Louis Dagneaux1,2, Maryama Dufrenot3, Alessio Bernasconi4, Nicholas A Bedard5, Cesar de Cesar Netto6, François Lintz7. 1. Department of Orthopaedic Surgery, Lower Limb Surgery Unit, Lapeyronie University Hospital, Montpellier, France. 2. Montpellier University, Montpellier, France. 3. Aix-Marseille University, CNRS, Marseille, France. 4. Trauma and Orthopaedics, University of Naples Federico II, Naples, Italy. 5. Department of Orthopedics and Rehabilitation, University of Iowa, Iowa City, IA, USA. 6. Department of Foot and Ankle Surgery, Hospital for Special Surgery, New York, NY, USA. 7. Department of Foot and Ankle Surgery, Union Private Hospital, Saint Jean, Toulouse, France.
Abstract
BACKGROUND: Previous studies focusing on the effects of knee surgery on hindfoot alignment have suggested some degree of compensation between the knee and the hindfoot. However, these studies did not investigate a preoperative relationship in patients without end-stage knee osteoarthritis using 3-dimensional (3D) biometrics. The purpose of this study was to investigate the relationship between knee and hindfoot alignment using 3D weightbearing imaging. METHODS: This retrospective comparative study included 95 lower limbs with weightbearing computed tomography and low-dose biplanar radiograph investigations. Cases with a history that may have caused a change in lower limb alignment were excluded. Hindfoot and knee alignments were measured using foot ankle offset (FAO) and hip-knee-ankle (HKA) angle, respectively. Patients were separated into 3 groups according to the knee deformity to investigate the distribution of FAO in each group. RESULTS: The mean (SD) FAO was 2% (7%) for the knee varus group, 1% (6%) for the neutral knee group, and 4% (5%) for the valgus knee group (P = .12). Fifty-three percent of patients with knee valgus showed a pathological hindfoot valgus (P = .04). We found a positive but moderate correlation between hindfoot valgus and HKA (ρ = 0.53; P = .01). Female sex was associated with higher FAO (3% ± 4% vs 0.6% ± 6%; P = .009). CONCLUSION: This feasibility study suggests a new opportunity using 3D biometrics to understand the relationship between knee and hindfoot alignment and to highlight different patterns of combined deformities in further investigations. LEVEL OF EVIDENCE: Level III, comparative study.
BACKGROUND: Previous studies focusing on the effects of knee surgery on hindfoot alignment have suggested some degree of compensation between the knee and the hindfoot. However, these studies did not investigate a preoperative relationship in patients without end-stage knee osteoarthritis using 3-dimensional (3D) biometrics. The purpose of this study was to investigate the relationship between knee and hindfoot alignment using 3D weightbearing imaging. METHODS: This retrospective comparative study included 95 lower limbs with weightbearing computed tomography and low-dose biplanar radiograph investigations. Cases with a history that may have caused a change in lower limb alignment were excluded. Hindfoot and knee alignments were measured using foot ankle offset (FAO) and hip-knee-ankle (HKA) angle, respectively. Patients were separated into 3 groups according to the knee deformity to investigate the distribution of FAO in each group. RESULTS: The mean (SD) FAO was 2% (7%) for the knee varus group, 1% (6%) for the neutral knee group, and 4% (5%) for the valgus knee group (P = .12). Fifty-three percent of patients with knee valgus showed a pathological hindfoot valgus (P = .04). We found a positive but moderate correlation between hindfoot valgus and HKA (ρ = 0.53; P = .01). Female sex was associated with higher FAO (3% ± 4% vs 0.6% ± 6%; P = .009). CONCLUSION: This feasibility study suggests a new opportunity using 3D biometrics to understand the relationship between knee and hindfoot alignment and to highlight different patterns of combined deformities in further investigations. LEVEL OF EVIDENCE: Level III, comparative study.
Authors: Edward O Rojas; Nacime Salomao Barbachan Mansur; Kevin Dibbern; Matthieu Lalevee; Elijah Auch; Eli Schmidt; Victoria Vivtcharenko; Shuyuan Li; Phinit Phisitkul; John Femino; Cesar de Cesar Netto Journal: Iowa Orthop J Date: 2021