Clinical usefulness of hindfoot assessment for total knee arthroplasty: persistent post-operative hindfoot pain and alignment in pre-existing severe knee deformity

Okamoto, Yukiko; Otsuki, Shuhei; Jotoku, Tsuyoshi; Nakajima, Mikio; Neo, Masashi

doi:10.1007/s00167-016-4122-1

Cited by 45 publications

(72 citation statements)

References 39 publications

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“…7,[27][28][29]41 HFA measures based on 2D radiographs are flawed by many anatomical and operator-related bias, which have been extensively investigated in the literature. * These include projection and rotational issues, 3,22 mostly with regards to the use of the tibia as a reference axis.…”

Section: Introductionmentioning

confidence: 99%

3D Biometrics for Hindfoot Alignment Using Weightbearing CT

Lintz

Welck

Bernasconi³

et al. 2017

Foot Ankle Int.

125

158

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Background: Hindfoot alignment on 2D radiographs can present anatomical and operator-related bias. In this study, software designed for weightbearing computed tomography (WBCT) was used to calculate a new 3D biometric tool: the Foot and Ankle Offset (FAO). We described the distribution of FAO in a series of data sets from clinically normal, varus, and valgus cases, hypothesizing that FAO values would be significantly different in the 3 groups. Methods: In this retrospective cohort study, 135 data sets (57 normal, 38 varus, 40 valgus) from WBCT (PedCAT; CurveBeam LLC, Warrington, PA) were obtained from a specialized foot and ankle unit. 3D coordinates of specific anatomical landmarks (weightbearing points of the calcaneus, of the first and fifth metatarsal heads and the highest and centermost point on the talar dome) were collected. These data were processed with the TALAS system (CurveBeam), which resulted in an FAO value for each case. Intraobserver and interobserver reliability were also assessed. Results: In normal cases, the mean value for FAO was 2.3% ± 2.9%, whereas in varus and valgus cases, the mean was −11.6% ± 6.9% and 11.4% ± 5.7%, respectively, with a statistically significant difference among groups (P < .001). The distribution of the normal population was Gaussian. The inter-and intraobserver reliability were 0.99 +/-0.00 and 0.97 +/-0.02 Conclusions: This pilot study suggests that the FAO is an efficient tool for measuring hindfoot alignment using WBCT. Previously published research in this field has looked at WBCT by adapting 2D biometrics. The present study introduces the concept of 3D biometrics and describes an efficient, semiautomatic tool for measuring hindfoot alignment. Level of Evidence: Level III, retrospective comparative study.

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Section: Introductionmentioning

confidence: 99%

3D Biometrics for Hindfoot Alignment Using Weightbearing CT

Lintz

Welck

Bernasconi³

et al. 2017

Foot Ankle Int.

125

158

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“…Fifth, this was a cross-sectional study and the longitudinal change of the relationship between the deformity of the knee and the hindfoot was not investigated. In the study with OA knee, the ankle promptly adapts to the postsurgical change in the angle of the knee because the hindfoot is mostly normal [ 3 , 5 ]. No evaluation was performed to determine if the same ability of adaptation was present in the patients with RA or to determine the occurrence of temporary or permanent pain in RA after TKA.…”

Section: Discussionmentioning

confidence: 99%

“…Varus knee deformity of the OA knee tends to have valgus hindfoot, and vice versa. In some previous reports, the change in the alignment of the knee due to a surgical intervention, such as total knee arthroplasty (TKA) [ 2 , 3 , 5 ] or high tibial osteotomy, [ 6 ] affects the alignment of the hindfoot within a short time after the surgery. Meanwhile, in rheumatoid arthritis (RA), it is not evident whether the compensatory correlation of the angle of the knee and hindfoot which is observed in OA patients can be applied using the same theory.…”

Section: Introductionmentioning

confidence: 99%

Correlation in the Coronal Angle between Knee and Hindfoot Was Observed in Patients with Rheumatoid Arthritis Unless Talocrural Joint Was Destroyed

