Change in the weight-bearing line ratio of the ankle joint and ankle joint line orientation after knee arthroplasty and high tibial osteotomy in patients with genu varum deformity

Kim, Jae Gyoon; Choi, Gi Won; Koo, Bum Hwan; Kim, Sang-Gyun

doi:10.1007/s00264-020-04799-0

Cited by 33 publications

(40 citation statements)

References 21 publications

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“…This work was based on the idea that a change of the weight-bearing line at the knee could alter the coronal orientation of the ankle. Given that a long leg standing X-ray is performed with the knees pointing forward, it can be deduced that the X-ray represents a natural illustration of a standing position of the lower extremity [17][18][19][20]. Therefore, one must understand that for an even foot sole contact with the ground after valgisation or varisation osteotomy around the knee, the joints distal to the talus (mainly the subtalar joint) have to adapt by inversion or eversion.…”

Section: Discussionmentioning

confidence: 99%

Osteotomies around the knee lead to corresponding frontal realignment of the ankle

Konrads

Eis

Ahmad

et al. 2021

Eur J Orthop Surg Traumatol

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Introduction Despite the fact that osteotomies around the knee represent well-established treatment options for the redistribution of loads and forces within and around the knee joint, unforeseen effects of these osteotomies on the ankle are still to be better understood. It was therefore the aim of this study to determine the influence of osteotomies around the knee on the coronal alignment of the ankle. We hypothesize that osteotomies around the knee for correction of genu varum or valgum lead to a change of the ankle orientation in the frontal plane by valgisation or varisation. Materials and methods Long-leg standing radiographs of 154 consecutive patients undergoing valgisation or varisation osteotomy around the knee in 2017 were obtained and utilized for the purpose of this study. Postoperative radiographs were obtained after union at the osteotomy site. The hip knee ankle angle (HKA), the mechanical lateral distal femur angle (mLDFA), the mechanical medial proximal tibia angle (mMPTA) and five angles around the ankle were measured. Comparison between means was performed using the Wilcoxon-Mann–Whitney test. Results One hundred fifty-four patients (96 males, 58 females) underwent osteotomies around the knee for coronal realignment. The mean age was 51 ± 11 years. Correction osteotomies consisted of 73 HTO, 54 DFOs, and 27 double level osteotomies. Of all osteotomies, 118 were for valgisation and 36 for varisation. For valgisation osteotomies, the mean HKA changed from 5.8° ± 2.9° preoperatively to − 0.9° ± 2.5° postoperatively, whereas the mMPTA changed from 85.9° ± 2.7° to 90.7° ± 3.1° and the malleolar-horizontal-orientation-angle (MHA) changed from 16.4° ± 4.2° to 10.9° ± 4.2°. For varisation osteotomies, the mean HKA changed from − 4.3° ± 3.7° to 1.1° ± 2.2° postoperatively, whereas the mLDFA changed from 85.7° ± 2.2° to 89.3° ± 2.3° and the MHA changed from 8.8° ± 5.1° to 11.2° ± 3.2°. Conclusion Osteotomies around the knee for correction of coronal limb alignment not only lead to lateralization or medialization of the weight-bearing line at the knee but also lead to a coronal reorientation of the ankle. This can be measured at the ankle using the MHA. When planning an osteotomy around the knee for correction of genu varum or valgum, the ankle should also be appreciated—especially in patients with preexisting deformities, ligament instabilities, or joint degeneration around the ankle.

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Section: Discussionmentioning

confidence: 99%

Osteotomies around the knee lead to corresponding frontal realignment of the ankle

Konrads

Eis

Ahmad

et al. 2021

Eur J Orthop Surg Traumatol

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“…Elson et al 11 presented the case of a patient with medial ankle pain and lateral instability in whom an HTO was performed, resulting in significant resolution of the ankle symptoms. Recently, Kim et al 12 reported that the correction of a knee varus deformity with HTO or TKA might improve the symptoms of medial ankle arthritis but could worsen lateral ankle arthritis. These reports corresponded to improvements in the symptoms of medial osteoarthritis in the ankle joint following HTO in our study.…”

Section: Discussionmentioning

confidence: 99%

Open‐wedge high tibial osteotomy for the treatment of osteoarthritis of both knee and ankle in the same leg: A report of two cases

Baek

Lee

Jin

et al. 2021

Clinical Case Reports

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“…The treatment methods for post-traumatic ankle arthritis include conservative treatment [4], arthroscopic surgery [14], osteotomy around the ankle [21], ankle distraction arthroplasty [22], ankle arthrodesis [14][23], total ankle arthroplasty [24], and combined internal and external xation surgery [12]. However, the optimal treatment remains unclari ed.…”

Section: Discussionmentioning

confidence: 99%

Clinical Outcomes of Ankle Distraction Arthroplasty Versus Supramalleolar Osteotomy

Yang

Cui

Tao

et al. 2021

Preprint

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BackgroundPost-traumatic ankle arthritis is increasing in young people and it is very important to preserve the ankle range of motion in young patients. This study aimed to compare ankle distraction arthroplasty versus supramalleolar osteotomy for post-traumatic ankle arthritis.MethodsThis retrospective study reviewed 32 consecutive patients who underwent surgery for post-traumatic ankle arthritis from January 2015 to December 2018 after failure of conservative treatment. Thirteen ankles that underwent ankle distraction arthroplasty were age-, sex-, and body mass index-matched with 19 ankles that underwent supramalleolar osteotomy. Patients returned for clinical and radiologic follow-up at an average of 32 (range, 24–48) months postoperatively. Outcomes were the comparison of the pre- and postoperative Visual Analog Scale (VAS) pain scores and American Orthopedic Foot & Ankle Society (AOFAS) ankle-hindfoot scores, complications, subjective patient-rated satisfaction, and ankle function.ResultsThe VAS and AOFAS scores of the two groups were significantly improved at final follow-up compared with preoperatively (p<0.05), but did not significantly differ between groups. The ankle distraction arthroplasty group had better postoperative ankle mobility than the supramalleolar osteotomy group. There was no significant difference between the two groups in the tibial anterior surface angle, talar tilt angle, tibial lateral surface angle, and other imaging parameters, but supramalleolar osteotomy was more effective in correcting the load-bearing line of the ankle and hindfoot. The complication rate was similar in both groupsConclusionsAnkle distraction arthroplasty and supramalleolar osteotomy both achieved good pain relief and improved function in patients with traumatic ankle arthritis.Level of evidence: Level III, retrospective comparative series.

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Change in the weight-bearing line ratio of the ankle joint and ankle joint line orientation after knee arthroplasty and high tibial osteotomy in patients with genu varum deformity

Cited by 33 publications

References 21 publications

Osteotomies around the knee lead to corresponding frontal realignment of the ankle

Osteotomies around the knee lead to corresponding frontal realignment of the ankle

Open‐wedge high tibial osteotomy for the treatment of osteoarthritis of both knee and ankle in the same leg: A report of two cases

Clinical Outcomes of Ankle Distraction Arthroplasty Versus Supramalleolar Osteotomy

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