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Three-dimensional lower extremity alignment in the weight-bearing standing position in healthy elderly subjects

  • Original Article
  • Published:
Journal of Orthopaedic Science

Abstract

Background

Although assessment of lower extremity alignment is important for the treatment and evaluation of diseases that present with malalignment of the lower extremity, it has generally been performed using only plain radiographs seen in two dimensions (2D). In addition, there is no consensus regarding the criteria for quantitative three-dimensional (3D) evaluation of the relative angle between the femur and tibia. The purpose of this study was to establish assessment methods and criteria for quantitatively evaluating lower extremity alignment in 3D and to obtain reference data from normal elderly subjects.

Methods

The normal alignment of 82 limbs of 45 healthy elderly subjects (24 women, 21 men; mean age 65 years, range 60–81 years) was analyzed in 3D with regard to flexion, adduction-abduction, and rotational angle of the knee in the weight-bearing, standing position. The obtained computed tomography (CT) and biplanar computed radiography (CR) data were used to define several anatomical axes of the femur and tibia as references.

Results

In the sagittal plane, the mean extension-flexion angle was significantly more recurvatum in women than in men. In the coronal plane, the mean 3D hip-knee-ankle angle was more varus by several degrees in this Japanese series than that in a Caucasian series reported previously. Regarding rotational alignment, the mean angle between the anteroposterior axis of the tibia and the transepicondylar axis of the femur in this series was slightly larger (externally rotated) than that of previously reported Japanese series examined in the supine position.

Conclusions

These data are believed to represent important references for 3D evaluation of morbid lower extremity alignment in the weight-bearing, standing position and are important for biomechanical research (e.g., 3D analyses of knee kinematics) because the relative angles between the femur and tibia are assessed three-dimensionally.

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Authors and Affiliations

  1. Department of Orthopaedic Surgery, Niigata Kobari Hospital, 3-27-11, Kobari, Niigata, 950-2022, Japan

    Akihiro Ariumi, Takashi Sato & Yoshio Koga

  2. Division of Orthopaedic Surgery, Department of Regenerative and Transplant Medicine, Niigata University Graduate School of Medicine and Dental Science, Niigata, Japan

    Akihiro Ariumi & Naoto Endo

  3. Department of Health Sciences, Niigata University School of Medicine, Niigata, Japan

    Koichi Kobayashi

  4. Center of Transdisciplinary Research, Niigata University, Niigata, Japan

    Go Omori

  5. Department of Orthopaedic Surgery, Niigata Rinko Hospital, Niigata, Japan

    Izumi Minato

Authors
  1. Akihiro Ariumi
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  2. Takashi Sato
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  3. Koichi Kobayashi
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  4. Yoshio Koga
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  5. Go Omori
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  6. Izumi Minato
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  7. Naoto Endo
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Ariumi, A., Sato, T., Kobayashi, K. et al. Three-dimensional lower extremity alignment in the weight-bearing standing position in healthy elderly subjects. J Orthop Sci 15, 64–70 (2010). https://doi.org/10.1007/s00776-009-1414-z

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  • DOI: https://doi.org/10.1007/s00776-009-1414-z

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