{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,11]],"date-time":"2026-07-11T18:37:43Z","timestamp":1783795063431,"version":"3.55.0"},"reference-count":49,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2025,5,23]],"date-time":"2025-05-23T00:00:00Z","timestamp":1747958400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2025,5,23]],"date-time":"2025-05-23T00:00:00Z","timestamp":1747958400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Knee Surg &amp; Relat Res"],"abstract":"<jats:title>Abstract<\/jats:title>\n          <jats:sec>\n            <jats:title>Purpose<\/jats:title>\n            <jats:p>The study\u2019s primary objective was to assess and quantify the ipsilateral (side A) and contralateral (side B) ankle joint line orientation (AJLO) changes after unilateral total knee arthroplasty (TKA) for primary knee osteoarthritis (OA) with varus deformity. The secondary objectives were to detect if there was a correlation between the knee deformity correction and AJLO changes and if the knee and ankle clinical outcomes on the TKA side correlate with joint alignment changes.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Methods<\/jats:title>\n            <jats:p>This retrospective cohort study included 70 patients with a mean age of 61.76\u2009\u00b1\u20095.96\u00a0years. The lower limb alignment was evaluated using the hip-knee-ankle (HKA) angle, while the AJLO was assessed using the tibial plafond to horizontal line angle (TPHA). The functional outcomes for side A were evaluated at a median follow-up of 18 (interquartile range (IQR): 12\u201346.2) months using the Knee Injury and Osteoarthritis Outcome Score (KOOS) and The American Orthopaedic Foot and Ankle Society (AOFAS) score for the knee and ankle joints, respectively.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Results<\/jats:title>\n            <jats:p>In side A, the HKA significantly improved from 167.49\u2009\u00b1\u20096.25 to 177.08\u2009\u00b1\u20094.39 (<jats:italic>p<\/jats:italic>\u2009&lt;\u20090.001). No difference in AJLO was found between both sides preoperatively (<jats:italic>p<\/jats:italic>\u2009=\u20090.329). At the last follow-up, in side A, the AJLO changed significantly into less varus from \u22127.11\u2009\u00b1\u20095.44\u00b0 to \u22121.10\u2009\u00b1\u20094.91\u00b0 (<jats:italic>p<\/jats:italic>\u2009&lt;\u20090.001); in side B, the AJLO showed no significant changes (\u22126.38\u2009\u00b1\u20096.10\u00b0 versus \u22126.65\u2009\u00b1\u20096.50\u00b0, <jats:italic>p<\/jats:italic>\u2009=\u20090.970). For side A, the KOOS and AOFAS showed significant improvement, 45.20\u2009\u00b1\u200914.94 versus 75.72\u2009\u00b1\u200913.28 (<jats:italic>p<\/jats:italic>\u2009&lt;\u20090.001) and 70 (65\u201375) versus 90 (80\u201390; <jats:italic>p<\/jats:italic>\u2009&lt;\u20090.001), respectively. The preoperative HKA and AJLO on side A and side B showed significant positive correlations (<jats:italic>r<\/jats:italic>\u00a0=\u20090.591, <jats:italic>p<\/jats:italic>\u2009&lt;\u20090.001 and <jats:italic>r<\/jats:italic>\u00a0=\u20090.611, <jats:italic>p<\/jats:italic>\u2009&lt;\u20090.001, respectively). On side A, the postoperative HKA and AJLO showed a significant positive correlation (<jats:italic>r<\/jats:italic>\u00a0=\u20090.298, <jats:italic>p<\/jats:italic>\u2009=\u20090.012). The preoperative and postoperative AJLO and AOFAS on side A showed nonsignificant negative correlations (<jats:italic>r<\/jats:italic>\u00a0=\u2009\u22120.202, <jats:italic>p<\/jats:italic>\u2009=\u20090.277 and <jats:italic>r<\/jats:italic>\u00a0=\u2009\u22120.115, <jats:italic>p<\/jats:italic>\u2009=\u20090.537, respectively). The preoperative and postoperative HKA and AOFAS on side A showed nonsignificant positive correlations (<jats:italic>r<\/jats:italic>\u00a0=\u20090.126, <jats:italic>p<\/jats:italic>\u2009=\u20090.499 and <jats:italic>r<\/jats:italic>\u00a0=\u20090.331, <jats:italic>p<\/jats:italic>\u2009=\u20090.069, respectively). The linear regression analysis indicated that for every 1\u00b0 correction in HKA, the AJLO changed by 0.5\u00b0 (<jats:italic>R<\/jats:italic>\n              <jats:sup>2<\/jats:sup>\u2009=\u20090.241, 95% confidence interval (CI) 0.298\u20130.747, <jats:italic>p<\/jats:italic>\u2009&lt;\u20090.001).