.04) and anteromedial (p = 0.012) zones. Conclusion Correct control of the posterior tibial slope can be achieved by avoiding a low point when beginning the osteotomy and placing the opening wedge in the posteromedial third of the tibia when performing an opening-wedge high tibial osteotomy. Level of evidence Controlled laboratory study.

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Supracondylar rotation osteotomy of the femur influences the coronal alignment of the ankle

Cited by 8 publications

References 21 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

Effects of pelvic obliquity and limb position on radiographic leg length discrepancy measurement: a Sawbones model

A lower starting point for the medial cut increases the posterior slope in opening-wedge high tibial osteotomy: a cadaveric study

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