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Foot loading pattern and hind foot alignment are corrected in varus knees following total knee arthroplasty: a pedobarographic analysis

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Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Purpose

Osteoarthritis of knees with varus deformity is associated with a compensatory valgus deformity of the hindfoot and a lateral loading foot pressure pattern. However, whether this abnormal loading pattern is corrected in total knee arthroplasty (TKA) is unclear.

Methods

The alignment and loading pattern of 91 consecutive patients (121 knees) undergoing TKA with pre-operative varus more than 10° were evaluated prospectively with functional outcome scores, static conventional radiography and dynamic pedobarogaphy pre-operatively and 1-year post-operatively. Outcomes assessed were Oxford Knee Scores, American Orthopaedic Foot and Ankle Scores, femorotibial mechanical angle, tibia–hindfoot angle, hindfoot valgus/varus index (VVI), foot line of pressure (LOP) laterality and peak pressure (PP) at both time points.

Results

Of 121 knees, 98 (81%) regained normal alignment of the knee and 114 (92%) of the hindfoot. Similarly, PP (p < 0.001), VVI (pre-operative: − 0.29 ± 0.22, post-operative: − 0.04 ± 0.23, p < 0.001) and LOP laterality (pre-operative: 7% medial, post-operative: 96% medial, p < 0.001) all medialised post-operatively. All patients had improved functional outcomes at the knee (pre-operative: 20 ± 2, post-operative: 40 ± 2, p < 0.001) and ankle (pre-operative: 59 ± 10, post-operative: 89 ± 6, p < 0.001).

Conclusion

The present study shows, following the correction of knee varus with TKA, hindfoot alignment and foot loading pattern are both restored in the majority of patients. TKA offers both static and dynamic correction as seen in the hindfoot and loading pattern, respectively.

Level of evidence

Level III: prospective case–control study.

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Abbreviations

TKA:

Total knee arthroplasty

FTMA:

Mechanical FemoroTibial Alignment

OKS:

Oxford Knee Score

AOFAS:

American Orthopaedic Foot and Ankle Scores

PACS:

Picture archiving and communication system

LOP:

Line of pressure

VVI:

Valgus/varus index

TH:

Tibia–hindfoot angle

N.S:

Not significant

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Acknowledgments

This study was funded by Ganga Orthopaedic Research & Education Foundation (GOREF). A.S. was supported by a Fulbright-Nehru Fellowship funded by the governments of the United States of America and India. The content and views in this article are solely the responsibility of the authors and does not necessarily represent the official views of the governments of the United States of America and Republic of India.

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Authors and Affiliations

  1. Department of Orthopaedics & Trauma, Ganga Medical Centre & Hospitals Pvt. Ltd, 313, Mettupalayam Road, Coimbatore, India

    Dhanasekara Raja Palanisami, Raja Bhaskara Rajasekaran, Praveen Kumar Reddy, Rajkumar Natesan, Arvinth Sethuraman & Shanmuganathan Rajasekaran

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  1. Dhanasekara Raja Palanisami
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  2. Raja Bhaskara Rajasekaran
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  3. Praveen Kumar Reddy
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  4. Rajkumar Natesan
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  5. Arvinth Sethuraman
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  6. Shanmuganathan Rajasekaran
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Correspondence to Raja Bhaskara Rajasekaran.

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The study was performed in accordance with the ethical standards in the 1964 Declaration of Helsinki.

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Palanisami, D.R., Rajasekaran, R.B., Reddy, P.K. et al. Foot loading pattern and hind foot alignment are corrected in varus knees following total knee arthroplasty: a pedobarographic analysis. Knee Surg Sports Traumatol Arthrosc 28, 1861–1867 (2020). https://doi.org/10.1007/s00167-019-05629-6

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  • DOI: https://doi.org/10.1007/s00167-019-05629-6

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