<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Conclusions<\/jats:title>\n            <jats:p>The ipsilateral ankle joint realigned to a less varus position after ipsilateral TKA for managing knee OA with varus deformity, with an estimated half a degree of less varus AJLO after HKA correction by a degree. No changes occurred in the contralateral ankle joint. The ankle joint function improvement was not correlated to the HKA or AJLO changes.<\/jats:p>\n          <\/jats:sec>","DOI":"10.1186\/s43019-025-00277-2","type":"journal-article","created":{"date-parts":[[2025,5,23]],"date-time":"2025-05-23T15:10:11Z","timestamp":1748013011000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":5,"title":["Assessment and quantification of ipsilateral and contralateral ankle joint alignment changes after unilateral total knee arthroplasty for knee osteoarthritis with varus deformity: a retrospective cohort study"],"prefix":"10.1186","volume":"37","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-0710-6487","authenticated-orcid":false,"given":"Ahmed A.","family":"Khalifa","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4032-6254","authenticated-orcid":false,"given":"Amr A.","family":"Fadle","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Abdelrahman A. Aziz","family":"Khalaf","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ahmed M.","family":"Abdelaal","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mohamed M. A.","family":"Moustafa","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2025,5,23]]},"reference":[{"key":"277_CR1","doi-asserted-by":"publisher","first-page":"122318","DOI":"10.52965\/001c.122318","volume":"16","author":"Z Alhifzi","year":"2024","unstructured":"Alhifzi Z (2024) Systematic review and meta-analysis of long term outcomes and innovations in total knee arthroplasty: kinematic personalized knee vs. conventional. Orthop Rev 16:122318. https:\/\/doi.org\/10.52965\/001c.122318","journal-title":"Orthop Rev"},{"issue":"7","key":"277_CR2","doi-asserted-by":"publisher","first-page":"718","DOI":"10.1055\/s-0040-1716850","volume":"35","author":"AA Khalifa","year":"2022","unstructured":"Khalifa AA, Fayez M, Elkady H, Abdelaal AM, Elassal MA (2022) The outcome of posterior-stabilized, rotating platform total knee arthroplasty at a minimum ten-year follow-up, a middle east institution experience. J Knee Surg 35(7):718\u2013724. https:\/\/doi.org\/10.1055\/s-0040-1716850","journal-title":"J Knee Surg"},{"issue":"10172","key":"277_CR3","doi-asserted-by":"publisher","first-page":"655","DOI":"10.1016\/S0140-6736(18)32531-5","volume":"393","author":"JT Evans","year":"2019","unstructured":"Evans JT, Walker RW, Evans JP, Blom AW, Sayers A, Whitehouse MR (2019) How long does a knee replacement last? A systematic review and meta-analysis of case series and national registry reports with more than 15 years of follow-up. Lancet 393(10172):655\u2013663. https:\/\/doi.org\/10.1016\/S0140-6736(18)32531-5","journal-title":"Lancet"},{"issue":"9","key":"277_CR4","doi-asserted-by":"publisher","first-page":"735","DOI":"10.2106\/JBJS.17.00883","volume":"100","author":"CB Chang","year":"2018","unstructured":"Chang CB, Jeong JH, Chang MJ, Yoon C, Song MK, Kang SB (2018) Concomitant ankle osteoarthritis is related to increased ankle pain and a worse clinical outcome following total knee arthroplasty. J Bone