Supine whole-leg radiography found reliable in prediction of knee osteotomy alignment
Preoperative planning with supine whole-leg radiography can predict postoperative alignment outcomes in medial open-wedge high tibial osteotomy more accurately than standing radiographs, according to published results.
“Adequate correction of the limb alignment, the single most important factor for successful outcomes and avoiding malalignment that can lead to under or overcorrection, can be achieved by accurate preoperative planning,” Kyun-Hi Shin, MD, from the department of orthopedic surgery at Anam Hospital, Korea University College of Medicine, and colleagues wrote. “This study aimed to verify the accuracy of supine non-weight-bearing radiography vs. standing radiography in preoperative planning to determine the predictors of unintended limb alignment correction in medial open-wedge high tibial osteotomy (OWHTO).”
In an institutional study, 59 patients who underwent medial OWHTO for medial osteoarthritis of the knee (n= 66 knees) were retrospectively reviewed for preoperative and postoperative radiologic measurements including mechanical axis deviation (MAD) on whole-leg radiographs (WLRs), predicted postoperative MAD on preoperative supine radiographs and standing WLRs. The surgical target was a final MAD of 62.5%.
Study results showed predicted MAD on preoperative supine had a greater reliability in predicting postoperative MAD. Additionally, postoperative MAD carried a strong correlation with the difference in hip-knee-ankle angle between standing WLRs and supine WLRs which did not differ significantly from the predicted supine MAD. The difference between MAD standing WLRs and MAD supine WLRs was significant in predicting MAD stand correction .
“The predicted MAD supine showed statistically greater reliability in predicting the postoperative MAD compared with the predicted MAD stand,” Shin and colleagues concluded. “Therefore, preoperative planning with supine WLRs accurately predicted postoperative limb alignment and minimized the effect of soft tissues.”
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