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J Knee Surg 2022; 35(01): 054-060
DOI: 10.1055/s-0040-1712945
Original Article

HKA Angle—A Reliable Planning Parameter for High Tibial Osteotomy: A Theoretical Analysis Using Standing Whole-Leg Radiographs

Xu Jiang‡   *
1   Shanghai Key Laboratory of Orthopedic Implants, Department of Orthopaedic Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, People's Republic of China
,
Kai Xie‡   *
1   Shanghai Key Laboratory of Orthopedic Implants, Department of Orthopaedic Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, People's Republic of China
,
Xuequan Han‡   *
1   Shanghai Key Laboratory of Orthopedic Implants, Department of Orthopaedic Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, People's Republic of China
,
Songtao Ai
2   Department of Radiology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, People's Republic of China
,
Haishan Wu
1   Shanghai Key Laboratory of Orthopedic Implants, Department of Orthopaedic Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, People's Republic of China
,
Liao Wang
1   Shanghai Key Laboratory of Orthopedic Implants, Department of Orthopaedic Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, People's Republic of China
,
Mengning Yan
1   Shanghai Key Laboratory of Orthopedic Implants, Department of Orthopaedic Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, People's Republic of China
› Author Affiliations Funding This work was supported by the Clinical Research Program of 9th People's Hospital affiliated with Shanghai Jiao Tong University School of Medicine (Grant No. JYLJ025); the Project of the Shanghai Collaborative Innovation Center for Translational Medicine (Grant No. TM201814); Technology and Innovation Fund (Chuang Ke) of the Ninth People's Hospital Shanghai Jiao Tong University School of Medicine (Grant No. CK2018011);3D Snowball Project of Shanghai Jiao Tong University School of Medicine (Grant No. GXQ201804); National Natural Science Foundation of China (81772425); the Science and Technology Commission of Shanghai Municipality (16441908700); Shanghai Jiao Tong University (YG2016MS11).
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Abstract

High tibial osteotomy (HTO) is a recognized treatment for early-stage medial compartment knee osteoarthritis. Preoperative planning with standing whole-leg radiographs (WLRs) is essential for ensuring optimal postoperative alignment. The primary purpose of this study is to investigate the theoretical accuracy of the wedge opening required for two different preoperative planning parameters in open-wedge HTO. The second purpose is to theoretically determine which parameter is superior. Preoperative planning for HTO was performed with standing WLRs for 39 knees with isolated medial osteoarthritis. The Miniaci preoperative planning method was applied to correct the hip-knee-ankle (HKA) angle to 3to 6 degrees of valgus and the weight-bearing line (WBL) percentage within 60 to 70% of the width of the tibial plateau. To ensure that the HKA angle was between 3 and 6 degrees of valgus, the required accuracy window for the Miniaci angle was 3.25 ± 0.03 degrees (range, 3.20–3.30°). To ensure that the WBL percentage was between 60 and 70%, the accuracy window required for the Miniaci angle was 2.35 ± 0.13 degrees (range, 2.10–2.65°). This study suggests that to correct the HKA angle and the WBL percentage within the target range on two-dimensional WLRs, the Miniaci angle must be controlled to an accuracy of ± 1.63 and ± 1.18 degrees, respectively. Theoretically, the HKA angle is highly suitable as a preoperative planning parameter for HTO with a large permissible error and a small variability in the degree of change in the Miniaci angle (ΔMiniaci).

Keywords

osteoarthritis - high tibial osteotomy - accuracy - preoperative planning - alignment parameter

* These authors contributed equally to this work.


Ethical Approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. For this type of study, formal consent is not required.


Authors’ Contributions

All authors contributed to the study conception and design. Material preparation, data collection, and analysis were performed by X.J., K.X., and X.H. The first draft of the manuscript was written by X.J. and K.X., and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.




Publication History

Received: 02 January 2020

Accepted: 14 April 2020

Article published online:
16 June 2020

© 2020. Thieme. All rights reserved.

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