Joint Surg Am 100(9):735\u2013741. https:\/\/doi.org\/10.2106\/JBJS.17.00883","journal-title":"J Bone Joint Surg Am"},{"key":"277_CR5","first-page":"381","volume":"64","author":"BT Manning","year":"2015","unstructured":"Manning BT, Lewis N, Tzeng TH, Saleh JK, Potty AG, Dennis DA, Mihalko WM, Goodman SB, Saleh KJ (2015) Diagnosis and management of extra-articular causes of pain after total knee arthroplasty. Instr Course Lect 64:381\u2013388","journal-title":"Instr Course Lect"},{"issue":"8","key":"277_CR6","doi-asserted-by":"publisher","first-page":"2632","DOI":"10.1007\/s00167-016-4122-1","volume":"25","author":"Y Okamoto","year":"2017","unstructured":"Okamoto Y, Otsuki S, Jotoku T, Nakajima M, Neo M (2017) Clinical usefulness of hindfoot assessment for total knee arthroplasty: persistent post-operative hindfoot pain and alignment in pre-existing severe knee deformity. Knee Surg Sports Traumatol Arthrosc 25(8):2632\u20132639. https:\/\/doi.org\/10.1007\/s00167-016-4122-1","journal-title":"Knee Surg Sports Traumatol Arthrosc"},{"issue":"11","key":"277_CR7","doi-asserted-by":"publisher","first-page":"3305","DOI":"10.1016\/j.arth.2020.06.027","volume":"35","author":"CB Chang","year":"2020","unstructured":"Chang CB, Chung CY, Park MS, Choi JH, Kim JS, Lee KM (2020) Aggravation of ankle varus incongruency following total knee replacement correcting \u2265\u00a010 degrees of genu varum deformity: a radiographic assessment. J Arthroplasty 35(11):3305\u20133310. https:\/\/doi.org\/10.1016\/j.arth.2020.06.027","journal-title":"J Arthroplasty"},{"issue":"1","key":"277_CR8","doi-asserted-by":"publisher","first-page":"15","DOI":"10.1186\/s13018-024-05433-0","volume":"20","author":"Z Huang","year":"2025","unstructured":"Huang Z, Zhang Z, Wang W, Chen F, Zhang H (2025) The association between varus knee deformity and morphological changes in the foot and ankle in patients with end-stage varus knee osteoarthritis. J Orthop Surg Res 20(1):15. https:\/\/doi.org\/10.1186\/s13018-024-05433-0","journal-title":"J Orthop Surg Res"},{"issue":"5","key":"277_CR9","doi-asserted-by":"publisher","first-page":"865","DOI":"10.1053\/j.jfas.2018.02.002","volume":"57","author":"CW Kim","year":"2018","unstructured":"Kim CW, Gwak HC, Kim JH, Lee CR, Kim JG, Oh M, Park JH (2018) Radiologic factors affecting ankle pain before and after total knee arthroplasty for the varus osteoarthritic knee. J Foot Ankle Surg 57(5):865\u2013869. https:\/\/doi.org\/10.1053\/j.jfas.2018.02.002","journal-title":"J Foot Ankle Surg"},{"issue":"12","key":"277_CR10","doi-asserted-by":"publisher","first-page":"1087","DOI":"10.3113\/FAI.2012.1087","volume":"33","author":"JH Lee","year":"2012","unstructured":"Lee JH, Jeong BO (2012) Radiologic changes of ankle joint after total knee arthroplasty. Foot Ankle Int 33(12):1087\u20131092. https:\/\/doi.org\/10.3113\/FAI.2012.1087","journal-title":"Foot Ankle Int"},{"issue":"1","key":"277_CR11","doi-asserted-by":"publisher","first-page":"7","DOI":"10.1186\/s43019-024-00212-x","volume":"36","author":"AK Choudhury","year":"2024","unstructured":"Choudhury AK, Bansal S, Pranav J, Raja BS, Gupta T, Paul S, Gupta K, Kalia RB (2024) Increased medial talar tilt may incite ankle pain and predispose ankle osteoarthritis after correction of severity of knee varus deformity among patients undergoing bilateral total knee arthroplasty: a prospective observation. Knee Surg Relat Res 36(1):7. https:\/\/doi.org\/10.1186\/s43019-024-00212-x","journal-title":"Knee Surg Relat Res"},{"issue":"3","key":"277_CR12","doi-asserted-by":"publisher","first-page":"838","DOI":"10.1007\/s00167-015-3890-3","volume":"25","author":"GW Choi","year":"2017","unstructured":"Choi GW, Yang JH, Park JH, Yun HH, Lee YI, Chae JE, Yoon JR (2017) Changes in coronal alignment of the ankle joint after high tibial osteotomy. Knee Surg