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Patient-specific prediction of joint line convergence angle after high tibial osteotomy using a whole-leg radiograph standing on lateral-wedge insole.
Knee Surgery, Sports Traumatology, Arthroscopy ( IF 3.8 ) Pub Date : 2019-12-11 , DOI: 10.1007/s00167-019-05821-8
Yukio Akasaki 1 , Hideki Mizu-Uchi 1 , Satoshi Hamai 1 , Hidetoshi Tsushima 1 , Shinya Kawahara 1 , Tomohiro Horikawa 2 , Yasuharu Nakashima 1
Affiliation  

Abstract

Purpose

To assess the usefulness of a whole-leg radiograph standing on lateral-wedge insole (LWI) for predicting the change in joint line convergence angle (JLCA) before vs. after high tibial osteotomy (HTO).

Methods

Forty knees with medial osteoarthritis underwent open-wedge HTO. Pre-operatively, all patients had whole-leg radiographs taken in three different conditions: supine, standing, and standing on LWI inclined at 20°. A standing whole-leg radiograph was also obtained post-operatively. Radiological measurements including JLCA and percentage of mechanical axis (%MA) were compared. Using pre-operative radiographs, correction angles were calculated with the target %MA at 62.5%. Correlations between the difference in calculated correction angle among the three pre-operative conditions and the change in JLCA before vs. after HTO were assessed.

Results

In the pre-operative standing conditions, the mean JLCA of 3.8° was significantly decreased to 3.2° using LWI, which did not differ from post-operative JLCA of 3.1°. Mean %MA significantly shifted laterally from 20.6 to 24.8% using LWI, and was strongly correlated with the change in JLCA (coefficient, 0.83). Calculated correction angles differed significantly among the three pre-operative conditions. The difference in calculated correction angle between standing with and without LWI was strongly correlated to the change in standing JLCA before vs. after HTO (coefficient, 0.73).

Conclusion

Larger differences in calculated correction angles between pre-operative radiographs standing with and without LWI predicted larger changes in JLCA after HTO. Whole-leg radiograph standing on LWI is a promising modality for correct pre-operative planning considering patient-specific changes in JLCA before vs. after HTO.

Level of evidence

IV.



中文翻译:

高位胫骨截骨术后,使用全腿X线照片站在侧楔鞋垫上,根据患者的具体情况预测关节线会聚角。

摘要

目的

评估站立在外侧楔形鞋垫(LWI)上的全腿X光片对预测胫骨截骨术(HTO)前后关节线会聚角(JLCA)的变化的有用性。

方法

40例内侧骨关节炎患者接受了开放式HTO手术。术前,所有患者均在三种不同情况下拍摄全腿X线照片:仰卧,站立和站立于20°倾斜的LWI。术后还获得了站立的全腿X光片。比较了包括JLCA和机械轴百分比(%MA)在内的放射学测量结果。使用术前X线照片,计算目标MA的校正角为62.5%。评估了三种术前条件之间计算的校正角差异与HTO前后JLCA变化之间的相关性。

结果

在术前站立状态下,使用LWI可使JLCA的平均值从3.8°显着降低至3.2°,与术后JLCA的3.1°无差异。使用LWI的平均%MA明显从20.6侧移到24.8%,并且与JLCA的变化密切相关(系数0.83)。在三种术前条件之间,计算出的校正角差异显着。有和没有LWI站立时之间计算的校正角度差异与HTO前后站立JLCA的变化密切相关(系数0.73)。

结论

在有和没有LWI的情况下,术前X线照片之间计算的校正角的较大差异预示了HTO后JLCA的较大变化。考虑到HTO前后患者JLCA的具体变化,全腿X线站立在LWI上是一种有前途的方式,可以正确地进行术前计划。

证据水平

IV。

更新日期:2020-01-04
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