Advertisement

Evaluation of hindfoot and knee alignment by the hip-to-calcaneus view in patients with knee osteoarthritis and healthy individuals

Published:September 07, 2022DOI:https://doi.org/10.1016/j.knee.2022.08.014

      Highlights

      • Hindfoot assessment with the hip-to-calcaneus view is high intra- and interobserver reliabilities.
      • The use of the hip-to-calcaneus view allows the evaluation of both the knee and the hindfoot alignment.
      • Using the hip-to-calcaneus view in total knee arthroplasty planning can reduce the cost of radiography and the patient’s exposure to radiation.

      Abstract

      Background

      Hip-to-calcaneus (HC) view is a whole-leg standing view that can visualize the hindfoot in detail. The aim of this study was to investigate the reliability and validity of tibiocalcaneal angle in HC view (H-TCA) by comparing it with that in long axial view (L-TCA). We also verified whether periarticular knee alignment parameters, measured conventionally in whole-leg standing radiography, could be measured in HC view.

      Method

      Sixty healthy volunteers and 61 patients with medial knee osteoarthritis were included. H-TCA was measured by two examiners in the healthy group, and intra-class correlation coefficients (ICCs) were evaluated. H-TCA and L-TCA were then measured in the healthy and osteoarthritis groups and correlated. Finally, we measured hip–knee–ankle angle, mechanical axis deviation ratio, mechanical lateral distal femoral angle, medial proximal tibial angle, and joint-line convergence angle in HC view and conventional whole-leg standing radiography to evaluate statistical differences and correlations.

      Results

      The intra-observer and inter-observer ICCs were 0.86 and 0.76, respectively. Correlation coefficients (r) between H-TCA and L-TCA were r = 0.87 in healthy group and r = 0.81 in osteoarthritis group, indicating a strong positive correlation in both groups. There was no significant difference in periarticular knee alignment parameters between HC view and conventional whole-leg radiography.

      Conclusions

      Hindfoot evaluation in HC view showed high intra-observer and inter-observer reliabilities and strong positive correlation with TCA in long axial view. By using HC view before knee surgery, such as total knee arthroplasty, other necessary alignments can be evaluated simultaneously.