Sports Traumatol Arthrosc 25(3):838\u2013845. https:\/\/doi.org\/10.1007\/s00167-015-3890-3","journal-title":"Knee Surg Sports Traumatol Arthrosc"},{"issue":"4","key":"277_CR13","doi-asserted-by":"publisher","first-page":"675","DOI":"10.1007\/s00590-021-03016-x","volume":"32","author":"C Konrads","year":"2022","unstructured":"Konrads C, Eis A, Ahmad SS, Stockle U, Dobele S (2022) Osteotomies around the knee lead to corresponding frontal realignment of the ankle. Eur J Orthop Surg Traumatol 32(4):675\u2013682. https:\/\/doi.org\/10.1007\/s00590-021-03016-x","journal-title":"Eur J Orthop Surg Traumatol"},{"issue":"8","key":"277_CR14","doi-asserted-by":"publisher","first-page":"2470","DOI":"10.1007\/s00167-015-3883-2","volume":"24","author":"S Gursu","year":"2016","unstructured":"Gursu S, Sofu H, Verdonk P, Sahin V (2016) Effects of total knee arthroplasty on ankle alignment in patients with varus gonarthrosis: do we sacrifice ankle to the knee? Knee Surg Sports Traumatol Arthrosc 24(8):2470\u20132475. https:\/\/doi.org\/10.1007\/s00167-015-3883-2","journal-title":"Knee Surg Sports Traumatol Arthrosc"},{"issue":"12","key":"277_CR15","doi-asserted-by":"publisher","first-page":"3758","DOI":"10.1007\/s00167-019-05812-9","volume":"28","author":"F Graef","year":"2020","unstructured":"Graef F, Falk R, Tsitsilonis S, Perka C, Zahn RK, Hommel H (2020) Correction of excessive intraarticular varus deformities in total knee arthroplasty is associated with deteriorated postoperative ankle function. Knee Surg Sports Traumatol Arthrosc 28(12):3758\u20133765. https:\/\/doi.org\/10.1007\/s00167-019-05812-9","journal-title":"Knee Surg Sports Traumatol Arthrosc"},{"key":"277_CR16","doi-asserted-by":"publisher","first-page":"713055","DOI":"10.3389\/fsurg.2021.713055","volume":"8","author":"Z Feng","year":"2021","unstructured":"Feng Z, Ma M, Wang Y, Yang C, Liu Z, Xia Y (2021) Clinical and radiological changes of ankle in knee osteoarthritis with varus after total knee arthroplasty: a systematic review. Front Surg 8:713055. https:\/\/doi.org\/10.3389\/fsurg.2021.713055","journal-title":"Front Surg"},{"issue":"4","key":"277_CR17","doi-asserted-by":"publisher","first-page":"598","DOI":"10.1002\/jor.22793","volume":"33","author":"EM Suero","year":"2015","unstructured":"Suero EM, Sabbagh Y, Westphal R, Hawi N, Citak M, Wahl FM, Krettek C, Liodakis E (2015) Effect of medial opening wedge high tibial osteotomy on intraarticular knee and ankle contact pressures. J Orthop Res 33(4):598\u2013604. https:\/\/doi.org\/10.1002\/jor.22793","journal-title":"J Orthop Res"},{"issue":"6","key":"277_CR18","doi-asserted-by":"publisher","first-page":"555","DOI":"10.1007\/s00402-007-0502-9","volume":"128","author":"K Tallroth","year":"2008","unstructured":"Tallroth K, Harilainen A, Kerttula L, Sayed R (2008) Ankle osteoarthritis is associated with knee osteoarthritis. Conclusions based on mechanical axis radiographs. Arch Orthop Trauma Surg 128(6):555\u2013560. https:\/\/doi.org\/10.1007\/s00402-007-0502-9","journal-title":"Arch Orthop Trauma Surg"},{"issue":"12","key":"277_CR19","doi-asserted-by":"publisher","first-page":"3694","DOI":"10.1016\/j.arth.2018.08.015","volume":"33","author":"K Xie","year":"2018","unstructured":"Xie K, Jiang X, Han X, Ai S, Qu X, Yan M (2018) Association between knee malalignment and ankle degeneration in patients with end-stage knee osteoarthritis. J Arthroplasty 33(12):3694-3698 e3691. https:\/\/doi.org\/10.1016\/j.arth.2018.08.015","journal-title":"J Arthroplasty"},{"issue":"1","key":"277_CR20","doi-asserted-by":"publisher","first-page":"154","DOI":"10.1097\/CORR.0000000000001067","volume":"478","author":"ABM Burssens","year":"2020","unstructured":"Burssens ABM, Buedts K, Barg A, Vluggen E, Demey P, Saltzman CL, Victor JMK (2020) Is lower-limb alignment associated with hindfoot deformity