BMC musculoskeletal disorders · 2026
Hindfoot realignment after coronal plane correction: a novel radiographic angle on long-leg standing radiograph.
СтатьяНазвание и аннотация: Перевод в очереди
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Kim Woo Sub, Lee Kyoung Min, Sung Ki Hyuk, Sim Youngwook, Lee Seung Yeol
Аннотация
BACKGROUND: Accurate assessment of hindfoot alignment is important when evaluating distal compensation after correction of varus knee osteoarthritis. Dedicated hindfoot imaging is not routinely obtained with standard long-leg radiographs. This study developed and validated a novel hindfoot alignment angle measurable on routine patella-facing long-leg standing radiographs.
METHODS: This retrospective cohort study included 170 operated lower limbs from adult patients who underwent high tibial osteotomy or total knee arthroplasty for varus knee osteoarthritis. Preoperative and postoperative patella-facing long-leg standing radiographs were analyzed. Interobserver reliability and construct validity were assessed in a 36-case subset with complete long-leg, foot, and Saltzman-view radiographs. Intraclass correlation coefficients were used for reliability. Pearson correlations, Shapiro-Wilk normality tests, Spearman sensitivity analyses, and Bland-Altman agreement analysis were performed.
RESULTS: The novel hindfoot alignment angle demonstrated excellent average-measure interobserver reliability (ICC = 0.905; 95% CI, 0.835-0.948). It showed a moderate correlation with the Saltzman-view hindfoot alignment angle (r = 0.443, P = 0.007) and a weak correlation with the lateral talus-first metatarsal angle (r = 0.331, P = 0.048). Bland-Altman analysis showed a systematic positive bias of 7.96° for the novel angle relative to the Saltzman-view angle, with 95% limits of agreement from - 1.05° to 16.98°. In the overall cohort, the hip-knee-ankle angle changed from 8.02 ± 3.08° to - 0.74 ± 2.95° (P < 0.001), and the novel hindfoot alignment angle changed from 9.53 ± 3.85° to 14.09 ± 3.83° (P < 0.001). With change defined as postoperative minus preoperative value, change in hip-knee-ankle angle correlated mildly with change in the novel hindfoot alignment angle (r = - 0.301, P < 0.001).
CONCLUSION: The novel hindfoot alignment angle is a reproducible radiographic parameter that can be measured on patella-facing long-leg standing radiographs and is moderately associated with Saltzman-view hindfoot alignment. The Bland-Altman findings indicate that the novel angle should not be used interchangeably with the Saltzman-view angle, but it may serve as a practical adjunct for assessing hindfoot alignment when long-leg radiographs are already being obtained.
LEVEL OF EVIDENCE: Level III, retrospective cohort study.
METHODS: This retrospective cohort study included 170 operated lower limbs from adult patients who underwent high tibial osteotomy or total knee arthroplasty for varus knee osteoarthritis. Preoperative and postoperative patella-facing long-leg standing radiographs were analyzed. Interobserver reliability and construct validity were assessed in a 36-case subset with complete long-leg, foot, and Saltzman-view radiographs. Intraclass correlation coefficients were used for reliability. Pearson correlations, Shapiro-Wilk normality tests, Spearman sensitivity analyses, and Bland-Altman agreement analysis were performed.
RESULTS: The novel hindfoot alignment angle demonstrated excellent average-measure interobserver reliability (ICC = 0.905; 95% CI, 0.835-0.948). It showed a moderate correlation with the Saltzman-view hindfoot alignment angle (r = 0.443, P = 0.007) and a weak correlation with the lateral talus-first metatarsal angle (r = 0.331, P = 0.048). Bland-Altman analysis showed a systematic positive bias of 7.96° for the novel angle relative to the Saltzman-view angle, with 95% limits of agreement from - 1.05° to 16.98°. In the overall cohort, the hip-knee-ankle angle changed from 8.02 ± 3.08° to - 0.74 ± 2.95° (P < 0.001), and the novel hindfoot alignment angle changed from 9.53 ± 3.85° to 14.09 ± 3.83° (P < 0.001). With change defined as postoperative minus preoperative value, change in hip-knee-ankle angle correlated mildly with change in the novel hindfoot alignment angle (r = - 0.301, P < 0.001).
CONCLUSION: The novel hindfoot alignment angle is a reproducible radiographic parameter that can be measured on patella-facing long-leg standing radiographs and is moderately associated with Saltzman-view hindfoot alignment. The Bland-Altman findings indicate that the novel angle should not be used interchangeably with the Saltzman-view angle, but it may serve as a practical adjunct for assessing hindfoot alignment when long-leg radiographs are already being obtained.
LEVEL OF EVIDENCE: Level III, retrospective cohort study.