Skip to main content
SpringerLink
Log in

Clinical usefulness of hindfoot assessment for total knee arthroplasty: persistent post-operative hindfoot pain and alignment in pre-existing severe knee deformity

  • Knee
  • Published:
Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Purpose

The purpose of this study was to compare the hindfoot alignment and symptoms in patients with pre-existing moderate and severe knee deformities after total knee arthroplasty (TKA).

Methods

Eighty knees of 75 patients who underwent TKA for varus osteoarthritis were enrolled retrospectively and evaluated the following pre-operatively and at 2 years post-operatively: the American Orthopaedic Foot and Ankle Society ankle–hindfoot scale (pain and function scores), calcaneal pitch, and naviculocuboid overlap as an indicator of hindfoot alignment. The knees were divided into two groups according to the pre-operative hip–knee–ankle angle defined as the angle between the mechanical axis of the femur and the tibia: group M with genu varus of ≤6°, and group S with varus >6°.

Results

The pain (p = 0.03) and function (p = 0.02) scores improved in group M; however, in group S, these measures did not change. The differences between the groups were not significant concerning the pre-operative calcaneal pitch and naviculocuboid overlap. The post-operative pitch (p = 0.03) and the overlap (p = 0.04) in group M was significantly greater and less than those in group S, respectively. Although the pitch (p < 0.01) and the overlap (p = 0.03) increased in group M, these did not change in group S. Post-operative hindfoot pain and valgus remained in patients in group S.

Conclusions

For pre-existing moderate knee deformities, a relationship was observed between post-operative knee alignment and compensatory hindfoot alignment, whereas patients with severe deformities experienced persistent post-operative hindfoot pain and valgus alignment. It was concluded that evaluations and managements of residual symptoms after TKA including the hindfoot are important. These findings are clinically relevant that perioperative evaluation of the hindfoot should be required in knee surgery. To help improve the outcomes of TKA, clinicians may consider perioperative intervention in the insole and/or physical therapy of the foot and ankle.

Level of evidence

Therapeutic study, Level III.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. Chandler JT, Moskal JT (2004) Evaluation of knee and hindfoot alignment before and after total knee arthroplasty: a prospective analysis. J Arthroplasty 19:211–216

    Article  PubMed  Google Scholar 

  2. Chang CH, Miller F, Schuyler J (2002) Dynamic pedobarograph in evaluation of varus and valgus foot deformities. J Pediatr Orthop 22:813–818

    PubMed  Google Scholar 

  3. Cobey JC (1976) Posterior roentgenogram of the foot. Clin Orthop Relat Res 118:202–207

    Google Scholar 

  4. Colin F, Horn Lang T, Zwicky L, Hintermann B, Knupp M (2014) Subtalar joint configuration on weightbearing CT scan. Foot Ankle Int 35:1057–1062

    Article  PubMed  Google Scholar 

  5. Cooke D, Scudamore A, Li J, Wyss U, Bryant T, Costigan P (1997) Axial lower limb alignment: comparison of knee geometry in normal volunteers and osteoarthritis patients. Osteoarthr Cartil 5:39–47

    Article  CAS  PubMed  Google Scholar 

  6. Davids JR, Gibson TW, Pugh LI (2005) Quantitative segmental analysis of weight-bearing radiographs of the foot and ankle for children: normal alignment. J Pediatr Orthop 25:769–776

    Article  PubMed  Google Scholar 

  7. De Muylder J, Victor J, Cornu O, Kaminski L, Thienpont E (2015) Total knee arthroplasty in patients with substantial deformities using primary knee components. Knee Surg Sports Traumatol Arthrosc 23:3653–3659

    Article  PubMed  Google Scholar 

  8. Desai SS, Shetty GM, Song HR, Lee SH, Kim TY, Hur CY (2007) 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 14:452–457

    Article  PubMed  Google Scholar 

  9. DiGiovanni JE, Smith SD (1976) Normal biomechanics of the adult rearfoot: a radiographic analysis. J Am Podiatry Assoc 66:812–824

    Article  CAS  PubMed  Google Scholar 

  10. Gao F, Ma J, Sun W, Guo W, Li Z, Wang W (2016) The influence of knee malalignment on the ankle alignment in varus and valgus gonarthrosis based on radiographic measurement. Eur J Radiol 85:228–232