in the coronal plane? A weightbearing CT analysis. Clin Orthop Relat Res 478(1):154\u2013168. https:\/\/doi.org\/10.1097\/CORR.0000000000001067","journal-title":"Clin Orthop Relat Res"},{"issue":"1","key":"277_CR21","doi-asserted-by":"publisher","first-page":"166","DOI":"10.1007\/s11999-014-3801-9","volume":"473","author":"AA Norton","year":"2015","unstructured":"Norton AA, Callaghan JJ, Amendola A, Phisitkul P, Wongsak S, Liu SS, Fruehling-Wall C (2015) Correlation of knee and hindfoot deformities in advanced knee OA: compensatory hindfoot alignment and where it occurs. Clin Orthop Relat Res 473(1):166\u2013174. https:\/\/doi.org\/10.1007\/s11999-014-3801-9","journal-title":"Clin Orthop Relat Res"},{"issue":"1","key":"277_CR22","doi-asserted-by":"publisher","first-page":"79","DOI":"10.1111\/os.13567","volume":"15","author":"S Hodel","year":"2023","unstructured":"Hodel S, Cavalcanti N, Fucentese S, Vlachopoulos L, Viehofer A, Wirth S (2023) The relationship between frontal, axial leg alignment, and ankle joint line orientation-A radiographic analysis of healthy subjects. Orthop Surg 15(1):79\u201384. https:\/\/doi.org\/10.1111\/os.13567","journal-title":"Orthop Surg"},{"key":"277_CR23","doi-asserted-by":"publisher","DOI":"10.3390\/jcm13164700","author":"AS Nazligul","year":"2024","unstructured":"Nazligul AS, Dogan M, Duran I, Moya-Angeler J, Akkaya M (2024) Mid-term clinical and radiological changes in the ankle joint in varus knee osteoarthritis following total knee arthroplasty. J Clin Med. https:\/\/doi.org\/10.3390\/jcm13164700","journal-title":"J Clin Med"},{"issue":"6","key":"277_CR24","doi-asserted-by":"publisher","first-page":"1199","DOI":"10.1007\/s00590-020-02853-6","volume":"31","author":"AA Khalifa","year":"2021","unstructured":"Khalifa AA, Mullaji AB, Gendy AN, Ahmed AM, Bakr HM, Khalifa YE, Abdelaal AM (2021) Prediction of leg length change (LLC) after correcting varus and flexion deformity in patients undergoing TKA. Eur J Orthop Surg Traumatol 31(6):1199\u20131205. https:\/\/doi.org\/10.1007\/s00590-020-02853-6","journal-title":"Eur J Orthop Surg Traumatol"},{"issue":"2","key":"277_CR25","doi-asserted-by":"publisher","first-page":"103787","DOI":"10.1016\/j.otsr.2023.103787","volume":"110","author":"SM Oh","year":"2024","unstructured":"Oh SM, Bin SI, Kim JM, Lee BS, Lee J, Bae K (2024) Limb length change after total knee arthroplasty for valgus deformity does not affect the clinical score and is not affected by fixed flexion deformity. Orthop Traumatol Surg Res 110(2):103787. https:\/\/doi.org\/10.1016\/j.otsr.2023.103787","journal-title":"Orthop Traumatol Surg Res"},{"key":"277_CR26","doi-asserted-by":"publisher","first-page":"102280","DOI":"10.1016\/j.jcot.2023.102280","volume":"45","author":"S Tanpure","year":"2023","unstructured":"Tanpure S, Phadnis A, Nagda T, Rathod C, Kothurkar R, Gad M (2023) Effect of total knee arthroplasty on contralateral knee: a prospective comparative gait analysis of non-operated legs in the Indian population. J Clin Orthop Trauma 45:102280. https:\/\/doi.org\/10.1016\/j.jcot.2023.102280","journal-title":"J Clin Orthop Trauma"},{"issue":"8","key":"277_CR27","doi-asserted-by":"publisher","first-page":"1886","DOI":"10.1007\/s11999-016-4732-4","volume":"474","author":"MD Kohn","year":"2016","unstructured":"Kohn MD, Sassoon AA, Fernando ND (2016) Classifications in brief: Kellgren\u2013Lawrence classification of osteoarthritis. Clin Orthop Relat Res 474(8):1886\u20131893. https:\/\/doi.org\/10.1007\/s11999-016-4732-4","journal-title":"Clin Orthop Relat Res"},{"issue":"2","key":"277_CR28","doi-asserted-by":"publisher","first-page":"195","DOI":"10.1055\/s-0041-1731458","volume":"36","author":"AB Mullaji","year":"2023","unstructured":"Mullaji AB, Khalifa AA, Shetty G, Thakur H (2023) Comparison with navigation of a novel three-step