Changes in Hindfoot Alignment After High or Low Tibial Osteotomy

2018 ◽  
Vol 39 (9) ◽  
pp. 1097-1105 ◽  
Author(s):  
Jun Young Choi ◽  
Si Jung Song ◽  
Sung Jung Kim ◽  
Sang Hee Kim ◽  
Ji Soo Park ◽  
...  
Keyword(s):  
Ankle Joint ◽  
Normal Values ◽  
Varus Deformity ◽  
Tibial Osteotomy ◽  
Moment Arm ◽  
Varus Alignment ◽  
Level Of Evidence ◽  
Hindfoot Alignment ◽  
Radiographic Findings ◽  
Radiographic Parameters

Background: We aimed to determine the change in hindfoot alignment after high (HTO) or low tibial osteotomy (LTO), which is commonly performed to prevent the progression of arthritis of the knee or ankle. Methods: We retrospectively reviewed the radiographic findings of patients who underwent HTO or LTO for arthritis with varus deformity of the knee or ankle joint. The hindfoot alignment view angle (HAVA), hindfoot alignment ratio (HAR), and hindfoot moment arm (HMA) were measured using the hindfoot alignment radiographs. All radiographic parameters were measured at 3, 6, and 12 months postoperatively to assess serial changes. Results: In the HTO group, the HAVA and HMA were significantly increased at 12 months postoperatively compared to preoperatively ( P = .03 and .001, respectively). Similarly, the HAR increased from 0.23 preoperatively to 0.44 at 12 months postoperatively, which was a statistically significant change ( P = .001). In the LTO group, the 12-month postoperative HAVA, HAR, and HMA were significantly decreased ( P = .001 for each), which represented a hindfoot alignment change to the valgus position. Conclusions: After HTO, preoperative hindfoot valgus deviation was significantly decreased at 12 months and approached normal values, while the preoperative mild hindfoot varus alignment was changed to valgus deviation after LTO. Level of Evidence: Level III, comparative series.

scholarly journals Changes of hindfoot alignment after high or low tibial osteotomy

2018 ◽  
Vol 3 (3) ◽  
pp. 2473011418S0019
Author(s):  
Jun Young Choi ◽  
Jin Soo Suh ◽  
Dong Joo Lee
Keyword(s):  
Ankle Joint ◽  
Normal Values ◽  
Varus Deformity ◽  
Tibial Osteotomy ◽  
Moment Arm ◽  
Varus Alignment ◽  
Hindfoot Alignment ◽  
Radiographic Findings ◽  
Radiographic Parameters ◽  
Significant Change

Category: Hindfoot Introduction/Purpose: We aimed to determine the change in hindfoot alignment after high (HTO) or low tibial osteotomy (LTO), which is commonly performed to prevent the progression of arthritis of the knee or ankle. Methods: We retrospectively reviewed the radiographic findings of patients who underwent HTO or LTO for arthritis with varus deformity of the knee or ankle joint. The hindfoot alignment view angle (HAVA), hindfoot alignment ratio (HAR), and hindfoot moment arm (HMA) were measured using the hindfoot alignment radiographs. All radiographic parameters were measured at 3, 6, and 12 months postoperatively to assess serial changes. Results: In the HTO group, the HAVA and HMA were significantly increased at 12 months postoperatively compared to preoperatively (P=0.03 and 0.001, respectively). Similarly, the HAR increased from 0.23 preoperatively to 0.44 at 12 months postoperatively, which was a statistically significant change (P=0.001). In the LTO group, the 12-month postoperative HAVA, HAR, and HMA were significantly decreased (P=0.001 for each), which represented a hindfoot alignment change to the valgus position. Conclusion: After HTO, preoperative hindfoot valgus deviation was significantly decreased at 12 months and approached normal values, while the preoperative mild hindfoot varus alignment was changed to valgus deviation after LTO.

Hindfoot Alignment Change After Total Ankle Arthroplasty for Varus Osteoarthritis

2020 ◽  
pp. 107110072097093
Author(s):  
Hyuck Sung Son ◽  
Jung Gyu Choi ◽  
Jungtae Ahn ◽  
Bi O Jeong
Keyword(s):  
Ankle Joint ◽  
Case Series ◽  
Deformity Correction ◽  
Varus Deformity ◽  
Total Ankle Arthroplasty ◽  
Level Of Evidence ◽  
Hindfoot Alignment ◽  
Ankle Arthroplasty ◽  
End Stage ◽  
Surface Angle

