title: Radiographic measures of knee alignment in patients with varus gonarthrosis: effect of weightbearing status and associations with dynamic joint load.
abstract: BACKGROUND
  Radiographic measures of lower limb malalignment are used to indicate abnormal loading of the knee and to plan corrective procedures.
  
  
  OBJECTIVE
  Weightbearing status during hip-to-ankle radiographs will significantly affect malalignment measures; malalignment in single-limb standing will be most highly correlated to the external knee adduction moment during gait, a proposed dynamic measure of functional knee joint load.
  
  
  METHODS
  Controlled laboratory study.
  
  
  METHODS
  Mechanical axis angle was measured in 40 patients with varus gonarthrosis from hip-to-ankle radiographs taken with patients in single-limb standing, double-limb standing, and supine positions. Kinematic and kinetic data were collected during walking and used to calculate the peak adduction moment about the knee.
  
  
  RESULTS
  Repeated-measures analysis of variance and Scheffé post hoc tests indicated that mechanical axis angle measured on single-limb standing radiographs (-8.7 degrees +/- 4.0 degrees) was significantly greater than on double-limb standing radiographs (-7.1 degrees +/- 3.8 degrees), which was significantly greater than on supine radiographs (-5.5 degrees +/- 2.8 degrees). The peak knee adduction moment (2.8 +/- 0.8 percentage body weight x height) was only moderately correlated with mechanical axis angle on single-limb standing (r = -0.46), double-limb standing (r = -0.45), and supine (r = -0.43) radiographs.
  
  
  CONCLUSIONS
  Patient position significantly affects frontal plane knee alignment. However, the peak knee adduction moment is only moderately correlated to mechanical axis angle, regardless of weightbearing status.
  
  
  CONCLUSIONS
  These findings are inconsistent with the hypothesis that mechanical axis angle measured in single-limb standing is more representative of dynamic joint load and further highlight the differences between static and dynamic measures. Results also underscore the importance of reporting patient position during radiographs and keeping positions consistent when evaluating patients over time.
authors.affiliation: Wolf Orthopaedic Biomechanics Laboratory, Fowler Kennedy Sport Medicine Clinic, Univerwity of Western Ontario, London, Canada. avspecog@ucalgary.ca
authors.forename: Adrian V
authors.initials: AV
authors.lastname: Specogna
authors.forename: Trevor B
authors.initials: TB
authors.lastname: Birmingham
authors.forename: Michael A
authors.initials: MA
authors.lastname: Hunt
authors.forename: Ian C
authors.initials: IC
authors.lastname: Jones
authors.forename: Thomas R
authors.initials: TR
authors.lastname: Jenkyn
authors.forename: Peter J
authors.initials: PJ
authors.lastname: Fowler
authors.forename: J Robert
authors.initials: JR
authors.lastname: Giffin
mesh_terms: D000328:Adult; D000368:Aged; D000704:Analysis of Variance; D001696:Biomechanical Phenomena; D005260:Female; D005684:Gait / Q000502:physiology; D006801:Humans; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D020370:Osteoarthritis, Knee / Q000000981:diagnostic imaging* / Q000503:physiopathology*; D011187:Posture / Q000502:physiology*; D011859:Radiography; D016474:Weight-Bearing / Q000502:physiology