Abstract
Purpose
This study aimed to assess radiological changes of the ankle joint, subtalar joint and foot following the correction of varus deformity of the knee with total knee arthroplasty (TKA). It was hypothesized that following the correction of varus deformity by TKA, compensatory reactions would occur at the subtalar joint in accordance with the extent of the correction.
Methods
For this prospective study, 375 knees of patients who underwent TKA between 2011 and 2012 were enrolled. The varus angle of the knee, talar tilt of the ankle joint (TT), ground-talar dome angle of the foot (GD), anterior surface angle of the distal tibia and lateral surface angle of the distal tibia, heel alignment ratio (HR), heel alignment angle (HA), and heel alignment distance (HD) were measured on radiographs obtained pre-operatively and at post-operative 6 months.
Results
The mean correction angle in varus deformity of the knee was 10.8 ± 4.1°. TT and GD changed significantly from 0.4 ± 1.9° and 6.5 ± 3.1° pre-operatively to 0.1 ± 1.8° and 0.2 ± 2.1°, respectively (p = 0.007, p < 0.001). No correlation was found between the preop–postop variance in mechanical axis of the lower extremity (MA) and TT, but there was a strong correlation between the preop–postop variance in MA and GD (r = 0.701). HR, HA and HD also changed significantly post-operatively, and the preop–postop variance in MA showed correlations with the preop–postop variances in HR, HA and HD (r = 0.206, − 0.348, and − 0.418). TT and the three indicators of hindfoot alignment all shifted to varus whereas GD was oriented in valgus.
Conclusion
Following the correction of varus deformity of the knee through TKA, significant compensatory changes occurred not only at the ankle and subtalar joints, but also at the foot. The findings of this study are useful in predicting the orientation of changes in the ankle and subtalar joints and the foot following TKA, and in determining the sequence of surgery when both the ankle and knee have a problem. In other words, changes in the parts of the lower extremity below the ankle joint following the correction of varus deformity of the knee must be considered when TKA is planned and performed. Patients who have problems at the ankle, subtalar, and foot joints in addition to varus deformity of the knee are recommended to undergo knee joint correction first.
Level of evidence
II.
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References
Chandler JT, Moskal JT (2004) Evaluation of knee and hindfoot alignment before and after total knee arthroplasty: a prospective analysis. J Arthroplasty 19:211–216
Cobey JC, Sella E (1981) Standardizing methods of measurement of foot shape by including the effects of subtalar rotation. Foot Ankle 2:30–36
Doets HC, Brand R, Nelissen RG (2006) Total ankle arthroplasty in inflammatory joint disease with use of two mobile-bearing designs. J Bone Jt Surg Am 88:1272–1284
Fang DM, Ritter MA, Davis KE (2009) Coronal alignment in total knee arthroplasty: just how important is it? J Arthroplasty 24:39–43
Frigg A, Nigg B, Davis E, Pederson B, Valderrabano V (2010) Does alignment in the hindfoot radiograph influence dynamic foot-floor pressures in ankle and tibiotalocalcaneal fusion? Clin Orthop Relat Res 468:3362–3370
Gao F, Ma J, Sun W, Guo W, Li Z, Wang W (2016) The influence of knee malalignment on the ankle alignment in varus and valgus gonarthrosis based on radiographic measurement. Eur J Radiol 85:228–232
Goto A, Moritomo H, Itohara T, Watanabe T, Sugamoto K (2009) Three-dimensional in vivo kinematics of the subtalar joint during dorsi-plantarflexion and inversion–version. Foot Ankle Int 30:432–438
Guichet JM, Javed A, Russell J, Saleh M (2003) Effect of the foot on the mechanical alignment of the lower limbs. Clin Orthop Relat Res 415:193–201