Background: In patients with end-stage varus ankle osteoarthritis (OA), hindfoot varus malalignment resulting from the varus deformity of the ankle joint is common. Although total ankle arthroplasty (TAA) performed to correct varus deformity of the ankle joint has the effect of correcting hindfoot alignment, no reports to date have described how much hindfoot alignment correction can be achieved. The purpose of this study was to identify correlation between ankle deformity correction and hindfoot alignment change after performing TAA in patients with end-stage varus ankle OA. Methods: A total of 61 cases that underwent TAA for end-stage varus ankle OA and followed up for at least 1 year were enrolled for this study. Correlation between changes of tibial-ankle surface angle (TAS), talar tilt (TT), and tibiotalar surface angle (TTS) and changes of hindfoot alignment angle (HA), hindfoot alignment ratio (HR), and hindfoot alignment distance (HD) measured preoperatively and at postoperative year 1 was analyzed. Results: TAS, TT, and TTS changed from 83.9 ± 4.1 degrees, 5.8 ± 5.0 degrees, and 78.1 ± 5.9 degrees, respectively, before operation to 89.2 ± 2.1 degrees, 0.4 ± 0.5 degrees, and 88.7 ± 2.3 degrees, respectively, after operation. HA, HR, and HD also changed from −9.2 ± 4.6 degrees, 0.66 ± 0.18, and −11.2 ± 6.9 mm to −3.7 ± 4.1 degrees, 0.48 ± 0.14, and −5.0 ± 5.3 mm. All the changes were statistically significant ( P < .001, respectively). The regression slope of correlation was 0.390 ( R2 = 0.654) between TTS and HA; 0.017 ( R2 = 0.617) between TTS and HR; and 0.560 ( R2 = 0.703) between TTS and HD. Conclusion: In patients with end-stage varus ankle OA, changes of hindfoot alignment could be predicted based on degree of ankle deformity corrected with TAA. Level of Evidence: Level IV, case series.

Assessment of Hindfoot Alignment Comparing Weightbearing Radiography to Weightbearing Computed Tomography

2021 ◽  
pp. 107110072110141
Author(s):  
Christopher B. Arena ◽  
Yantarat Sripanich ◽  
Richard Leake ◽  
Charles L. Saltzman ◽  
Alexej Barg
Keyword(s):  
Computed Tomography ◽  
Intraclass Correlation ◽  
Correlation Coefficients ◽  
Motion Artifact ◽  
Imaging Modalities ◽  
Moment Arm ◽  
Varus Alignment ◽  
Level Of Evidence ◽  
Hindfoot Alignment ◽  
Highly Correlated

Background: Hindfoot alignment view (HAV) radiographs are widely utilized for 2-dimensional (2D) radiographic assessment of hindfoot alignment; however, the development of weightbearing computed tomography (WBCT) may provide more accurate methods of quantifying 3-dimensional (3D) hindfoot alignment. The aim of this study was to compare the 2D calcaneal moment arm measurements on HAV radiographs with WBCT. Methods: This retrospective cohort study included 375 consecutive patients with both HAV radiographs and WBCT imaging. Measurement of the 2D hindfoot alignment moment arm was compared between both imaging modalities. The potential confounding influence of valgus/varus/neutral alignment, presence of hardware, and motion artifact were further analyzed. Results: The intraclass correlation coefficients (ICCs) of interobserver and intraobserver reliability for measurements with both imaging modalities were excellent. Both modalities were highly correlated (Spearman coefficient, 0.930; P < .001). HAV radiographs exhibited a mean calcaneal moment arm difference of 3.9 mm in the varus direction compared with WBCT (95% CI, –4.9 to 12.8). The difference of hindfoot alignment between both modalities was comparable in subgroups with neutral/valgus/varus alignment, presence of hardware, and motion artifact. Conclusion: Both HAV radiographs and WBCT are highly reliable and highly correlated imaging methods for assessing hindfoot alignment. Measurements were not influenced by severe malalignment, the presence of hardware, or motion artifact on WBCT. On average, HAV radiographs overestimated 3.9 mm of varus alignment as compared with WBCT. Level of Evidence: Level III, retrospective comparative study.

scholarly journals Evaluation of surgical outcomes of arthroscopic subtalar arthrodesis performed through two lateral portals

2018 ◽  
Vol 12 (4) ◽  
Author(s):  
Rafael Freitas Villela ◽  
João Murilo Brandão Magalhães ◽  
Rogério de Andrade Gomes ◽  
Anderson Humberto Gomes ◽  
Bernardo Cardoso Pinto Coelho ◽  
...  
Keyword(s):  
Surgical Outcomes ◽  
Case Series ◽  
Varus Deformity ◽  
Level Of Evidence ◽  
Hindfoot Alignment ◽  
Bone Consolidation ◽  
Subtalar Arthrodesis ◽  
Postoperative Score ◽  
Sinus Tarsi ◽  
The Mean