Nishitani

Ito

Shimozono

et al. 2017

BioMed Research International

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The purpose of this study is to investigate the compensatory correlation between knee and hindfoot in patients with rheumatoid arthritis (RA). This cross-sectional study included 218 patients (407 lower extremities). Radiographs of the hindfoot and full-length posteroanterior hip-to-calcaneus standing radiographs were evaluated. The destruction of the hindfoot was evaluated using the Larsen grading system. The coronal angular deformity of the knee and hindfoot was evaluated by the femorotibial angle (FTA) and the angle between the tibial shaft and the entire hindfoot (tibiohindfoot angle, THFA). The correlation between FTA and THFA was determined by Pearson's coefficient. For all patients, FTA correlated to THFA (R = 0.28, p < 0.001). The correlation was observed as long as the talocrural joint was preserved (Larsen grade ≤ 2), even if the subtalar joint had been destroyed (Larsen grade ≥ 3). However, the correlation was not observed when the talocrural joint was destroyed (Larsen grade ≥ 3, R = −0.02, p = 0.94). The pain in the hindfoot did not correlate with FTA or THFA. In conclusion, a compensatory deformity of the hindfoot against the deformity of the knee was observed in RA, and the correlation was lost when talocrural joint was destroyed.

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“…However, they did not clearly explain the correlation between them. Thereafter, several reports found that the compensatory subtalar valgus was corrected after TKA in patients with knee OA [7, 8, 11, 13, 14, 31]. Hara et al [31] and Takenaka et al [8] evaluated the subtalar joint alignment using the V-V angle, which averaged a normal value of 76.0° [6] and showed significant improvement in the subtalar joint alignment in patients with subtalar valgus (V-V angle ≥ 76.0°) from 80.5° ± 3.1° to 78.6° ± 3.7° three weeks after TKA and further improved to 77.1° ± 2.7° one year after TKA.…”

Section: The Subtalar Joint Alignment After Surgery For the Knee Mmentioning

confidence: 99%

“…Each joint of the lower extremity compensates the malalignment caused by deformities of the other joints [10, 11, 20]. In particular, recent studies have discussed the compensatory function of the subtalar joint [7, 13, 19]: several reports show that the subtalar joint compensates for the deformities of the knee and ankle joints [10, 12, 17, 18, 20], and the subtalar joint alignment which was 2°-6° valgus in healthy legs [21, 22] changed after surgery to correct these deformities [7, 14, 16]. When surgery for knee or ankle deformity is needed, it is helpful for surgical planning to understand the mechanism of subtalar joint compensation and how the subtalar joint alignment changes after surgery.…”

Section: Introductionmentioning

confidence: 99%

Compensatory Function of the Subtalar Joint for Lower Extremity Malalignment

Yoshimoto¹,

Noguchi²,

Yamada³

et al. 2019

Advances in Orthopedics

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It is important to evaluate the subtalar joint and hip-knee-ankle alignment to understand lower extremity alignment. In this review, we focused on the compensatory changes in the subtalar joint alignment for the deformity of the knee and ankle joint, reviewing previous research. The subtalar joint alignment was compensatory valgus in patients with varus knee and ankle deformity, whereas it was uncertain whether the subtalar joint alignment was compensatory varus in patients with valgus knee and ankle deformity. The subtalar joint valgus alignment improved after total knee arthroplasty or high tibial osteotomy for varus knee deformity, even if the deformity was severe. In contrast, whether the subtalar joint alignment changed after the surgery for ankle or valgus knee deformity has not been considered. Further research on the compensatory function of the subtalar joint is needed.

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Clinical usefulness of hindfoot assessment for total knee arthroplasty: persistent post-operative hindfoot pain and alignment in pre-existing severe knee deformity

Abstract: Therapeutic study, Level III.

Cited by 45 publications

References 39 publications

3D Biometrics for Hindfoot Alignment Using Weightbearing CT

3D Biometrics for Hindfoot Alignment Using Weightbearing CT

Correlation in the Coronal Angle between Knee and Hindfoot Was Observed in Patients with Rheumatoid Arthritis Unless Talocrural Joint Was Destroyed

Compensatory Function of the Subtalar Joint for Lower Extremity Malalignment

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