Joint-line obliquity angle is significantly affected by hip abduction and adduction: A simulated analysis

Abstract

Purpose: Different methods for quantifying joint-line obliquity (JLO) have been described, including joint-line obliquity angle (JLOA), Mikulicz joint-line angle (MJLA) and medial proximal tibial angle (MPTA). The goal of the present study was to quantify the variation of JLOA based on the position of the hip. The hypothesis of our study is that JLO is significantly influenced by the abduction/adduction of the limb, unlike MJLA.

Methods: One hundred long-leg-weightbearing X-rays were used. At time 0 and after 30 days, two observers performed different measurements, including (1) distance between pubic symphysis and center of the femoral head, (2) distance between center of the femoral head and center of the ankle joint, (3) distance between center of the ankle and medial malleolus, (4) hip-knee-ankle angle, (5) MPTA, (6) lateral distal femoral angle, (7) joint-line congruency angle, (8) JLOA, (9) MJL and (10) angle between Mikulicz line and line perpendicular to the ground. The changes of the JLOA based on the position of the hip (abducted, neutral, bipedal stance adduction and monopodal stance adduction) were calculated with trigonometric formulas and with simulation on an orthopaedic planning digital software.

Results: The JLOA change between adducted and abducted positions was on average 12.8° (SD 0.9 mm). The MJL did not vary significantly based on hip position.

Conclusions: The adduction/abduction of the lower limb has a considerable impact on JLOA. Methods like MJLA which are not affected by hip position should be preferred for JLO evaluation.

Level of evidence: Level III, diagnostic study.

Keywords: femoro‐tibial morphology; hip position; knee alignment; knee joint‐line obliquity (JLO); preoperative measurement.