Objective: The purpose of this study is to present the surgical outcomes of twelve patients undergoing arthroscopic subtalar arthrodesis using two lateral portals (anterior and medial) in the sinus tarsi. Methods: A retrospective study was conducted with twelve patients (7 men and 5 women) with a mean age of 55.1 (36-74) years who underwent arthroscopic subtalar arthrodesis through the sinus tarsi between May 2015 and December 2016. The post-surgical follow-up was 12 months. Consolidation time and postoperative complications were evaluated, and a validated functional questionnaire from the American OrthopedicFoot and Ankle Society (AOFAS) and the visual analog scale (VAS) for pain were applied both before and after surgery. Results: The mean bone fusion time was 11.5 weeks. Bone consolidation was observed in all analyzed patients. Four patients developed late complications, three of which were related to screw positioning in the calcaneus, while one was related to residual hindfoot varus deformity. Screw-related complications are common with all subtalar arthrodesis techniques, and such complications are considered less relevant when evaluating the effectiveness of the presented technique. The mean preoperative AOFAS score was 42.3 (27-66) points, while the mean postoperative score was 83 (73-94) points. The mean preoperative VAS score for pain was 8.1 (5-10) points, and the mean postoperative score was 2.1 (0-5) points. The above data are similar to those reported in other published studies and reflect high bone consolidation rates. Conclusion: Arthroscopic subtalar arthrodesis through two lateral portals in the sinus tarsi is a safe and effective technique for the treatment of primary and secondary disorders of the subtalar joint. Correct positioning of screws and hindfoot alignment must be carefully ensured to avoid complications related to the synthesis material and hindfoot varus deformity. Level of Evidence IV; Therapeutic Studies; Case Series.

scholarly journals Peri-talar Osteotomy as Part of Treatment of Talar Osteochondral Defect of Varus Ankle

2017 ◽  
Vol 2 (3) ◽  
pp. 2473011417S0000
Author(s):  
Bibo Wang
Keyword(s):  
Osteochondral Defect ◽  
Corrective Osteotomy ◽  
Varus Deformity ◽  
Lateral View ◽  
Hindfoot Alignment ◽  
Routine Treatment ◽  
Vas Score ◽  
Radiographic Parameters ◽  
Sf36 Score ◽  
Double Osteotomy

Category: Ankle Introduction/Purpose: The etiology of osteochondral defect (OCD) of talus is not fully understood. Besides trauma, malalignment of ankle or hindfoot may play a role in the development of OCD. The aim of this study is to assess the efficacy of peri-talar osteotomy in addition to routine treatment of OCD of talus. Methods: This is a retrospective study of 52 cases of varus talar OCD during the period of 2009.9 to 2014.12. Micro-fracture or autograft transplantation were applied for the OCD first according to the dimension of the lesion in all cases. Then peri-talar osteotomy were performed to correct ankle or hindfoot mal-alignment in 26 cases according to the position of varus deformity, including 18 supramalleolar osteotomy, 6 calcaneal osteotomy and 2 combined distal tibial and calcaneal double osteotomy. Pre- and post-operative radiographic parameters of TAS, TTS, TLS angles and MoA were measured on mortise view, lateral view and hindfoot alignment view respectively. AOFAS-AH score, VAS score and SF36 score were performed to assess both subjective and objective outcome. Results: For the osteotomy group, there were statistically changes (P < 0.05) radiographically (TAS, TTS, MoA, TLS) after surgery. While the radiographic parameters didn’t change in the group without corrective osteotomy. AOFAS-AH score and VAS score increased significantly (P < 0.05) in both the osteotomy group and the non-osteotomy group. The SF36 scores score increased significantly (P < 0.05) in the osteotomy group while not significant in the non-osteotomy group. The AOFAS-AH and SF36 scores were statistically higher in the osteotomy group after surgery (p<0.05), and the VAS score were not statistically different in two groups. There were 5 out of 26 revised cases in the non-osteotomy group while 2 out of 26 revised cases in the osteotomy group. Conclusion: Peri-talar osteotomy in addition to routine treatment of OCD of talus results in better radiographic and functional outcome and lower recurrence for patients of varus talar osteochondral defect. Mechanical malalignment may contribute to progression of OCD of talus and thus should be corrected simultaneously.