      Keywords

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to The Knee
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Blazek K.
        • Favre J.
        • Asay J.
        • Erhart-Hledik J.
        • Andriacchi T.
        Age and obesity alter the relationship between femoral articular cartilage thickness and ambulatory loads in individuals without osteoarthritis.
        J Orthop Res. 2014; 32: 394-402https://doi.org/10.1002/jor.22530
        • Prieto-Alhambra D.
        • Judge A.
        • Javaid M.K.
        • Cooper C.
        • Diez-Perez A.
        • Arden N.K.
        Incidence and risk factors for clinically diagnosed knee, hip and hand osteoarthritis: Influences of age, gender and osteoarthritis affecting other joints.
        Ann Rheum Dis. 2014; 73: 1659-1664https://doi.org/10.1136/annrheumdis-2013-203355
        • Gursu S.
        • Sofu H.
        • Verdonk P.
        • Sahin V.
        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. 2016; 24: 2470-2475https://doi.org/10.1007/s00167-015-3883-2
        • Harding P.
        • Holland A.E.
        • Delany C.
        • Hinman R.S.
        Do activity levels increase after total hip and knee arthroplasty?.
        Clin Orthop Relat Res. 2014; 472: 1502-1511https://doi.org/10.1007/s11999-013-3427-3
        • Chandler J.T.
        • Moskal J.T.
        Evaluation of knee and hindfoot alignment before and after total knee arthroplasty.
        J Arthroplasty. 2004; 19: 211-216https://doi.org/10.1016/j.arth.2003.09.007
        • Hara Y.
        • Ikoma K.
        • Arai Y.
        • Ohashi S.
        • Maki M.
        • Kubo T.
        Alteration of hindfoot alignment after total knee arthroplasty using a novel hindfoot alignment view.
        J Arthroplasty. 2015; 30: 126-129https://doi.org/10.1016/j.arth.2014.07.026
        • Mullaji A.
        • Shetty G.M.
        Persistent hindfoot valgus causes lateral deviation of weightbearing axis after total knee arthroplasty.
        Clin Orthop Relat Res. 2011; 469: 1154-1160https://doi.org/10.1007/s11999-010-1703-z
        • Okamoto Y.
        • Otsuki S.
        • Jotoku T.
        • Nakajima M.
        • Neo M.
        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. 2017; 25: 2632-2639https://doi.org/10.1007/s00167-016-4122-1
        • Mansur H.
        • Rocha F.A.
        • Garcia P.B.L.
        • de Alencar F.H.U.
        • Guilme P.
        • de Castro I.M.
        Alteration of hindfoot axis after total knee arthroplasty.
        J Arthroplasty. 2019; 34: 2376-2382https://doi.org/10.1016/j.arth.2019.05.029
        • Haraguchi N.
        • Ota K.
        • Tsunoda N.
        • Seike K.
        • Kanetake Y.
        • Tsutaya A.
        Weight-bearing-line analysis in supramalleolar osteotomy for varus-type osteoarthritis of the ankle.
        J Bone Joint Surg. 2015; 97: 333-339https://doi.org/10.2106/JBJS.M.01327
        • Kikuchi N.
        • Kanamori A.
        • Kadone H.
        • Okuno K.
        • Hyodo K.
        • Yamazaki M.
        Radiographic analysis using the hip-to-calcaneus line and its association with lower limb joint kinetics in varus knee osteoarthritis.
        Knee. 2022; 35: 142-148
        • Lamm B.M.
        • Mendicino R.W.
        • Catanzariti A.R.
        • Hillstrom H.J.
        Static rearfoot alignment: a comparison of clinical and radiographic measures.
        J Am Podiatr Med Assoc. 2005; 95: 26-33https://doi.org/10.7547/0950026
        • Paley D.
        Principles of Deformity Correction.
        Springer Berlin Heidelberg, Berlin, Heidelberg2002
        • Bernasconi A.
        • Najefi A.A.
        • Goldberg A.J.
        Comparison of mechanical axis of the limb versus anatomical axis of the tibia for assessment of tibiotalar alignment in end-stage ankle arthritis.
        Foot Ankle Int. 2021; 42: 616-623https://doi.org/10.1177/1071100720972664
        • Tanaka Y.
        • Takakura Y.
        • Hayashi K.
        • Taniguchi A.
        • Kumai T.
        • Sugimoto K.
        Low tibial osteotomy for varus-type osteoarthritis of the ankle.
        J Bone Joint Surg Br. 2006; 88: 909-913https://doi.org/10.1302/0301-620X.88B7.17325
        • Neri T.
        • Barthelemy R.
        • Tourné Y.
        Radiologic analysis of hindfoot alignment: Comparison of Méary, long axial, and hindfoot alignment views.
        Orthop Traumatol Surg Res. 2017; 103: 1211-1216https://doi.org/10.1016/j.otsr.2017.08.014
        • Reilingh M.L.
        • Beimers L.
        • Tuijthof G.J.
        • Stufkens S.A.
        • Maas M.
        • van Dijk C.N.
        Measuring hindfoot alignment radiographically: the long axial view is more reliable than the hindfoot alignment view.
        Skeletal Radiol. 2010; 39: 1103-1108https://doi.org/10.1007/s00256-009-0857-9
        • Robinson I.
        • Dyson R.
        • Halson-Brown S.
        Reliability of clinical and radiographic measurement of rearfoot alignment in a patient population.
        Foot. 2001; 11: 2-9https://doi.org/10.1054/foot.2000.0645
        • Sheehy L.
        • Felson D.
        • Zhang Y.
        • Niu J.
