Discrepancy of alignment in different weight bearing conditions before and after high tibial osteotomy

Purpose: To evaluate the differences in the amount of varus malalignment and valgus (over) correction in relation to three different weight bearing conditions from whole leg AP radiographs (single-limb (SL) stance, double-limb (DL) stance, supine position (S)) before and after high tibial osteotomy (HTO), and to evaluate which alignment parameters affect the changes for patients in three different weight bearing conditions.

Methods: A total of 40 consecutive patients (43 knees) with varus osteoarthritis underwent navigation assisted open wedge HTO. Mechanical axis angle (MA) was measured before and after surgery from hip-to-ankle radiographs taken with patients in three different weight bearing conditions. To find significant factors that affect the alignment differences, several variables including patient demographics, soft tissue laxity, pelvic obliquity, and ground mechanical axis deviation of tibia (calculated by the angle between two lines, tibial anatomical axis and weight-bearing line) were evaluated.

Results: Pre-operatively, mean MA measured on SL stance radiographs was significantly more varus than on DL stance (10.1° ± 2.4° and 8.0° ± 2.6°, respectively, p < 0.001), which was significantly more varus than on supine position (6.6° ± 2.6°, p < 0.001). Meanwhile, in patients with post-operatively valgus corrected knee, MA did not show the same pattern of change as with pre-operative varus knee. Mean MA measured on DL stance radiographs was more valgus than in supine position (-3.0^o ± 2.4^o and -2.6^o ± 3.1^o, p = 0.455), while mean MA on SL stance radiographs (-2.0^o ± 2.1^o) was significantly less valgus than on DL stance (p = 0.002). The ground mechanical axis deviation of tibia showed a significant correlation with MA difference between SL and DL stance radiographs before (β = -0.341, p = 0.045) and after surgery (β = -0.536, p = 0.001).

Conclusion: In pre-operative varus knee, the mean MA on SL stance was changed to more varus than on DL stance, which changed to less valgus in post-operative valgus knee. The understanding in discrepancy of alignment in different weight bearing conditions before and after HTO should be considered for the appropriate realignment of the limb.

Study design: Level II Prospective comparative study.