Novel Double Osteotomy Technique of Distal Tibia for Correction of Asymmetric Varus Osteoarthritic Ankle

2017 ◽  
Vol 38 (9) ◽  
pp. 970-981 ◽  
Author(s):  
Beat Hintermann ◽  
Roxa Ruiz ◽  
Alexej Barg
Keyword(s):  
Perioperative Complications ◽  
Weight Bearing ◽  
Distal Tibia ◽  
Tibial Osteotomy ◽  
Level Of Evidence ◽  
Hindfoot Alignment ◽  
Tibiotalar Joint ◽  
Joint Congruency ◽  
Supramalleolar Osteotomy ◽  
Double Osteotomy

Background: A most challenging condition for balancing a varus arthritic ankle is the presence of a defect in the medial tibial plafond. After our initial results with a medial tibial plafondplasty did not fulfill our expectations of success, we hypothesized that adding a correcting supramalleolar osteotomy of the distal tibia would move the loading force to the tibiotalar joint more medially and move the center of rotation of the talus more laterally. In this study, we analyzed midterm clinical and radiographic outcomes in patients with double tibial osteotomy. Methods: Between January 2005 and February 2010, 20 patients were treated with a medial tibial plafondplasty and a medial supramalleolar osteotomy of the distal tibia. The mean age of the patients was 44 ± 12 years (range, 17-60 years). Follow-up averaged 5.9 ± 2.1 years (range, 4-11.2 years). Weight-bearing radiographs were used to assess osteotomy union and hindfoot alignment. Results: There were no intraoperative or perioperative complications. The average VAS pain score decreased significantly from 7.9 ± 1.3 (range, 6-10) to 1.3 ± 1.6 (range, 0-7). The average AOFAS hindfoot score increased significantly from 49 ± 15 points (range, 36-68) preoperatively to 86 ± 12 points (range, 66-96) postoperatively. The varus tilt improved significantly from 19.4° ± 8.2° (range, 6°-32°) to 6.9° ± 3.9° (range, 1°-12°). Conclusion: The novel double osteotomy was found to be an efficient and successful method to restore tibiotalar joint congruency and to normalize hindfoot alignment. Level of Evidence: Level IV, prospective cohort study.

scholarly journals Changes in Coronal Alignment of the Knee Joint after Supramalleolar Osteotomy

2021 ◽  
Vol 2021 ◽  
pp. 1-8
Author(s):  
Dong-Il Chun ◽  
Jahyung Kim ◽  
Sung Hun Won ◽  
Jaeho Cho ◽  
Jeongku Ha ◽  
...  
Keyword(s):  
Logistic Regression ◽  
Knee Joint ◽  
Ankle Joint ◽  
Lower Limb ◽  
Varus Deformity ◽  
Limb Alignment ◽  
Coronal Alignment ◽  
Lower Limb Alignment ◽  
Radiographic Parameters ◽  
Supramalleolar Osteotomy

Background. Assessing knee joint orientation changes after SMO may help clinical advancement in managing patients with ipsilateral ankle and knee joint arthritis. However, knee joint changes after supramalleolar osteotomy (SMO) have not been reported. We investigated changes in coronal alignment of the knee joint after SMO. Methods. In this multicentre study, from January 2014 to December 2018, 47 ankles with varus osteoarthritis treated with SMO were retrospectively identified. Ankle joint changes were assessed using the tibiotalar angle, talar tilt angle, and lateral distal tibial angle (LDTA); knee joint changes using the medial proximal tibial angle (MPTA), medial and lateral joint space widths (mJSW and lJSW, respectively), and medial and lateral joint line convergence angles (JLCA); and lower limb alignment changes using mechanical axis deviation angle (MADA) and the hip-knee-ankle (HKA) angle measured on full-length anteroposterior radiographs of the lower extremity. Correlation analysis and binary logistic regression analysis were performed. Results. Postoperatively, LDTA ( p < 0.001 ) and tibiotalar angle ( p < 0.001 ) significantly changed, indicating meaningful improvement in the ankle joint varus deformity. Regarding the knee joint changes, JLCA significantly changed into valgus direction ( p = 0.044 ). As for lower limb alignment changes, MADA significantly decreased ( p < 0.001 ), whereas the HKA angle significantly increased ( p < 0.001 ). In univariate and multivariate logistic regression analyses, changes in the MADA ( p < 0.001 ) and the HKA angle ( p < 0.001 ) were significantly correlated with the correction angle. Conclusions. SMO remarkably improves ankle joint varus deformity, followed by significant lower limb alignment changes. Despite meaningful changes in JLCA, the relationship between the amount of osteotomy near the ankle joint and improvement in knee joint radiographic parameters was not significant. Radiographic parameters of the knee joint would less likely be changed following SMO.