    Article  PubMed  Google Scholar 

  11. Guichet JM, Javed A, Russell J, Saleh M (2003) Effect of the foot on the mechanical alignment of the lower limbs. Clin Orthop Relat Res 415:193–201

    Article  Google Scholar 

  12. Gursu S, Sofu H, Verdonk P, Sahin V (2015) 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. doi:10.1007/s00167-015-3883-2

    Google Scholar 

  13. Hara Y, Ikoma K, Arai Y, Ohashi S, Maki M, Kubo T (2015) Alteration of hindfoot alignment after total knee arthroplasty using a novel hindfoot alignment view. J Arthroplasty 30:126–129

    Article  PubMed  Google Scholar 

  14. Haraguchi N, Ota K, Tsunoda N, Seike K, Kanetake Y, Tsutaya A (2015) Weight-bearing-line analysis in supramalleolar osteotomy for varus-type osteoarthritis of the ankle. J Bone Joint Surg Am 97:333–339

    Article  PubMed  Google Scholar 

  15. Insall JN, Dorr LD, Scott RD, Scott WN (1989) Rationale of the knee society clinical rating system. Clin Orthop Relat Res 248:13–14

    Google Scholar 

  16. Ikoma K, Noguchi M, Nagasawa K, Maki M, Kido M, Hara Y, Kubo T (2013) A new radiographic view of the hindfoot. J Foot Ankle Res 6:48

    Article  PubMed  PubMed Central  Google Scholar 

  17. Kitaoka HB, Alexander IH, Adelaar RS, Nunley JA, Myerson MS, Sanders M (1994) Clinical rating systems for the ankle hindfoot, midfoot, hallux and lesser toes. Foot Ankle Int 15:349–353

    Article  CAS  PubMed  Google Scholar 

  18. Kurtz S, Ong K, Lau E, Mowat F, Halpern M (2007) Projections of primary and revision hip and knee arthroplasty in the United States from 2005 to 2030. J Bone Joint Surg Am 89:780–785

    PubMed  Google Scholar 

  19. Landis JR, Koch GG (1977) The measurement of observer agreement for categorical data. Biometrics 33:159–174

    Article  CAS  PubMed  Google Scholar 

  20. Ledoux WR, Shofer JB, Ahroni JH, Smith DG, Sangeorzan BJ, Boyko EJ (2003) Biomechanical differences among pes cavus, neutral aligned, and pes planus feet in subjects with diabetes. Foot Ankle Int 24:845–850

    Article  PubMed  Google Scholar 

  21. Lee KM, Chung CY, Park MS, Lee SH, Cho JH, Choi IH (2010) Reliability and validity of radiographic measurements in hindfoot varus and valgus. J Bone Joint Surg Am 92:2319–2327

    Article  PubMed  Google Scholar 

  22. Liow RY, Walker K, Wajid MA, Bedi G, Lennox CM (2000) The reliability of the American Knee Society Score. Acta Orthop Scand 71:603–608

    Article  CAS  PubMed  Google Scholar 

  23. Luyckx T, Vanhoorebeeck F, Bellemans J (2015) Should we aim at undercorrection when doing a total knee arthroplasty? Knee Surg Sports Traumatol Arthrosc 23:1706–1712

    Article  CAS  PubMed  Google Scholar 

  24. Manning BT, Lewis N, Tzeng TH, Saleh JK, Potty AG, Dennis DA, Mihalko WM, Goodman SB, Saleh KJ (2015) Diagnosis and management of extra-articular causes of pain after total knee arthroplasty. Instr Course Lect 64:381–388

    PubMed  Google Scholar 

  25. Martin A, Quah C, Syme G, Lammin K, Segaren N, Pickering S (2015) Long term survivorship following scorpio total knee replacement. Knee 22:192–196

    Article  CAS  PubMed  Google Scholar 

  26. Meding JB, Keating EM, Ritter MA, Faris PM, Berend ME, Malinzak RA (2005) The planovalgus foot: a harbinger of failure of posterior cruciate-retaining total knee replacement. J Bone Joint Surg Am 87(Suppl 2):59–62