technique for improving accuracy of the distal femoral resection during conventional TKA: a case-control study. J Knee Surg 36(2):195\u2013200. https:\/\/doi.org\/10.1055\/s-0041-1731458","journal-title":"J Knee Surg"},{"issue":"1","key":"277_CR29","doi-asserted-by":"publisher","first-page":"1","DOI":"10.4055\/cios.2014.6.1.1","volume":"6","author":"BK Daines","year":"2014","unstructured":"Daines BK, Dennis DA (2014) Gap balancing vs. measured resection technique in total knee arthroplasty. Clin Orthop Surg 6(1):1\u20138. https:\/\/doi.org\/10.4055\/cios.2014.6.1.1","journal-title":"Clin Orthop Surg"},{"issue":"1","key":"277_CR30","doi-asserted-by":"publisher","first-page":"705","DOI":"10.1186\/s13018-023-04199-1","volume":"18","author":"AM Abdelaal","year":"2023","unstructured":"Abdelaal AM, Khalifa AA (2023) Total knee arthroplasty post-high tibial osteotomy, results of an early experience from a North African arthroplasty unit, and a comprehensive review of the literature. J Orthop Surg Res 18(1):705. https:\/\/doi.org\/10.1186\/s13018-023-04199-1","journal-title":"J Orthop Surg Res"},{"key":"277_CR31","doi-asserted-by":"publisher","first-page":"95","DOI":"10.2147\/ORR.S320372","volume":"13","author":"AA Khalifa","year":"2021","unstructured":"Khalifa AA, Mullaji AB, Mostafa AM, Farouk OA (2021) A protocol to systematic radiographic assessment of primary total knee arthroplasty. Orthop Res Rev 13:95\u2013106. https:\/\/doi.org\/10.2147\/ORR.S320372","journal-title":"Orthop Res Rev"},{"issue":"2","key":"277_CR32","doi-asserted-by":"publisher","first-page":"133","DOI":"10.55095\/achot2023\/018","volume":"90","author":"MA Alshrouf","year":"2023","unstructured":"Alshrouf MA, Ahrend MD, Konrads C (2023) The tibia plafond horizontal orientation angle for frontal alignment evaluation of the distal lower extremity. Acta Chir Orthop Traumatol Cech 90(2):133\u2013137","journal-title":"Acta Chir Orthop Traumatol Cech"},{"issue":"5","key":"277_CR33","doi-asserted-by":"publisher","first-page":"344","DOI":"10.55095\/achot2022\/055","volume":"89","author":"C Konrads","year":"2022","unstructured":"Konrads C, Dobele S, Eis A, Stockle U, Ahmad SS (2022) the association between constitutional knee alignment and the horizontal orientation of the ankle joint line. Acta Chir Orthop Traumatol Cech 89(5):344\u2013348","journal-title":"Acta Chir Orthop Traumatol Cech"},{"key":"277_CR34","doi-asserted-by":"publisher","first-page":"64","DOI":"10.1186\/1477-7525-1-64","volume":"1","author":"EM Roos","year":"2003","unstructured":"Roos EM, Lohmander LS (2003) The Knee injury and Osteoarthritis Outcome Score (KOOS): from joint injury to osteoarthritis. Health Qual Life Outcomes 1:64. https:\/\/doi.org\/10.1186\/1477-7525-1-64","journal-title":"Health Qual Life Outcomes"},{"issue":"8","key":"277_CR35","doi-asserted-by":"publisher","first-page":"1547","DOI":"10.1007\/s00296-018-4072-7","volume":"38","author":"SA Alfadhel","year":"2018","unstructured":"Alfadhel SA, Vennu V, Alnahdi AH, Omar MT, Alasmari SH, AlJafri Z, Bindawas SM (2018) Cross-cultural adaptation and validation of the Saudi Arabic version of the Knee Injury and Osteoarthritis Outcome Score (KOOS). Rheumatol Int 38(8):1547\u20131555. https:\/\/doi.org\/10.1007\/s00296-018-4072-7","journal-title":"Rheumatol Int"},{"issue":"8","key":"277_CR36","doi-asserted-by":"publisher","first-page":"876","DOI":"10.1016\/j.fas.2019.11.001","volume":"26","author":"M Alhadhoud","year":"2020","unstructured":"Alhadhoud M, Alsiri N, Alsaffar M, Glazebrook M (2020) Cross-cultural adaptation and validation of an Arabic version of the American Orthopedics Foot and Ankle Score (AOFAS). Foot Ankle Surg 26(8):876\u2013882. https:\/\/doi.org\/10.1016\/j.fas.2019.11.001","journal-title":"Foot Ankle