Influence of different standing positions on anatomical parameters of coronal whole‐leg weight‐bearing radiographs in preoperative planning for high tibial osteotomy

Abstract Purpose The purpose of this study was to assess the differences in lower limb global alignment and anatomical parameters of coronal whole‐leg radiographs, which were generally used in preoperative planning for high tibial osteotomy (HTO), according to different weight‐bearing standing positions. Methods Between April 2021 and December 2022, 176 patients (60 males and 116 females) were investigated. Full‐weight‐bearing coronal whole‐leg radiographs were obtained with the patella centred on the femoral condyle. Patients were divided by Kellgren–Lawrence grade (KL‐0, KL‐I, KL‐II and KL‐III) and assessed in two standing positions: legs closed and legs spread. Patients with flexion contractures or those unable to stand with full weight bearing were excluded. The mechanical distal femoral angle, medial proximal tibial angle (MPTA), femorotibial angle, joint line convergence angle, percentage weight‐bearing line (%WBL) and hip‐knee‐ankle angle (HKAA) were measured. The Student's t test was used to compare the two standing positions. A p value < 0.05 indicated a statistically significant difference. Results The MPTAs of legs closed standing and legs spread standing were 84.9 ± 2.6° and 85.1 ± 2.4° in KL‐0, 84.7 ± 2.0° and 84.9 ± 2.1° in KL‐I and 85.0 ± 2.43° and 85.4 ± 2.4° in KL‐II, respectively. There were statistically significant differences in the MPTA between the two standing positions in KL‐0, KL‐I and KL‐II. In contrast, the %WBL and HKAA did not change regardless of the standing position. In the KL‐III group, no statistical significance was observed for any of the anatomical parameters. Conclusion Several anatomical parameters were changed between the legs closed standing and the legs spread standing positions. It was suggested that the standing position should be taken into consideration in the planning for HTO. Level of Evidence Level IV, Case series with no comparison group.