Effects of rotation on measurement of lower limb alignment for knee osteotomy

Hideo Kawakami*, Nobuhiko Sugano, Kazuo Yonenobu, Hideki Yoshikawa, Takahiro Ochi, Asaki Hattori, Naoki Suzuki

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

93 Citations (Scopus)


The purposes of this study were to clarify the effects of rotation on two-dimensional measurement of lower limb alignment for knee osteotomy using a three-dimensional method and to determine whether this 3-D simulation method could help with planning of knee osteotomy. We developed computer software to calculate femorotibial angle (FTA) and hip-knee-ankle angle (HKA) and simulate knee osteotomy from a CT-based 3-D bone model of the lower limb. Lower limb rotation on anteroposterior long-standing radiographs was measured by superimposing the 3-D bone models. Changes in alignment with limb rotation were calculated using the software. FTA after virtual closed-wedged osteotomy was measured for a hypothetical case of a rotation error of the osteotomy plane in reattaching the proximal cutting surface to the distal cutting surface. For 31 varus knees in 20 patients with medial compartment arthritis, the mean rotation angle, relative to the epicondylar axis, with variable limb position was 7.4 ± 3.9° of internal rotation (mean ± SD), ranging from 8° of external rotation to 14° of internal rotation; the mean changes in FTA and HKA were 3.5 ± 2.2° (range, 0.4-8.6) and 1.6 ± 1.3° (range, 0.2-4.9), respectively. The FTA "flexion angle" (lateral view alignment from neutral AP) and the absolute HKA "flexion angle" correlated with the change in FTA and HKA with limb rotation, respectively (FTA, R=0.999; HKA, R=0.993). The mean change in FTA after virtual closed-wedged osteotomy was 3.2° for internal and external 10° rotation errors in reattaching the osteotomy plane. Rotation may affect measurement of lower limb alignment for knee osteotomy, and 3-D methods are preferable for surgical planning.

Original languageEnglish
Pages (from-to)1248-1253
Number of pages6
JournalJournal of Orthopaedic Research
Issue number6
Publication statusPublished - 2004 Nov
Externally publishedYes


  • 3-D CT simulation
  • High tibial osteotomy
  • Lower limb alignment

ASJC Scopus subject areas

  • Orthopedics and Sports Medicine


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