---
title: Global varus malalignment increase from double-leg to single-leg stance due to intra-articular changes
description: This paper assesses lower limb alignment pre-MOWHTO for varus malalignment, noting increased deformity under progressive loading in different stances.
---

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# [Global varus malalignment increase from double-leg to single-leg stance due to intra-articular changes](https://blog.peekmed.com/papers/global-varus-malalignment-increase-from-double-leg-to-single-leg-stance-due-to-intra-articular-changes)

 Written by [PeekMed](https://blog.peekmed.com/papers/author/peekmed) | Jan 7, 2021 12:07:00 PM

Authors

Léo-Pôhl Bardot, Grégoire Micicoi, Henri Favreau, Petr Zeman, Raghbir Khakha, Matthieu Ehlinger & Matthieu Ollivier

 

Keywords

Genu varum; Joint line convergence; Knee; Osteotomy; Weight-bearing; Weight-bearing radiographs

Published on

Knee Surgery, Sports Traumatology, Arthroscopy 

Abstract

Purpose: Preoperatively planned correction for tibial osteotomy surgery is usually based on weightbearing long-leg Xrays, while the surgery is performed in a supine non-weightbearing position. The purpose of this study was to assess the differences in lower limb alignment in three different weightbearing conditions: supine position, double-leg (DL) stance and single-sleg (SL) stance prior to performing a medial opening wedge high tibial osteotomy (MOWHTO) for varus malalignment. The hypothesis of this study was that progressive limb-loading would lead to an increased preoperative varus deformity.  
Material and methods: This retrospective study included 89 patients (96 knees) with isolated medial knee osteoarthritis (Ahlbäck grade I or II) and significant metaphyseal tibial vara (> 6°). The differences between supine position, DL stance and SL stance were analysed for the hip-knee-ankle angle (HKA), lateral distal femoral angle (LDFA), medial proximal tibial angle (MPTA), weight-bearing line ratio (WBL) and joint line convergence angle (JLCA).  
Results: From a supine position to DL stance, the HKA angle slightly increased from 175.5° ± 1.1° to 176.3° ± 1.1° and JLCA changed from 2.0° ± 0.3° to 1.8° ± 0.3° without a statistically significant difference. From DL to SL stances, the HKA angle decreased from 176.3° ± 1.1° to 174.4° ± 1.1° (p < 0.05) and the JLCA increased from 1.8° ± 0.3° to 2.6° ± 0.3° (p < 0.05). A significant correlation was found between ΔHKA and ΔJLCA between the DL and the SL stances (R2 = 0.46; p = 0.01).  
Conclusion: Varus malalignment increases with weight-bearing loading from double-leg to single-leg stances with an associated JLCA increase. Thus, single-leg stance radiographs may be useful to correct preoperative planning considering patient-specific changes in JLCA.  
Level of clinical evidence: III, retrospective comparative study.

[See full article

](https://pubmed.ncbi.nlm.nih.gov/33486561/)

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