Department of Orthopaedic Surgery, Chonnam National University Hwasun Hospital, College of Medicine, Chonnam National University, Seoyang, Republic of Korea.
J Bone Joint Surg Am. 2024 May 15;106(10):896-905. doi: 10.2106/JBJS.23.00720. Epub 2024 Feb 22.
This article was updated on May 15, 2024 because of previous errors, which were discovered after the preliminary version of the article was posted online. On page 898, in the section entitled "Materials and Methods," the sentence that had read "The WBL ratio of the knee joint was defined as the point where the GA or MA passed through the width of the tibia and intersected a line from the center of the femoral head to the center of the calcaneus (for the GA) or talus (for the MA), with the medial edge defined as 0% and the lateral edge as 100%." now reads "The WBL ratio of the knee joint was defined as the point where the GA or MA passed through the width of the tibia and intersected a line from the center of the femoral head to the lowest point of the calcaneus (for the GA) or the center of the talus (for the MA), with the medial edge defined as 0% and the lateral edge as 100%." Likewise, in the legend for Figure 3 on page 899, the sentence that had read "Depiction of the ground mechanical axis (GA), defined as the line (represented by the solid red line) from the center of the femoral head to the ground reaction point at the center of the calcaneus, passing lateral to the traditional mechanical axis (MA; represented by the dashed red line)." now reads "Depiction of the ground mechanical axis (GA), defined as the line (represented by the solid red line) from the center of the femoral head to the ground reaction point at the lowest point of the calcaneus, passing lateral to the traditional mechanical axis (MA; represented by the dashed red line)." Finally, on page 903, "HKA" was changed to "HKA angle" in Table III.
The hip-to-calcaneus axis, previously known as the ground mechanical axis (GA), ideally passes through the center of the knee joint in the native knee. The aim of this study was to elucidate, with use of hip-to-calcaneus radiographs, changes in knee and hindfoot alignment and changes in outcomes following high tibial osteotomy (HTO).
We reviewed the records for 128 patients who underwent HTO between 2018 and 2020. Patients were stratified into 2 groups, a hindfoot valgus group (n = 94) and a hindfoot varus group (n = 34), on the basis of their preoperative hindfoot alignment. The hindfoot alignment was evaluated with use of the hindfoot alignment angle (HAA). To evaluate lower-limb alignment, full-length standing posteroanterior hip-to-calcaneus radiographs were utilized to measure 4 radiographic parameters preoperatively and 2 years postoperatively: the hip-knee-ankle (HKA) angle, hip-knee-calcaneus (HKC) angle, and the weight-bearing line (WBL) ratios of the mechanical axis (MA) and GA.
The mean HAA improved significantly from 5.1° valgus preoperatively to 1.9° valgus postoperatively in the hindfoot valgus group (p < 0.001). In contrast, in the hindfoot varus group, the HAA showed no meaningful improvement in the coronal alignment of the hindfoot following HTO (p = 0.236). The postoperative mean HKC angle in the hindfoot varus group was 2° more varus than that in the hindfoot valgus group (1.0° versus 3.0°; p = 0.001), and the GA in the hindfoot varus group passed across the knee 8.0% more medially than that in the hindfoot valgus group (55% versus 63% from the most medial to the most lateral part of the tibial plateau). The hindfoot varus group had worse postoperative clinical outcomes than the hindfoot valgus group in terms of the mean Knee injury and Osteoarthritis Outcome Score for pain and American Orthopaedic Foot & Ankle Society Ankle-Hindfoot Score.
Although our findings did not provide sufficient evidence to establish clinically relevant differences between the groups, they indicated that the group with a preoperative fixed hindfoot varus deformity had a higher rate of undercorrection and worse clinical outcomes, especially pain, following HTO. Therefore, modification of the procedure to shift the GA more laterally may be required for these patients.
Prognostic Level III . See Instructions for Authors for a complete description of levels of evidence.
本文于 2024 年 5 月 15 日进行了更新，原因是初步版本在线发布后发现了之前的错误。在第 898 页，题为“材料和方法”的部分中，原句为“膝关节 WBL 比定义为 GA 或 MA 通过胫骨宽度并与从股骨头中心到跟骨中心（GA）或距骨中心（MA）的线相交的点，内侧边缘定义为 0%，外侧边缘为 100%。”现在改为“膝关节 WBL 比定义为 GA 或 MA 通过胫骨宽度并与从股骨头中心到跟骨最低处（GA）或距骨中心（MA）的线相交的点，内侧边缘定义为 0%，外侧边缘为 100%。”同样，在第 899 页的图 3 图例中，原句为“描绘地面机械轴（GA），定义为从股骨头中心到跟骨反应点的线（由实线表示），穿过传统机械轴（MA；由虚线表示）的外侧。”现在改为“描绘地面机械轴（GA），定义为从股骨头中心到跟骨最低处的线（由实线表示），穿过传统机械轴（MA；由虚线表示）的外侧。”最后，在第 903 页，表 III 中“HKA”改为“HKA 角”。
髋关节跟骨轴，以前称为地面机械轴（GA），在正常膝关节中理想情况下穿过膝关节中心。本研究的目的是通过髋关节跟骨射线照片，阐明在接受胫骨高位截骨术（HTO）后膝关节和后足对线的变化以及结果的变化。
我们回顾了 2018 年至 2020 年期间接受 HTO 的 128 名患者的记录。根据术前后足对线，患者分为两组，后足外翻组（n=94）和后足内翻组（n=34）。后足对线采用后足对线角（HAA）评估。为了评估下肢对线，使用全长站立前后髋关节跟骨射线照片测量术前和术后 2 年的 4 个放射学参数：髋关节-膝关节-踝关节（HKA）角、髋关节-膝关节-跟骨（HKC）角以及机械轴（MA）和 GA 的承重线（WBL）比。
在后足外翻组，HAA 从术前的 5.1°外翻显著改善至术后的 1.9°外翻（p<0.001）。相比之下，在后足内翻组中，HTO 后后足冠状位对线的 HAA 没有明显改善（p=0.236）。后足内翻组术后平均 HKC 角比后足外翻组更内翻 2°（1.0°对 3.0°；p=0.001），并且后足内翻组 GA 穿过膝关节内侧比后足外翻组多 8.0%（55%对 63%，从胫骨平台最内侧到最外侧部分）。在术后疼痛和美国矫形足踝协会踝关节-后足评分方面，后足内翻组的临床结果比后足外翻组差。
尽管我们的研究结果没有提供足够的证据来确定两组之间存在临床相关差异，但它们表明术前存在固定的后足内翻畸形的组有更高的矫正不足率和更差的临床结果，尤其是疼痛，在 HTO 后。因此，可能需要修改手术以将 GA 更向外转移，以适应这些患者。
预后 III 级。有关证据水平的完整描述，请参见作者说明。
