scholarly journals Changes in the Ankle Joint and Hindfoot Alignment Following Varus Deformity Correction of the Knee with Total Knee Arthroplasty

2017 ◽  
Vol 2 (3) ◽  
pp. 2473011417S0000
Author(s):  
Bi O Jeong ◽  
Jong Hun Baek ◽  
Wookjae Song
Keyword(s):  
Knee Joint ◽  
Ankle Joint ◽  
Mechanical Axis ◽  
Deformity Correction ◽  
Varus Deformity ◽  
Valgus Deformity ◽  
Hindfoot Alignment ◽  
Total Knee ◽  
The Mean ◽  
Surface Angle

Category: Ankle, Hindfoot Introduction/Purpose: Compensatory changes occur in the ankle joint and the subtalar joint of the hindfoot to maintain neutral alignment in coronal plane when varus or valgus deformity is present in the knee joint. The purpose of this study is (1) to analyze how the ankle and hindfoot joint compensate the changes in mechanical axis that occur with varus deformity of the knee, (2) to analyze the changes in ankle and hindfoot joint alignment when mechanical axis alignment is corrected by correction of varus deformity of the knee with total knee arthroplasty (TKA), and (3) to radiographically evaluate the degree of changes in ankle and hindfoot joint alignment according to the degree of varus deformity correction. Methods: 375 knees that underwent TKA with varus deformity were prospectively studied. The degree of varus deformity of the knee joint was measured in standing long leg anteroposterior views taken before and 6 months after TKA. The angle between the ground surface and the superior dome of the talus, and the talar tilt were measured in standing ankle joint anteroposterior views taken before and 6 months after TKA. Preoperative tibial anterior surface angle and tibial lateral surface angle were measured. Hindfoot alignment was evaluated in hindfoot alignment views taken before and 6 months after operation by measuring the heel ratio, the heel angle, and the heel distance. These measurements were used to analyze the change in ankle joint and hindfoot alignment between before and 6 months after varus deformity correction. The relationship between the degree of varus knee correction and the change in ankle joint and hindfoot alignment was also analyzed. Results: The mean mechanical angle of the knee changed from varus 10.6±5.1° before operation to varus 0.1±3.2° after operation, which was statistically significant (P<0.001). The mean correction angle was 10.6±4.6°. Before operation, the mean tibial anterior surface angle was 89.9±3.1° and the mean tibial lateral surface angle was 81.5±2.9°. Talar tilt changed significantly from 0.3±2.0° to 0.0±1.6°, implying a varus change of the ankle joint (P=0.002). All of the evaluated hindfoot alignment parameters demonstrated a significant varus change (P<0.001), as the heel ratio changed from 0.2±0.2 preoperatively to 0.3±0.2 postoperatively (P<0.001), the heel angle changed from 11.4±7.0° preoperatively to 5.0±7.4°postoperatively (P<0.001), and the heel distance changed from 10.5±6.6 mm preoperatively to 6.4±6.4 mm postoperatively (P<0.000). Conclusion: Varus knee deformity tended to be associated with valgus deformity of the ankle joint and hindfoot alignment. Alignment in the ankle joint and the hindfoot both changed to a varus trend after correction of varus deformity of the knee. Such changes in ankle joint and hindfoot alignment are considered to be due to the compensatory changes following alterations in lower limb alignment. Therefore, it is necessary to perform a meticulous examination of the ankle joint as well as the knee joint and consider subsequent alteration of ankle joint and hindfoot alignment before surgical correction of knee joint alignment.

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.

Total Knee Arthroplasty for Fixed Valgus Deformity Correction Using a Modified Lateral Parapatellar Approach

2019 ◽  
Vol 33 (04) ◽  
pp. 372-377 ◽  
Author(s):  
Hu Li ◽  
Danielle Y. Ponzio ◽  
Alvin Ong ◽  
Wei Wei ◽  
Baicheng Wang ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Knee Arthroplasty ◽  
Soft Tissues ◽  
Case Series ◽  
Deformity Correction ◽  
Valgus Deformity ◽  
Radiographic Measurement ◽  
Functional Scores ◽  
Total Knee ◽  
The Mean

