Defining the load bearing axis of the lower extremity obtained from anterior-posterior digital radiographs of the whole limb in stance Y. Iseki, T. Takahashi,

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Defining the load bearing axis of the lower extremity obtained from anterior-posterior digital radiographs of the whole limb in stance Y. Iseki, T. Takahashi, H. Takeda, I. Tsuboi, H. Imai, N. Mashima, S. Watanabe, H. Yamamoto Osteoarthritis and Cartilage Volume 17, Issue 5, Pages 586-591 (May 2009) DOI: 10.1016/j.joca.2008.10.001 Copyright © 2008 Osteoarthritis Research Society International Terms and Conditions

Fig. 1 Methods of evaluating the alignment of the whole lower extremity. Left: Two lines are drawn from the center of the femoral head to the center of the distal femur and from the center of the distal femur to the center of the ankle mortise. The mechanical axis (degrees varus) is measured at the intersection of these lines. Middle: The load bearing axis deviation of the lower limb is the perpendicular distance from the weight-bearing line (hip-to-ankle line) and the center of the knee. Right: The weight-bearing ratio is calculated by measuring the distance from the medial edge of the proximal tibia to the point where the weight-bearing line intersects the proximal tibia (B), and dividing the measurement by the entire width of the tibia (A). A percentage is calculated by multiplying this ratio by 100%11. Osteoarthritis and Cartilage 2009 17, 586-591DOI: (10.1016/j.joca.2008.10.001) Copyright © 2008 Osteoarthritis Research Society International Terms and Conditions

Fig. 2 The measurement method (using Fuji Film OP-A software) was based on five anatomical points: (1) the center of the femoral head; (2) the middle of the distal tibial plafond; (3) the medial border of the proximal tibia; (4) the lateral border of the proximal tibia; and (5) the intersection of the line connection (3) and (4), and the load bearing axis of the lower extremity. Osteoarthritis and Cartilage 2009 17, 586-591DOI: (10.1016/j.joca.2008.10.001) Copyright © 2008 Osteoarthritis Research Society International Terms and Conditions

Fig. 3 Method for calculating the load bearing axis of the lower extremity (%). The distance from the midpoint of the proximal tibia to the mechanical axis of the lower extremity (B) is divided by the width of the proximal tibia (A). Osteoarthritis and Cartilage 2009 17, 586-591DOI: (10.1016/j.joca.2008.10.001) Copyright © 2008 Osteoarthritis Research Society International Terms and Conditions

Fig. 4 (A): Correlation between the TFA and the load bearing axis deviation of the lower extremity measurements (expressed in %) obtained by rater A. The first set of measurements obtained by A was used (A1). (B): Correlation between the HKA and the load bearing axis deviation of the lower extremity measurements (expressed in %) obtained by rater A. The first set of measurements obtained by A was used (A1). Osteoarthritis and Cartilage 2009 17, 586-591DOI: (10.1016/j.joca.2008.10.001) Copyright © 2008 Osteoarthritis Research Society International Terms and Conditions

Fig. 5 Correlations between the load bearing axis deviation of the lower extremity measurements as independently obtained by three raters (A, B, and C) for the same patients (A1, first set of measurements). Osteoarthritis and Cartilage 2009 17, 586-591DOI: (10.1016/j.joca.2008.10.001) Copyright © 2008 Osteoarthritis Research Society International Terms and Conditions

Fig. 6 Correlation between two independent measurements of the load bearing axis deviation of the lower extremity in the same patient by the same rater (A). A1 and A2 represent the first and second sets of measurements, respectively. Osteoarthritis and Cartilage 2009 17, 586-591DOI: (10.1016/j.joca.2008.10.001) Copyright © 2008 Osteoarthritis Research Society International Terms and Conditions