Skip to main content

Advertisement

SpringerLink
Log in

Coronal and sagittal alignment of ankle joint is significantly affected by high tibial osteotomy

  • KNEE
  • Published:
Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Purpose

Changes in coronal and sagittal alignment of the knee joint after HTO have been reported in several previous studies. However, only few of them investigated the changes only on coronal alignment of the ankle joint. The purpose of this study was to investigate changes in both coronal and sagittal alignment of the ankle joint after HTO.

Methods

46 patients (49 cases) who underwent HTO were retrospectively analyzed. Preoperative and postoperative lower extremity scanogram and EOS imaging system were investigated. The hip–knee–ankle (HKA) angle, medial proximal tibial angle (MPTA), and knee tibia plafond angle (KTPA) were measured by scanogram to evaluate coronal alignment of the knee. Tibial anterior surface angle (TAS), talar tilt (TT), tibial plafond inclination (TPI), and ankle joint axis point on the weight-bearing-line (AAWBL) ratio were measured by scanogram to investigate coronal alignment of the ankle. Knee lateral ankle surface angle (KLAS) and tibial lateral surface angle (TLS) were measured by EOS to evaluate sagittal alignment of the ankle.

Results

Varus alignment of the knee was corrected by significant change of the HKA angle (5.8 ± 3.1° vs. − 2.1 ± 2.8°, p < 0.001), MPTA (85.7 ± 2.9° vs. 91.7 ± 3.3°, p < 0.001), and KTPA (5.0 ± 3.5° vs. − 2.1 ± 4.2°, p < 0.001) after HTO. Regarding the ankle coronal alignment, there was significant change in TPI (3.9 ± 3.4° vs. − 0.9 ± 3.8°, p < 0.001) and AAWBL ratio (45.5 ± 14.7% vs. 61.6 ± 13.3%, p < 0.001). In sagittal alignment of the ankle, KLAS (4.5 ± 3.1° vs. 7.7 ± 3.7°, p < 0.001) significantly increased. Among the variables, the amount of correction in AAWBL ratio (R = 0.608, p < 0.01) showed strongest relationship with tibial correction angle.

Conclusion

Based on the present study, coronal and sagittal alignment of ankle joint was significantly affected by HTO. After HTO, AAWBL ratio increased due to lateralization of the ankle joint axis, and KLAS increased due to increased posterior tibial slope.

Level of Evidence

III.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others

Data availability

Not applicable.

Abbreviations

HTO:

High tibial osteotomy

OA:

Osteoarthritis

ICC:

Intraclass correlation coefficient

HKA:

Hip knee ankle

MPTA:

Medial proximal tibial angle

KTPA:

Knee tibia plafond angle

TAS:

Tibial anterior surface angle

TT:

Talar tilt

TPI:

Tibial plafond inclination

AAWBL:

Ankle joint axis point on the weight-bearing line

WBL:

Weight bearing line

KLAS:

Knee lateral ankle surface angle

TLS:

Tibial lateral surface angle

TKA:

Total knee arthroplasty

References

  1. Chang CB, Jeong JH, Chang MJ, Yoon C, Song MK, Kang SB (2018) Concomitant ankle osteoarthritis is related to increased ankle pain and a worse clinical outcome following total knee arthroplasty. J Bone Joint Surg Am 100:735–741

    Article  PubMed  Google Scholar 

  2. Cho BW, Lee TH, Kim S, Choi CH, Jung M, Lee KY et al (2021) Evaluation of the reliability of lower extremity alignment measurements using EOS imaging system while standing in an even weight-bearing posture. Sci Rep 11:22039

    Article  PubMed  PubMed Central  Google Scholar 

  3. Choi JY, Song SJ, Kim SJ, Kim SH, Park JS, Suh JS (2018) Changes in hindfoot alignment after high or low tibial osteotomy. Foot Ankle Int 39:1097–1105

    Article  PubMed  Google Scholar 

  4. Ducat A, Sariali E, Lebel B, Mertl P, Hernigou P, Flecher X et al (2012) Posterior tibial slope changes after opening- and closing-wedge high tibial osteotomy: a comparative prospective multicenter study. Orthop Traumatol Surg Res 98:68–74

    Article  CAS  PubMed  Google Scholar 

  5. Haraguchi N, Ota K, Tsunoda N, Seike K, Kanetake Y, Tsutaya A (2015) Weight-bearing-line analysis in supramalleolar osteotomy for varus-type osteoarthritis of the ankle. J Bone Joint Surg Am 97:333–339