AbstractTotal knee arthroplasty (TKA) for patients with valgus deformity (> 10 degrees) is technically challenging and has produced variable clinical results in terms of deformity correction, instability, and overall outcomes. The lateral parapatellar approach (LPA) is an alternative to the traditional medial parapatellar approach with potential advantages of direct access for release of tight lateral ligamentous structures with preservation of the medial structures, optimized patellar tracking, preserved medial blood supply to the patella, and less use of constrained implants. We present a case series of a single institution's experience with use of a modified LPA using a Z-capsuloplasty for 35 primary TKA cases in 30 patients with osteoarthritis and Ranawat's type-II fixed valgus deformity with attenuation of medial soft tissues. The mean age of patients was 64.8 years (range: 42–78 years). Follow-up duration was a mean of 47.3 months (range: 3–130 months). The patients were assessed pre- and postoperatively using radiographic measurement of the anatomic femorotibial angle (FTA) and clinical measurement of range of motion (ROM) and the Chinese knee society score (KSS). Complications and reoperations were recorded. The mean coronal alignment was corrected from 20.4 degrees of valgus (range: 11.3–42 degrees) preoperatively to 7.0 degrees of valgus (range: 3.6–15.1 degrees) postoperatively. One case required use of a constrained condylar design implant. At a mean of 47.3 months, the mean Knee Society objective and functional scores improved to 91.8 ± 6.6 and 84.3 ± 18.2 points, respectively. Mean ROM was 94.9 degrees preoperatively and 105.7 degrees postoperatively. Three cases (8.6%) had postoperative complications, including transient common peroneal nerve palsy, hematoma, and deep infection. One patient underwent two-stage revision for infection. There were no cases of late instability. The modified LPA using a Z-capsuloplasty is a reproducible and effective surgical technique for performing TKA in the setting of osteoarthritis and severe valgus deformity.

scholarly journals Postoperative laxity of the lateral soft tissue is largely negligible in total knee arthroplasty for varus osteoarthritis

2021 ◽  
Vol 29 (1) ◽  
pp. 230949902110020
Author(s):  
Seikai Toyooka ◽  
Hironari Masuda ◽  
Nobuhiro Nishihara ◽  
Takashi Kobayashi ◽  
Wataru Miyamoto ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Soft Tissue ◽  
Knee Arthroplasty ◽  
Mechanical Axis ◽  
Varus Deformity ◽  
Varus Knee ◽  
Before And After ◽  
Knee Deformity ◽  
Varus Stress ◽  
Total Knee

Purpose: To evaluate the integrity of lateral soft tissue in varus osteoarthritis knee by comparing the mechanical axis under varus stress during navigation-assisted total knee arthroplasty before and after compensating for a bone defect with the implant. Methods: Sixty-six knees that underwent total knee arthroplasty were investigated. The mechanical axis of the operated knee was evaluated under manual varus stress immediately after knee exposure and after navigation-assisted implantation. The correlation between each value of the mechanical axis and degree of preoperative varus deformity was compared by regression analysis. Results: The maximum mechanical axis under varus stress immediately after knee exposure increased in proportion to the degree of preoperative varus deformity. Moreover, the maximum mechanical axis under varus stress after implantation increased in proportion to the degree of preoperative varus deformity. Therefore, the severity of varus knee deformity leads to a progressive laxity of the lateral soft tissue. However, regression coefficients after implantation were much smaller than those measured immediately after knee exposure (0.99 vs 0.20). Based on the results of the regression formula, the postoperative laxity of the lateral soft tissue was negligible, provided that an appropriate thickness of the implant was compensated for the bone and cartilage defect in the medial compartment without changing the joint line. Conclusion: The severity of varus knee deformity leads to a progressive laxity of the lateral soft tissue. However, even if the degree of preoperative varus deformity is severe, most cases may not require additional procedures to address the residual lateral laxity.

scholarly journals Early Results of Total Knee Arthroplasty with a Low Contact Stress Anteroposterior Glide

2009 ◽  
Vol 17 (2) ◽  
pp. 174-178 ◽  
Author(s):  
Adrian J Bauze ◽  
Mark S Falworth ◽  
Roger D Oakeshott
Keyword(s):  
Soft Tissue ◽  
Contact Stress ◽  
Cruciate Ligament ◽  
Valgus Deformity ◽  
Rotating Platform ◽  
Active Flexion ◽  
Early Results ◽  
Total Knee ◽  
The Mean ◽  
Low Contact Stress

Purpose. To present early results of 400 consecutive low contact stress (LCS) anteroposterior (AP) glide total knee arthroplasties (TKAs) performed by a single surgeon. Methods. 304 consecutive patients aged 30 to 96 (mean, 66) years underwent 400 TKAs using LCS AP glides performed by a single surgeon. Only patients with an intact posterior cruciate ligament, a fixed flexion deformity of <15°, and a valgus deformity of <15° were included. Patients were assessed pre- and post-operatively using the American Knee Society (AKS) and Hospital for Special Surgery (HSS) scores. Range of motion was measured using a goniometer. AP and lateral radiographs were assessed for radiolucencies and osteolysis. Results. The mean follow-up period was 4.2 (range, 1–8) years. The mean fixed flexion improved to 1° from 11° and the mean active flexion improved to 120° from 111°. Both AKS and HSS scores improved significantly. There were 28 anterior soft tissue impingements; 9 of them were in the first year of the study. Thereafter, the anterior lip of the bearing was modified and any offending osteophytes, soft tissue, or fat pads were excised. Of 39 (10%) knees that underwent re-operation (16 were due to anterior soft tissue impingement), 20 (5%) did not require change of the AP glide bearing and the remaining 19 were converted to a rotating platform bearing. No patellar baja was noted after fat pad excision. No patient had catastrophic wear or failure of the polyethylene bearing. The survival rate of the AP glide bearing was 95%. Conclusion. The early-to-mid-term outcomes of the LCS AP glide TKA are promising.

