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Global varus malalignment increase from double-leg to single-leg stance due to intra-articular changes

Knee Surgery, Sports Traumatology, Arthroscopy volume 30, pages 715–720 (2022)Cite this article

Abstract

Purpose

Preoperatively planned correction for tibial osteotomy surgery is usually based on weightbearing long-leg Xrays, while the surgery is performed in a supine non-weightbearing position. The purpose of this study was to assess the differences in lower limb alignment in three different weightbearing conditions: supine position, double-leg (DL) stance and single-sleg (SL) stance prior to performing a medial opening wedge high tibial osteotomy (MOWHTO) for varus malalignment. The hypothesis of this study was that progressive limb-loading would lead to an increased preoperative varus deformity.

Material and methods

This retrospective study included 89 patients (96 knees) with isolated medial knee osteoarthritis (Ahlbäck grade I or II) and significant metaphyseal tibial vara (> 6°). The differences between supine position, DL stance and SL stance were analysed for the hip-knee-ankle angle (HKA), lateral distal femoral angle (LDFA), medial proximal tibial angle (MPTA), weight-bearing line ratio (WBL) and joint line convergence angle (JLCA).

Results

From a supine position to DL stance, the HKA angle slightly increased from 175.5° ± 1.1° to 176.3° ± 1.1° and JLCA changed from 2.0° ± 0.3° to 1.8° ± 0.3° without a statistically significant difference. From DL to SL stances, the HKA angle decreased from 176.3° ± 1.1° to 174.4° ± 1.1° (p < 0.05) and the JLCA increased from 1.8° ± 0.3° to 2.6° ± 0.3° (p < 0.05). A significant correlation was found between ΔHKA and ΔJLCA between the DL and the SL stances (R2 = 0.46; p = 0.01).

Conclusion

Varus malalignment increases with weight-bearing loading from double-leg to single-leg stances with an associated JLCA increase. Thus, single-leg stance radiographs may be useful to correct preoperative planning considering patient-specific changes in JLCA.

Level of clinical evidence

III, retrospective comparative study.

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Funding

No funding was needed for this study.

Author information

Authors and Affiliations

  1. Department of Orthopedics and Traumatology, Institute of Movement and Locomotion, St. Marguerite Hospital, 270 Boulevard Sainte Marguerite, BP 29, 13274, Marseille, France

    Léo-Pôhl Bardot, Petr Zeman & Matthieu Ollivier

  2. Department of Orthopedics and Traumatology, Institute for Locomotion, APHM, CNRS, ISM, Sainte-Marguerite Hospital, Aix Marseille University, Marseille, France

    Léo-Pôhl Bardot, Grégoire Micicoi, Raghbir Khakha & Matthieu Ollivier

  3. iULS-University Institute for Locomotion and Sports, Pasteur 2 Hospital, University Côte d’Azur, Nice, France

    Grégoire Micicoi

  4. Service de Chirurgie Orthopedique et de TraumatologieHôpital de Hautepierre, Hôpitaux Universitaires de Strasbourg, Strasbourg, France

    Henri Favreau & Matthieu Ehlinger

  5. Guys and St Thomas’ Hospitals, Great Maze Pond, London, SE1 9RT, England

    Raghbir Khakha

Authors
  1. Léo-Pôhl Bardot
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  2. Grégoire Micicoi
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  6. Matthieu Ehlinger
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  7. Matthieu Ollivier
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Contributions

MO designed the protocol and performed statistical analysis. LB and HF collected the Data. LB wrote the initial draft and perform edition for the different version of the manuscript. GM, RK, ME and MO corrected the different versions of the draft. All the authors approved the submitted version.

Corresponding author

Correspondence to Matthieu Ollivier.

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Conflict of interest

LB, GM, RK have nothing to disclose. MO is educational consultant for Stryker, AO-Recon and Newclip-Technics. ME is educational consultant for Amplitude, Groupe Lépine and Newclip-Technics.

Ethical approval

The local ethics committee approved our study protocol prior to investigation.

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Bardot, LP., Micicoi, G., Favreau, H. et al. Global varus malalignment increase from double-leg to single-leg stance due to intra-articular changes. Knee Surg Sports Traumatol Arthrosc 30, 715–720 (2022). https://doi.org/10.1007/s00167-021-06446-6

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  • DOI: https://doi.org/10.1007/s00167-021-06446-6

Keywords

  • Knee
  • Osteotomy
  • Weight-bearing
  • Genu varum
  • Weight-bearing radiographs
  • Joint line convergence