Ankle and Hindfoot Symptoms after Medial Open Wedge High Tibial Osteotomy

Shah, Siddharth; Roberts, Jason; Picard, F.

doi:10.1055/s-0038-1641143

Cited by 8 publications

(10 citation statements)

References 10 publications

(15 reference statements)

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“…Based on 13 retrospective cohort studies (20,21,22,28,29,30,31,32,33,34,35,36,37), two case-control studies (38,39) and three laboratory studies (40,41,42), a total of 770 subjects were assessed. Five of these reports were classified as biomechanical (35,38,40,42) and thirteen as clinical studies (20-22, 28-34, 36, 37, 39).…”

Section: Study Characteristicsmentioning

confidence: 99%

“…Regarding the investigational modalities, three studies applied intra-articular pressure sensors (40,41,42), two studies used full-leg X-radiographs (35,38), one study added concomitant computed tomography (CT) imaging (35) and one study implemented a mobility capturing (MoCap) system (38). Clinical reports included twelve retrospective studies (20,21,22,28,29,30,31,32,33,34,36,37) and one case-control study (39). The mean sample size of patients included in the clinical studies was 53.1 (range: 10-118).…”

Section: Study Characteristicsmentioning

confidence: 99%

“…The mean follow-up period was 33.7 months (range: 3 months-8 years). Six of the clinical studies assessed the PROMs using subjective clinical scoring systems (20,21,22,37,38,39). Radiographic analysis relied on full-leg radiographs.…”

Section: Study Characteristicsmentioning

confidence: 99%

“…The clinical effect of knee osteotomy on the ankle and hindfoot was described in 13 studies by investigating the PROMs and radiographic parameters (20,21,22,28,29,30,31,32,33,34,36,37,39). Regarding the PROMs, (21).…”

Section: Clinical Effect On the Ankle/hindfootmentioning

confidence: 99%

“…As this HKA axis stops at the tibial plafond, the hindfoot is not taken into account (4,5,6,15,16,17,18,19). However, the correction of knee alignment can induce changes in the alignment of the tibiotalar and the subtalar joints, which might improve or deteriorate ankle function (20,21,22). Despite this replicated observation, the mechanism by which this interaction occurs is complex and poorly understood.…”

Section: Introductionmentioning

confidence: 99%

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Osteotomies around the knee alter alignment of the ankle and hindfoot: a systematic review of biomechanical and clinical studies

Van Oevelen,

Burssens,

Krähenbühl

et al. 2023

EFORT Open Reviews

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Purpose Emerging reports suggest an important involvement of the ankle/hindfoot alignment in the outcome of knee osteotomy; however, a comprehensive overview is currently not available. Therefore, we systematically reviewed all studies investigating biomechanical and clinical outcomes related to the ankle/hindfoot following knee osteotomies. Methods A systematic literature search was conducted on PubMed, Web of Science, EMBASE and Cochrane Library according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and registered on international prospective register of systematic reviews (PROSPERO) (CRD42021277189). Combining knee osteotomy and ankle/hindfoot alignment, all biomechanical and clinical studies were included. Studies investigating knee osteotomy in conjunction with total knee arthroplasty and case reports were excluded. The QUality Appraisal for Cadaveric Studies (QUACS) scale and Methodological Index for Non-Randomized Studies (MINORS) scores were used for quality assessment. Results Out of 3554 hits, 18 studies were confirmed eligible, including 770 subjects. The minority of studies (n = 3) assessed both high tibial- and distal femoral osteotomy. Following knee osteotomy, the mean tibiotalar contact pressure decreased (n = 4) except in the presence of a rigid subtalar joint (n = 1) or a talar tilt deformity (n = 1). Patient symptoms and/or radiographic alignment at the level of the ankle/hindfoot improved after knee osteotomy (n = 13). However, factors interfering with an optimal outcome were a small preoperative lateral distal tibia angle, a small hip–knee–ankle axis (HKA) angle, a large HKA correction (>14.5°) and a preexistent hindfoot deformity (>15.9°). Conclusions Osteotomies to correct knee deformity alter biomechanical and clinical outcomes at the level of the ankle/hindfoot. In general, these changes were beneficial, but several parameters were identified in association with deterioration of ankle/hindfoot symptoms following knee osteotomy.

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Section: Study Characteristicsmentioning

confidence: 99%

Section: Study Characteristicsmentioning

confidence: 99%

Section: Study Characteristicsmentioning

confidence: 99%

Section: Clinical Effect On the Ankle/hindfootmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Osteotomies around the knee alter alignment of the ankle and hindfoot: a systematic review of biomechanical and clinical studies

Van Oevelen,

Burssens,

Krähenbühl

et al. 2023

EFORT Open Reviews

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Osteotomies around the knee are not correlated to substantial post-operative ankle pain

Monteiro

Barbosa

Cardoso

et al. 2021

Knee Surg Sports Traumatol Arthrosc

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PurposeThe relationship between osteotomies around the knee and ankle alignment has been well established. However, little is known about the incidence of new-onset ankle pain after knee osteotomies in the setting of both varus and valgus lower limb malalignments. The purpose of this study is to determine the incidence and characteristics of ankle pain after knee osteotomies; and to clarify the relationship between knee alignment correction, coronal changes sufered by the ankle joint and the development of new-onset ankle pain. Methods Fifty-four lower limbs in 51 consecutive patients, who underwent realignment osteotomies around the knee between April 2013 and October 2020, were retrospectively reviewed. Ultimately, 39 patients (42 knees) were enrolled: 34 had varus deformities and eight had valgus deformities. Ankle pain was assessed according to the Numerical Pain Rating Scale by telephonic interview. The magnitude of alignment correction and the consequent change of both knee and ankle joint lines were analyzed. Correlation between the former and the onset of post-operative ankle pain was evaluated. Patient satisfaction and complications were also noted. ResultsThe incidence of new-onset ankle pain after knee realignment osteotomy was 14%, at a mean follow-up of 55 ± 26 months (range 12-93 months). The mean time between osteotomy and onset of ankle pain was 21 ± 25 months (range 2-60 months). The degree of coronal correction was signiicantly correlated with ankle joint obliquity changes. However, a signiicant correlation with post-operative ankle pain was not found (p > 0.05). Conclusion Fourteen percent of the patients who underwent osteotomies around the knee developed new-onset persistent low-intensity ankle pain. The knee and ankle joint biomechanics are closely related, however, only a small percentage of patients sufer from low-intensity ankle pain which is successfully managed with occasional analgesics. Most osteotomies around the knee seem to require no particular concern for the ipsilateral ankle function.

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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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Ankle and Hindfoot Symptoms after Medial Open Wedge High Tibial Osteotomy

Cited by 8 publications

References 10 publications

Osteotomies around the knee alter alignment of the ankle and hindfoot: a systematic review of biomechanical and clinical studies

Osteotomies around the knee alter alignment of the ankle and hindfoot: a systematic review of biomechanical and clinical studies

Osteotomies around the knee are not correlated to substantial post-operative ankle pain

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

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