scholarly journals RADIOGRAPHIC EVOLUTION AND CERVICAL SAGITAL BALANCE OF LAMINOPLASTY VERSUS LAMINECTOMY IN PATIENTS WITH CERVICAL SPONDYLOTIC MYELOPATHY

2020 ◽  
Vol 19 (2) ◽  
pp. 92-95
Author(s):  
LUIZ CARLOS MILAZZO NETTO ◽  
RAPHAEL DE REZENDE PRATALI ◽  
VINÍCIO NUNES NASCIMENTO ◽  
PEDRO FELISBINO JR ◽  
NILO CARRIJO MELO ◽  
...  
Keyword(s):  
Cervical Spondylotic Myelopathy ◽  
Case Series ◽  
Level Of Evidence ◽  
Sagittal Vertical Axis ◽  
Thoracic Inlet ◽  
Radiographic Findings ◽  
Radiographic Parameters ◽  
Significant Difference ◽  
Cervical Sagittal Alignment ◽  
Over Time

ABSTRACT Objective To compare radiographic findings of patients who underwent laminoplasty and laminectomy with arthrodesis for spondylotic cervical myelopathy. Methods Who were submitted to laminectomy with arthrodesis or laminoplasty to treat cervical spondylotic myelopathy with minimum follow-up of 6 months. The radiographic parameters related to the cervical spine evaluated were C0C2 lordosis (C0C2), cervical lordosis (CL), T1 slope (T1S), thoracic inlet angle (TIA), neck tilt (NT), cervical sagittal vertical axis (CSVA), and T1S – CL mismatch (T1S-CL). Results We evaluated 34 patients, 23 (68%) of whom were men. The mean age was 65 years (SD ± 13). There was no statistical difference in any of the preoperative radiographic parameters. Considering the patients submitted to laminectomy alone, a significant difference was observed for C0C2 (P = 0.045), CSVA (P = 0.0008), with differences between IPO and POS times (P = 0.026) and between PRE and POS (P = 0.0013) and T1S – CL mismatch (P = 0.0004), with a difference between IPO and POS (P = 0.0076) and between PRE and POS (P=0.001). Considering the patients submitted to laminoplasty alone, there was no difference over time for any radiographic parameters considered. Comparing the radiographic parameters between the laminectomy and laminoplasty groups in the three time periods, there was no significant difference for any of them. Conclusion This study suggests that patients with cervical spondylotic myelopathy who underwent laminectomy with instrumentation may present worse radiographic evolution as regards cervical sagittal alignment over time when compared to patients who underwent laminoplasty. Level of evidence III; Retrospective case series.

Radiographic Outcomes of Proximal vs Distal Syndesmotic Low Tibial Osteotomy

2021 ◽  
pp. 107110072110357
Author(s):  
Jun Young Choi ◽  
Jin Ho Cho ◽  
Tae Hun Song ◽  
Jin Soo Suh
Keyword(s):  
Tibial Osteotomy ◽  
Ankle Arthritis ◽  
Level Of Evidence ◽  
Radiographic Findings ◽  
Fibular Osteotomy ◽  
Radiographic Outcomes ◽  
Intermalleolar Distance ◽  
Talar Tilt ◽  
Retrospective Comparative Study ◽  
Distance Correction

Background: We aimed to determine whether the location of tibial osteotomy affects the outcome during low tibial osteotomy (LTO) with fibular osteotomy for varus ankle arthritis by comparing proximal syndesmotic (PS) and distal syndesmotic (DS) tibial osteotomy. Methods: We retrospectively reviewed the radiographic findings of 50 cases (among 47 patients) who underwent LTO with fibular osteotomy for varus ankle arthritis. The enrolled patients were divided into 2 groups according to the location of the tibial osteotomy: the PS group (25 cases, 24 patients) and the DS group (25 cases, 23 patients). Radiographic parameters were compared between the 2 groups. Results: There were no significant differences in tibial anterior and lateral surface angles, tibiomedial malleolar angle, talar center migration, and intermalleolar distance correction between the 2 groups (all P > .05). However, the decreases in talar tilt (TT) and talocrural angle (TCA) were more pronounced in the DS group than in the PS group (both P < .05). Among patients with TT ≥8 degrees, a greater decrease in TT (+1.0 degrees vs –2.8 degrees) and TCA was observed in the DS group, whereas the PS group demonstrated greater increases in TCA and intermalleolar distance (all P < .01). Conclusion: In this series, DS tibial osteotomy combined with fibular osteotomy was a more effective operative option than PS tibial osteotomy to correct both extra- and intra-articular deformity for varus ankle arthritis. Level of evidence: Level III, retrospective comparative study.

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