scholarly journals Rotation Distortion Syndrome of Ankle Joint and Knee in Car Drivers and Passengers

2021 ◽  
Vol 4 (1) ◽  
Keyword(s):  
Czech Republic ◽  
Knee Joint ◽  
Hallux Valgus ◽  
Ankle Joint ◽  
Joint Pain ◽  
Pain Syndrome ◽  
Valgus Deformity ◽  
Brain Dysfunction ◽  
Front Part ◽  
Minimal Brain Dysfunction

The most common feet pathologies of children are valgus and valgus planus deformities, which are congenital or connected with neurological dysfunctions (Minimal Brain Dysfunction). In adults, and mostly in women, we observe: 1. Köhler’s disease among girls wearing improper shoes. 2. Insufficiency and pain of the front part of feet connected with limited toes flexion, 3. Valgus deformity of the big toes (hallux valgus), 4. “Ankle Joint Pain Syndrome” (AJPS)-sometimes also “Knee Joint Pain Syndrome” (KJPS)-described by us only in USA, India and Czech Republic. In presented article, we describe this special type of foot insufficiency- “instability of ankle or knee, or both joints”-on left leg in drivers and right leg in passengers in countries with right-hand traffic. More frequent it concerns the foot and article focus on this problem.

Radiographic Comparison of the Mechanical Axis Including Calcaneus to the Conventional Mechanical Axis in Medial Unicompartmental Knee Arthroplasty

2019 ◽  
Author(s):  
Yuichi Kuroda ◽  
Koji Takayama ◽  
Kazunari Ishida ◽  
Shinya Hayashi ◽  
Shingo Hashimoto ◽  
...  
Keyword(s):  
Knee Arthroplasty ◽  
Unicompartmental Knee Arthroplasty ◽  
Tibial Component ◽  
Mechanical Axis ◽  
Weight Bearing ◽  
Postoperative Outcome ◽  
Diagnostic Study ◽  
Hindfoot Alignment ◽  
Unicompartmental Knee ◽  
The Mean

AbstractSince a hindfoot alignment is not included in the conventional mechanical axis (hip–ankle [HA] line), a mechanical axis including the calcaneus (hip–calcaneus [HC] line) has recently attracted attention as an alternative weight-bearing line. However, there are few reports on unicompartmental knee arthroplasty (UKA) regarding the HC line. Therefore, this study aimed to compare postoperative alignments after UKA between the HA line and the HC line. Postoperatively, HC radiographs were taken in 88 consecutive patients who underwent medial UKA. The hip–knee–ankle (HKA) and hip–knee–calcaneus (HKC) angles were compared in the same patient. Regarding tibial inclination, the conventional tibial component–ankle (TCA) angle was compared with reference to the HC line (tibial component–calcaneus [TCC] angle). The mean postoperative HKA and HKC angles were 2.8 ± 2.7 and 2.0 ± 2.5 degree, respectively. The mean postoperative TCA and TCC angles were 87.7 ± 2.1 and 88.5 ± 2.1 degree, respectively. There were significant differences between the two groups in both lower limb alignment and tibial component angle. The present study indicated that the HKC and the TCC angles significantly decreased the varus alignment by approximately 1 degree compared with the HKA and TCA angles. Neutral in the HA line corresponds to valgus in reference to the HC line, which may result in overcorrection. Surgeons should consider evaluating the HC line in place of the HA line, which may affect preoperative planning and postoperative outcome during UKA. This is a Level II, diagnostic study.

scholarly journals Extensor hallucis longus tendon is a new distal landmark for coronal tibial component alignment in total knee arthroplasty: A study of magnetic resonance imaging

2020 ◽  
Vol 28 (1) ◽  
pp. 230949902091234
Author(s):  
Manabu Hino ◽  
Shuji Nakagawa ◽  
Yuji Arai ◽  
Hiroaki Inoue ◽  
Hiroyuki Kan ◽  
...  
Keyword(s):  
Magnetic Resonance Imaging ◽  
Total Knee Arthroplasty ◽  
Magnetic Resonance ◽  
Knee Joint ◽  
Ankle Joint ◽  
Resonance Imaging ◽  
Tibial Torsion ◽  
Valgus Angle ◽  
Extensor Hallucis Longus ◽  
Total Knee