Gursu S, Sofu H, Verdonk P, Sahin V (2016) Effects of total knee arthroplasty on ankle alignment in patients with varus gonarthrosis: do we sacrifice ankle to the knee? Knee Surg Sports Traumatol Arthrosc 24:2470–2475
Hara Y, Ikoma K, Arai Y, Ohashi S, Maki M, Kubo T (2015) Alteration of hindfoot alignment after total knee arthroplasty using a novel hindfoot alignment view. J Arthroplasty 30:126–129
Hayashi K, Tanaka Y, Kumai T, Sugimoto K, Takakura Y (2008) Correlation of compensatory alignment of the subtalar joint to the progression of primary osteoarthritis of the ankle. Foot Ankle Int 29:400–406
Hintermann B, Valderrabano V (2003) Total ankle replacement. Foot Ankle Clin 8:375–405
Lee HS, Wapner KL, Park SS, Kim JS, Lee DH, Sohn DW (2009) Ligament reconstruction and calcaneal osteotomy for osteoarthritis of the ankle. Foot Ankle Int 30:475–480
Lee JH, Jeong BO (2012) Radiologic changes of ankle joint after total knee arthroplasty. Foot Ankle Int 33:1087–1092
Lee KM, Chung CY, Park MS, Lee SH, Cho JH, Choi IH (2010) Reliability and validity of radiographic measurements in hindfoot varus and valgus. J Bone Jt Surg Am 92:2319–2327
Lee WC, Moon JS, Lee HS, Lee K (2011) Alignment of ankle and hindfoot in early stage ankle osteoarthritis. Foot Ankle Int 32:693–699
Moreland JR, Bassett LW, Hanker GJ (1987) Radiographic analysis of the axial alignment of the lower extremity. J Bone Jt Surg Am 69:745–749
Mullaji A, Shetty GM (2011) Persistent hindfoot valgus causes lateral deviation of weightbearing axis after total knee arthroplasty. Clin Orthop Relat Res 469:1154–1160
Norton AA, Callaghan JJ, Amendola A, Phisitkul P, Wongsak S, Liu SS et al (2015) Correlation of knee and hindfoot deformities in advanced knee OA: compensatory hindfoot alignment and where it occurs. Clin Orthop Relat Res 473:166–174
Nunley RM, Ellison BS, Zhu J, Ruh EL, Howell SM, Barrack RL (2012) Do patient-specific guides improve coronal alignment in total knee arthroplasty? Clin Orthop Relat Res 470:895–902
Okamoto Y, Otsuki S, Jotoku T, Nakajima M, Neo M (2017) Clinical usefulness of hindfoot assessment for total knee arthroplasty: persistent post-operative hindfoot pain and alignment in pre-existing severe knee deformity. Knee Surg Sports Traumatol Arthrosc 25:2632–2639
Reilingh ML, Beimers L, Tuijthof GJ, Stufkens SA, Maas M, van Dijk CN (2010) Measuring hindfoot alignment radiographically: the long axial view is more reliable than the hindfoot alignment view. Skeletal Radiol 39:1103–1108
Saltzman CL, el-Khoury GY (1995) The hindfoot alignment view. Foot Ankle Int 16:572–576
Strash WW, Berardo P (2004) Radiographic assessment of the hindfoot and ankle. Clin Podiatr Med Surg 21:295–304
Takenaka T, Ikoma K, Ohashi S, Arai Y, Hara Y, Ueshima K et al (2016) Hindfoot alignment at one year after total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 24:2442–2446
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Bi O Jeong, MD, PhD, Tae Yong Kim, MD, Jong Hun Baek, MD, PhD, Hyuk Jung, MD and Seung Hyun Song, MD declare that they have no conflict of interest.
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The authors received no financial support for the research, authorship, and publication of this article.
Ethical approval
This study was approved by the institutional review board at the Kyung Hee University Hospital (KMC IRB 1336-02).
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Informed consent for study participation was obtained from each patient.
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Jeong, B.O., Kim, T.Y., Baek, J.H. et al. Following the correction of varus deformity of the knee through total knee arthroplasty, significant compensatory changes occur not only at the ankle and subtalar joint, but also at the foot. Knee Surg Sports Traumatol Arthrosc 26, 3230–3237 (2018). https://doi.org/10.1007/s00167-018-4840-7
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DOI: https://doi.org/10.1007/s00167-018-4840-7