Surg"},{"issue":"3","key":"277_CR37","doi-asserted-by":"publisher","first-page":"177","DOI":"10.1016\/0268-0033(92)90033-Z","volume":"7","author":"L Weidenhielm","year":"1992","unstructured":"Weidenhielm L, Svensson OK, Brostrom LA (1992) Change of adduction moment about the hip, knee and ankle joints after high tibial osteotomy in osteoarthrosis of the knee. Clin Biomech 7(3):177\u2013180. https:\/\/doi.org\/10.1016\/0268-0033(92)90033-Z","journal-title":"Clin Biomech"},{"key":"277_CR38","doi-asserted-by":"publisher","first-page":"19","DOI":"10.1051\/sicotj\/2021021","volume":"7","author":"S Lustig","year":"2021","unstructured":"Lustig S, Sappey-Marinier E, Fary C, Servien E, Parratte S, Batailler C (2021) Personalized alignment in total knee arthroplasty: current concepts. SICOT J 7:19. https:\/\/doi.org\/10.1051\/sicotj\/2021021","journal-title":"SICOT J"},{"issue":"2","key":"277_CR39","doi-asserted-by":"publisher","first-page":"232","DOI":"10.1016\/j.joca.2014.11.001","volume":"23","author":"KM Lee","year":"2015","unstructured":"Lee KM, Chang CB, Park MS, Kang SB, Kim TK, Chung CY (2015) Changes of knee joint and ankle joint orientations after high tibial osteotomy. Osteoarthr Cartil 23(2):232\u2013238. https:\/\/doi.org\/10.1016\/j.joca.2014.11.001","journal-title":"Osteoarthr Cartil"},{"issue":"1","key":"277_CR40","doi-asserted-by":"publisher","first-page":"81","DOI":"10.1007\/s00402-021-04001-z","volume":"143","author":"K Miyazaki","year":"2023","unstructured":"Miyazaki K, Maeyama A, Yoshimura I, Kobayashi T, Ishimatsu T, Yamamoto T (2023) Influence of hindfoot alignment on postoperative lower limb alignment in medial opening wedge high tibial osteotomy. Arch Orthop Trauma Surg 143(1):81\u201390. https:\/\/doi.org\/10.1007\/s00402-021-04001-z","journal-title":"Arch Orthop Trauma Surg"},{"issue":"2","key":"277_CR41","doi-asserted-by":"publisher","first-page":"e139","DOI":"10.5435\/JAAOS-D-20-00189","volume":"30","author":"BC Lau","year":"2022","unstructured":"Lau BC, Allahabadi S, Palanca A, Oji DE (2022) Understanding radiographic measurements used in foot and ankle surgery. J Am Acad Orthop Surg 30(2):e139\u2013e154. https:\/\/doi.org\/10.5435\/JAAOS-D-20-00189","journal-title":"J Am Acad Orthop Surg"},{"issue":"6","key":"277_CR42","doi-asserted-by":"publisher","first-page":"1861","DOI":"10.1007\/s00167-019-05629-6","volume":"28","author":"DR Palanisami","year":"2020","unstructured":"Palanisami DR, Rajasekaran RB, Reddy PK, Natesan R, Sethuraman A, Rajasekaran S (2020) Foot loading pattern and hind foot alignment are corrected in varus knees following total knee arthroplasty: a pedobarographic analysis. Knee Surg Sports Traumatol Arthrosc 28(6):1861\u20131867. https:\/\/doi.org\/10.1007\/s00167-019-05629-6","journal-title":"Knee Surg Sports Traumatol Arthrosc"},{"issue":"3","key":"277_CR43","doi-asserted-by":"publisher","first-page":"367","DOI":"10.1016\/S0030-5898(20)31921-0","volume":"25","author":"K Tetsworth","year":"1994","unstructured":"Tetsworth K, Paley D (1994) Malalignment and degenerative arthropathy. Orthop Clin North Am 25(3):367\u2013377","journal-title":"Orthop Clin North Am"},{"issue":"3","key":"277_CR44","doi-asserted-by":"publisher","first-page":"379","DOI":"10.1016\/S0030-5898(20)31922-2","volume":"25","author":"EY Chao","year":"1994","unstructured":"Chao EY, Neluheni EV, Hsu RW, Paley D (1994) Biomechanics of malalignment. Orthop Clin North Am 25(3):379\u2013386","journal-title":"Orthop Clin North Am"},{"issue":"2","key":"277_CR45","doi-asserted-by":"publisher","first-page":"445","DOI":"10.1007\/s00264-020-04809-1","volume":"45","author":"W Wang","year":"2021","unstructured":"Wang W, Ding R, Zhang N, Hernigou P (2021) Subchondral bone cysts regress after correction of malalignment in knee osteoarthritis: comply with Wolff\u2019s law. Int Orthop 45(2):445\u2013451. https:\/\/doi.org\/10.1007\/s00264-020-04809-1","journal-title":"Int