    PubMed  Google Scholar 

  27. Moreland JR, Bassett LW, Hanker GJ (1987) Radiographic analysis of the axial alignment of the lower extremity. J Bone Joint Surg Am 69:745–749

    Article  CAS  PubMed  Google Scholar 

  28. Mullaji A, Shetty GM (2011) Persistent hindfoot valgus causes lateral deviation of weightbearing axis after total knee arthroplasty. Clin Orthop Relat Res 469:1154–1160

    Article  PubMed  Google Scholar 

  29. Niki H, Tatsunami S, Haraguchi N, Aoki T, Okuda R, Suda Y, Takao M, Tanaka Y (2011) Development of the patient-based outcome instrument for the foot and ankle. Part 1: project description and evaluation of the outcome instrument version 1. J Orthop Sci 16:536–555

    Article  PubMed  Google Scholar 

  30. Norton AA, Callaghan JJ, Amendola A, Phisitkul P, Wongsak S, Liu SS, Fruehling-Wall C (2015) Correlation of knee and hindfoot deformities in advanced knee OA: compensatory hindfoot alignment and where it occurs. Clin Orthop Relat Res 473:166–174

    Article  PubMed  Google Scholar 

  31. Okuda R, Kinoshita M, Yasuda T, Jotoku T, Shima H (2008) Proximal metatarsal osteotomy for hallux valgus: comparison of outcome for moderate and severe deformities. Foot Ankle Int 29:664–670

    Article  PubMed  Google Scholar 

  32. Raikin SM, Slenker N, Ratigan B (2008) The association of a varus hindfoot and fracture of the fifth metatarsal metaphyseal-diaphyseal junction. Am J Sports Med 36:1367–1372

    Article  PubMed  Google Scholar 

  33. Seltzer SE, Weissman BN, Braunstein EM, Adams DF, Thomas WH (1985) Computed tomography of the hindfoot with rheumatoid arthritis. Arthritis Rheum 28:1234–1242

    Article  CAS  PubMed  Google Scholar 

  34. Singh J, Sloan JA, Johanson NA (2010) Challenges with health-related quality of life assessment in arthroplasty patients: problems and solutions. J Am Acad Orthop Surg 18:72–82

    Article  PubMed  PubMed Central  Google Scholar 

  35. Takenaka T, Ikoma K, Ohashi S, Arai Y, Hara Y, Ueshima K, Sawada K, Shirai T, Fujiwara H, Kubo T (2015) Hindfoot alignment at one year after total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc. doi:10.1007/s00167-015-3916-x

    PubMed  PubMed Central  Google Scholar 

  36. Tallroth K, Harilainen A, Kerttula L, Sayed R (2008) Ankle osteoarthritis is associated with knee osteoarthritis. Conclusions based on mechanical axis radiographs. Arch Orthop Trauma Surg 128:555–560

    Article  PubMed  Google Scholar 

  37. Tochigi Y, Suh JS, Amendola A, Pedersen DR, Saltzman CL (2006) Ankle alignment on lateral radiographs. Part 1: sensitivity of measures to perturbations of ankle positioning. Foot Ankle Int 27:82–87

    Article  PubMed  PubMed Central  Google Scholar 

  38. Weinstein AM, Rome BN, Reichmann WM, Collins JE, Burbine SA, Thornhill TS, Wright J, Katz JN, Losina E (2013) Estimating the burden of total knee replacement in the United States. J Bone Joint Surg Am 95:385–392

    Article  PubMed  PubMed Central  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Orthopedic Surgery, Osaka Medical College, Takatsuki, Osaka, Japan

    Yoshinori Okamoto, Shuhei Otsuki, Tsuyoshi Jotoku, Mikio Nakajima & Masashi Neo

Authors
  1. Yoshinori Okamoto
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Shuhei Otsuki
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Tsuyoshi Jotoku
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Mikio Nakajima
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Masashi Neo
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Yoshinori Okamoto.

Ethics declarations

Conflict of interest

The authors declare no competing interests.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Okamoto, Y., Otsuki, S., Jotoku, T. et al. 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 25, 2632–2639 (2017). https://doi.org/10.1007/s00167-016-4122-1

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00167-016-4122-1

Keywords

Search

Navigation