title: The value of valgus stress radiographs in the workup for medial unicompartmental arthritis.
abstract: BACKGROUND
  High tibial osteotomy and unicompartmental knee arthroplasty are surgical treatment options for unicompartmental knee arthritis; these procedures are indicated for patients who do not have severe arthritis in the lateral compartment. Valgus stress radiographs sometimes are used to make this evaluation, but this test has not been critically evaluated.
  
  
  OBJECTIVE
  We sought to determine (1) whether valgus stress radiographs help to evaluate the integrity of the cartilage in the lateral compartment in patients undergoing TKA for noninflammatory arthritis, and (2) whether valgus stress radiographs can identify patients whose varus deformity is correctable.
  
  
  METHODS
  We reviewed preoperative hip-to-ankle standing radiographs, AP standing radiographs, and valgus stress radiographs of 84 patients (91 knees) who underwent TKA for varus knee arthritis between July 2010 and January 2012. Valgus stress radiographs were obtained with the patient supine with the knee 20° flexed and a firm manual valgus force was applied through the knee. On valgus stress radiographs, the lateral compartment joint space width and the corrected mechanical alignment were measured. Intraoperative cartilage assessment (Outerbridge grade) was compared with lateral compartment joint space width. Knees with mechanical leg alignment of 3° varus to 3° valgus on valgus stress radiographs were considered correctable deformities.
  
  
  RESULTS
  The lateral compartment joint space width on valgus stress radiographs did not correlate with the intraoperative Outerbridge grading of the lateral compartment cartilage (rs = -0.154; p = 0.146). The majority of knees (93%; 55 of 59) with 10° or less mechanical varus on hip-to-ankle standing radiographs were correctable within the range of 3° varus to 3° valgus.
  
  
  CONCLUSIONS
  Valgus stress radiographs provided no added benefit to the radiographic assessment of the lateral compartment cartilage and regarding the correctability of the varus deformity.
authors.affiliation: Adult Reconstruction & Joint Replacement Division, Hospital for Special Surgery, 535 East 70th Street, New York, NY, 10021, USA.
authors.forename: Wenzel
authors.initials: W
authors.lastname: Waldstein
authors.forename: Jad
authors.initials: J
authors.lastname: Bou Monsef
authors.forename: Johannes
authors.initials: J
authors.lastname: Buckup
authors.forename: Friedrich
authors.initials: F
authors.lastname: Boettner
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D019645:Arthroplasty, Replacement, Knee / Q000379:methods*; D002356:Cartilage / Q000000981:diagnostic imaging / Q000601:surgery; D005260:Female; D006801:Humans; D007719:Knee Joint / Q000000981:diagnostic imaging* / Q000601:surgery; D008297:Male; D008875:Middle Aged; D020370:Osteoarthritis, Knee / Q000000981:diagnostic imaging* / Q000601:surgery; D010027:Osteotomy / Q000379:methods*; D011446:Prospective Studies; D011859:Radiography; D016059:Range of Motion, Articular; D016896:Treatment Outcome
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