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Alignment and stability are two key factors for success in total knee arthroplasty (TKA). Several techniques have been advocated, the two best known being measured resection and tensioned gaps.
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Dogma and fuzzy wording have cast an obscure shadow on the dualistic discussion between proponents of both techniques.
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This review is an attempt to clarify definitions, analyse the flaws and pitfalls in the different techniques and make some suggestions for improvement.
Cite this article: EFORT Open Rev 2017;2. DOI: 10.1302/2058-5241.2.170001. Originally published online at www.efortopenreviews.org
Department of Orthopaedics, University Hospital of Ghent, Ghent, Belgium
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Department of Electromechanics, InViLab research group, University of Antwerp, Antwerp, Belgium
Department of Trauma and Orthopedics, Addenbrooke’s Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
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Purpose
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Emerging reports suggest an important involvement of the ankle/hindfoot alignment in the outcome of knee osteotomy; however, a comprehensive overview is currently not available. Therefore, we systematically reviewed all studies investigating biomechanical and clinical outcomes related to the ankle/hindfoot following knee osteotomies.
Methods
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A systematic literature search was conducted on PubMed, Web of Science, EMBASE and Cochrane Library according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and registered on international prospective register of systematic reviews (PROSPERO) (CRD42021277189). Combining knee osteotomy and ankle/hindfoot alignment, all biomechanical and clinical studies were included. Studies investigating knee osteotomy in conjunction with total knee arthroplasty and case reports were excluded. The QUality Appraisal for Cadaveric Studies (QUACS) scale and Methodological Index for Non-Randomized Studies (MINORS) scores were used for quality assessment.
Results
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Out of 3554 hits, 18 studies were confirmed eligible, including 770 subjects. The minority of studies (n = 3) assessed both high tibial- and distal femoral osteotomy. Following knee osteotomy, the mean tibiotalar contact pressure decreased (n = 4) except in the presence of a rigid subtalar joint (n = 1) or a talar tilt deformity (n = 1). Patient symptoms and/or radiographic alignment at the level of the ankle/hindfoot improved after knee osteotomy (n = 13). However, factors interfering with an optimal outcome were a small preoperative lateral distal tibia angle, a small hip–knee–ankle axis (HKA) angle, a large HKA correction (>14.5°) and a preexistent hindfoot deformity (>15.9°).
Conclusions
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Osteotomies to correct knee deformity alter biomechanical and clinical outcomes at the level of the ankle/hindfoot. In general, these changes were beneficial, but several parameters were identified in association with deterioration of ankle/hindfoot symptoms following knee osteotomy.