    Article  PubMed  Google Scholar 

  6. Jang KM, Lee JH, Cho IY, Park BK, Han SB (2017) Intraoperative fluoroscopic assessment of limb alignment is a reliable predictor for postoperative limb alignment in biplanar medial opening-wedge high tibial osteotomy. J Arthroplasty 32:756–760

    Article  PubMed  Google Scholar 

  7. Kim JG, Suh DH, Choi GW, Koo BM, Kim SG (2021) Change in the weight-bearing line ratio of the ankle joint and ankle joint line orientation after knee arthroplasty and high tibial osteotomy in patients with genu varum deformity. Int Orthop 45:117–124

    Article  PubMed  Google Scholar 

  8. Kwon SS, Yoo JD, Lee SY (2022) Linear mixed modeling on the effects of varus knee surgery on the ankle joint weight-bearing axis. Foot Ankle Surg 28:114–118

    Article  PubMed  Google Scholar 

  9. Lee DC, Byun SJ (2012) High tibial osteotomy. Knee Surg Relat Res 24:61–69

    Article  PubMed  PubMed Central  Google Scholar 

  10. Lee KM, Chang CB, Park MS, Kang SB, Kim TK, Chung CY (2015) Changes of knee joint and ankle joint orientations after high tibial osteotomy. Osteoarthritis Cartilage 23:232–238

    Article  CAS  PubMed  Google Scholar 

  11. Machado A, Micicoi L, Ernat J, Schippers P, Bernard de Dompsure R, Bronsard N et al (2023) Normo-or slightly overcorrection show better results after medial closing wedge high tibial osteotomy. Knee Surg Sports Traumatol Arthrosc. https://doi.org/10.1007/s00167-023-07465-1

    Article  PubMed  Google Scholar 

  12. Melhem E, Assi A, El Rachkidi R, Ghanem I (2016) EOS® biplanar x-ray imaging: concept, developments, benefits, and limitations. J Child Orthop 10:1–14

    Article  PubMed  PubMed Central  Google Scholar 

  13. Park SB, Lee YS (2023) Association of the joint line orientation angle of the contralateral limb with the alignment change of the unilateral and bilateral opening-wedge high tibial osteotomy. Knee Surg Sports Traumatol Arthrosc 31:1593–1602

    Article  PubMed  Google Scholar 

  14. Suero EM, Sabbagh Y, Westphal R, Hawi N, Citak M, Wahl FM et al (2015) Effect of medial opening wedge high tibial osteotomy on intraarticular knee and ankle contact pressures. J Orthop Res 33:598–604

    Article  PubMed  Google Scholar 

  15. Takeuchi R, Saito T, Koshino T (2008) Clinical results of a valgus high tibial osteotomy for the treatment of osteoarthritis of the knee and the ipsilateral ankle. Knee 15:196–200

    Article  PubMed  Google Scholar 

  16. Vanadurongwan B, Siripisitsak T, Sudjai N, Harnroongroj T (2013) The anatomical safe zone for medial opening oblique wedge high tibial osteotomy. Singapore Med J 54:102–104

    Article  PubMed  Google Scholar 

Download references

Acknowledgements

This work was supported by the National Research Foundation of Korea (NRF) grant funded by the Korea government (MSIT) No. RS-2023-00211971 and No. 2022R1F1A1074656.

Funding

Not applicable.

Author information

Author notes

  1. Byung Hak Oh and Kyung Deok Seo are first authors.

Authors and Affiliations

  1. Department of Orthopedic Surgery, Konyang University Hospital, 158 Gwanjeodong-ro, Seo-gu, Daejeon, 35365, Republic of Korea

    Byung Hak Oh, Kyung Deok Seo, Youn Moo Heo, Tae Kyun Kim, Jae Kyu Choi & Jae Hwang Song

Authors
  1. Byung Hak Oh
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Kyung Deok Seo
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Youn Moo Heo
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Tae Kyun Kim
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Jae Kyu Choi
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Jae Hwang Song
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Jae Hwang Song.

Ethics declarations

Conflict of interest

The authors have declared that no competing interests exist.

Ethical approval

This study was approved by the Institutional Review Board of the Konyang University Hospital (No.: KYUH 2022 04 024).

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Oh, B.H., Seo, K.D., Heo, Y.M. et al. Coronal and sagittal alignment of ankle joint is significantly affected by high tibial osteotomy. Knee Surg Sports Traumatol Arthrosc 31, 4878–4885 (2023). https://doi.org/10.1007/s00167-023-07531-8

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00167-023-07531-8

Keywords

Search

Navigation