Purpose: In total knee arthroplasty (TKA), various landmarks are generally used to ensure correct osteotomy. In this study, we examined whether the tibialis anterior tendon (TAT) or the extensor hallucis longus tendon (EHLT) could be used as a landmark of the center of the ankle joint in patients with knee osteoarthrosis (OA), using magnetic resonance imaging (MRI). Methods: The subjects were 61 patients with OA in 79 knees (males: 8 with 9 knees and females: 53 with 70 knees). With the ankle joint secured in the intermediate position, MRI from the knee joint to the ankle joint was performed in the same foot position. We prepared individual lines connecting the center of the ankle joint with the TAT or EHLT to measure the angle difference (ΔA) from Akagi’s line in the knee joint. We analyzed whether the ΔA might be affected by deformity of the knee joint or foot region, and tibial torsion. Results: At the ankle joint level, the ΔA of EHLT was the smallest, with an average of 1.6 ± 3.4°. The ΔA for the femorotibial angle, hallux valgus angle, and varus–valgus angle showed no correlations with deformity of the knee joint and foot region, or tibial torsion. Conclusions: MRI findings showed that EHLT would be useful as a landmark of the ankle joint center in extramedullary tibial osteotomy in TKA for medial knee OA. It was also clarified that the landmark would not be affected by severe deformity of the knee joint, deformity of the foot region, or external torsion of the tibia.

scholarly journals Analysis of the Hindfoot Alignment Measured in 3D After a Medializing Calcaneal Osteotomy Using a Pre- and Postoperative Weightbearing CT

2018 ◽  
Vol 3 (3) ◽  
pp. 2473011418S0003
Author(s):  
Arne Burssens ◽  
Alexej Barg ◽  
Timothy Leenders ◽  
Stefan Clockaerts ◽  
Peter Burssens ◽  
...  
Keyword(s):  
Valgus Deformity ◽  
Stage Ii ◽  
Tibial Rotation ◽  
Flat Foot ◽  
Hindfoot Alignment ◽  
Software Analysis ◽  
Calcaneal Osteotomy ◽  
Significant Difference ◽  
Significant Correction ◽  
The Mean

Category: Hindfoot Introduction/Purpose: An adult acquired flat foot (AAFD) is a complex 3D deformity. A medializing calcaneal osteotomy (MCO) is a surgical procedure frequently performed to correct the valgus alignment of the hindfoot in a stage II AAFD, when conservative measurements fail. However currently little is known on its accurate influence regarding the hindfoot alignment (HA). The aim is therefore to assess the influence of a MCO on the 3D HA using computer aided software analysis of the images retrieved from a weightbearing cone beam CT (WBCT). Methods: Twelve patients with a mean age of 49,4 years (range 18-67yrs) were prospectively included in a pre-post study design. Indications for surgical correction by a MCO with a solitary translation consisted of an AAFD stage II (N=10) and a posttraumatic valgus deformity (N=2). Fixation of the osteotomy was performed by a step-plate or double screw. WBCT was obtained pre- and post-operative. Images were subsequently segmented to allow a HA calculation in 3D(HA3D) by an angle between the anatomical tibia axis and the axis connecting the computed inferior calcaneuspoint and the centroid of the talus in the coronal plane based on a Cartesian coordinatesystem(Fig 1A, C). The tibia in the HA3D was separately assessed by the anatomical tibia axis (TAx 3D) and the axis to determine the tibial rotation(TR 3D) in the axial plane by connecting the computed most outer point of the anterior and posterior tubercle of the incisura fibularis(Fig 2A, D). Results: The mean medial translation of the calcaneal osteotomy during surgery was 5.72 mm (SD = 3.9). The mean HA3D pre-operatively equaled 18.21 degrees of valgus (SD = 6.6) and post-operatively 9.31 degrees of valgus (SD = 6.18). The Paired Student’s t-test showed a significant correction of 8.89 degrees (95%CI [5.99, 11.80], P<0.001). The mean TAX 3D pre-operatively was 6.80 degrees of valgus (SD = 3.38) and post-operatively 4.11 degrees of valgus (SD = 2.77), with a significant difference of 2.69 degrees (95%CI [1.79, 3.59], P <0.001). The mean TR3D pre-operatively was -27.11 degrees (SD = 4.77) and post-operatively - 28.80 degrees (SD = 5.98) and showed a significant difference of 1.69 degrees (95%CI [0.41, 2.97], P = 0,016). Conclusion: This study shows an effective correction of the valgus hindfoot in an AAFD. It appears that the correction is not only situated in the calcaneus but also to a lesser extent in the tibia and this resulted in 15% of the achieved HA correction. The novelty is the 3D weightbearing assessment of a hindfoot correction and the shown influence on the tibia. This information could be of use to take in to account when performing a pre-operative planning of a hindfoot deformity.

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