Orthop"},{"issue":"1","key":"277_CR46","doi-asserted-by":"publisher","first-page":"117","DOI":"10.1007\/s00264-020-04799-0","volume":"45","author":"JG Kim","year":"2021","unstructured":"Kim JG, Suh DH, Choi GW, Koo BM, Kim SG (2021) Change in the weight-bearing line ratio of the ankle joint and ankle joint line orientation after knee arthroplasty and high tibial osteotomy in patients with genu varum deformity. Int Orthop 45(1):117\u2013124. https:\/\/doi.org\/10.1007\/s00264-020-04799-0","journal-title":"Int Orthop"},{"issue":"3","key":"277_CR47","doi-asserted-by":"publisher","first-page":"777","DOI":"10.1016\/j.knee.2020.04.018","volume":"27","author":"S Bartholomeeusen","year":"2020","unstructured":"Bartholomeeusen S, Van den Bempt M, van Beek N, Claes T, Claes S (2020) Changes in knee joint line orientation after high tibial osteotomy are the result of adaptation of the lower limb to the new alignment. Knee 27(3):777\u2013786. https:\/\/doi.org\/10.1016\/j.knee.2020.04.018","journal-title":"Knee"},{"issue":"11","key":"277_CR48","doi-asserted-by":"publisher","first-page":"3596","DOI":"10.1007\/s00167-016-4278-8","volume":"25","author":"WS Cho","year":"2017","unstructured":"Cho WS, Cho HS, Byun SE (2017) Changes in hindfoot alignment after total knee arthroplasty in knee osteoarthritic patients with varus deformity. Knee Surg Sports Traumatol Arthrosc 25(11):3596\u20133604. https:\/\/doi.org\/10.1007\/s00167-016-4278-8","journal-title":"Knee Surg Sports Traumatol Arthrosc"},{"issue":"11","key":"277_CR49","doi-asserted-by":"publisher","first-page":"3230","DOI":"10.1007\/s00167-018-4840-7","volume":"26","author":"BO Jeong","year":"2018","unstructured":"Jeong BO, Kim TY, Baek JH, Jung H, Song SH (2018) Following the correction of varus deformity of the knee through total knee arthroplasty, significant compensatory changes occur not only at the ankle and subtalar joint, but also at the foot. Knee Surg Sports Traumatol Arthrosc 26(11):3230\u20133237. https:\/\/doi.org\/10.1007\/s00167-018-4840-7","journal-title":"Knee Surg Sports Traumatol Arthrosc"}],"container-title":["Knee Surgery &amp; Related Research"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s43019-025-00277-2.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1186\/s43019-025-00277-2\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s43019-025-00277-2.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,5,23]],"date-time":"2025-05-23T15:10:14Z","timestamp":1748013014000},"score":1,"resource":{"primary":{"URL":"https:\/\/kneesurgrelatres.biomedcentral.com\/articles\/10.1186\/s43019-025-00277-2"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,5,23]]},"references-count":49,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2025,12]]}},"alternative-id":["277"],"URL":"https:\/\/doi.org\/10.1186\/s43019-025-00277-2","relation":{},"ISSN":["2234-2451"],"issn-type":[{"value":"2234-2451","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,5,23]]},"assertion":[{"value":"11 February 2025","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"8 May 2025","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"23 May 2025","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"This article does not contain any experimental studies with human participants or animals performed by any of the authors, and the ethical committee of our institution approved it (IRB no. 17101707, Faculty of Medicine, Assiut University, Egypt (tel., fax:\u2009+\u200920 88-233-2278, ethics-committee12@yahoo.com, IRB-Asyut@aun.Edu.eg, ).","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}},{"value":"Not applicable.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"There are no conflicts of interest for any author concerning this manuscript.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"26"}}