        • Lam Y.-M.
        • Segal N.
        • et al.
        Does measurement of the anatomic axis consistently predict hip-knee-ankle angle (HKA) for knee alignment studies in osteoarthritis? Analysis of long limb radiographs from the multicenter osteoarthritis (MOST) study.
        Osteoarthr Cartil. 2011; 19: 58-64
        • Takeuchi R.
        • Ishikawa H.
        • Aratake M.
        • Bito H.
        • Saito I.
        • Kumagai K.
        • et al.
        Medial opening wedge high tibial osteotomy with early full weight bearing.
        Arthroscopy. 2009; 25: 46-53
        • Landis J.R.
        • Koch G.G.
        The measurement of observer agreement for categorical data.
        Biometrics. 1977; 33: 159-174https://doi.org/10.2307/2529310
        • Walter S.D.
        • Eliasziw M.
        • Donner A.
        Sample size and optimal designs for reliability studies.
        Stat Med. 1998; 17: 101-110https://doi.org/10.1002/(sici)1097-0258(19980115)17:1<101::aid-sim727>3.0.co;2-e
        • Cobey J.C.
        Posterior roentgenogram of the foot.
        Clin Orthop Relat Res. 1976; 118: 202-207
        • Ikoma K.
        • Noguchi M.
        • Nagasawa K.
        • Maki M.
        • Kido M.
        • Hara Y.
        • et al.
        A new radiographic view of the hindfoot.
        J Foot Ankle Res. 2013; 6: 48https://doi.org/10.1186/1757-1146-6-48
        • Dagneaux L.
        • Moroney P.
        • Maestro M.
        Reliability of hindfoot alignment measurements from standard radiographs using the methods of Meary and Saltzman.
        Foot Ankle Surg. 2019; 25: 237-241https://doi.org/10.1016/j.fas.2017.10.018
        • Mansur H.
        • Rocha F.A.
        • Sousa P.G.T.
        • Castro I.M.
        Relationship between the knee and hindfoot axes in patients with severe knee osteoarthritis.
        Acta Ortop Bras. 2020; 28: 229-232https://doi.org/10.1590/1413-785220202805231351
        • Kim S.-G.
        • Choi G.W.
        • Kim H.K.
        • Kim J.G.
        Hip-to-calcaneus alignment differs from hip-to-talus alignment in patients with genu varum deformity.
        Knee Surg Sports Traumatol Arthrosc. 2021; 29: 975-981
        • Norton A.A.
        • Callaghan J.J.
        • Amendola A.
        • Phisitkul P.
        • Wongsak S.
        • Liu S.S.
        • et al.
        Correlation of knee and hindfoot deformities in advanced knee OA: Compensatory hindfoot alignment and where it occurs.
        Clin Orthop Relat Res. 2015; 473: 166-174https://doi.org/10.1007/s11999-014-3801-9
        • Méary R.
        • Filipe G.
        • Aubriot J.H.
        • Tomeno B.
        Functional study of a double arthrodesis of the foot.
        Rev Chir Orthop Reparatrice Appar Mot. 1977; 63: 345-359
        • Saltzman C.L.
        • el-Khoury G.Y.
        The hindfoot alignment view.
        Foot Ankle Int. 1995; 16: 572-576https://doi.org/10.1177/107110079501600911
        • Buck F.M.
        • Hoffmann A.
        • Mamisch-Saupe N.
        • Espinosa N.
        • Resnick D.
        • Hodler J.
        Hindfoot alignment measurements: rotation-stability of measurement techniques on hindfoot alignment view and long axial view radiographs.
        AJR Am J Roentgenol. 2011; 197: 578-582https://doi.org/10.2214/AJR.10.5728
        • Choi J.Y.
        • Lee H.I.
        • Kim J.H.
        • Suh J.S.
        Radiographic measurements on hindfoot alignment view in 1128 asymptomatic subjects.
        Foot Ankle Surg. 2021; 27: 366-370https://doi.org/10.1016/j.fas.2020.04.010
        • Gutteck N.
        • Schilde S.
        • Delank K.S.
        • Arbab D.
        Ätiologie, pathogenese, klinik, diagnostik und konservative therapie des adulten erworbenen plattfußesEtiology, pathogenesis, clinical features, diagnostics and conservative treatment of adult flatfoot.
        Der Orthopäde. 2020; 49: 942-953
        • Hadi H.
        • Jabal Ameli M.
        • Bagherifard A.
        • Behrouzi A.
        • Safi F.
        • Azimi A.
        • et al.
        The effect of total knee arthroplasty on hindfoot alignment in patients with severe genu varum and genu valgum.
        Arch Bone Jt Surg. 2020; 8: 413-419https://doi.org/10.22038/abjs.2019.33735.1883
        • Wang J.H.
        • Shin J.M.
        • Kim H.H.
        • Kang S.-H.
        • Lee B.H.
        Discrepancy of alignment in different weight bearing conditions before and after high tibial osteotomy.
        Int Orthop. 2017; 41: 85-92
        • Na Y.G.
        • Chang M.J.
        • Eom S.H.
        • Kim S.J.
        • Park S.C.
        • Kim T.K.
        Coronal alignment on the single-limb stance radiograph in posterolateral rotatory instability, osteoarthritis and healthy knees.
        Knee. 2017; 24: 63-69
        • Desai S.S.
        • Shetty G.M.
        • Song H.-R.
        • Lee S.H.
        • Kim T.Y.
        • Hur C.Y.
        Effect of foot deformity on conventional mechanical axis deviation and ground mechanical axis deviation during single leg stance and two leg stance in genu varum.
        Knee. 2007; 14: 452-457https://doi.org/10.1016/j.knee.2007.07.009