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J Knee Surg 2019; 32(08): 820-824
DOI: 10.1055/s-0038-1669788
Original Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Neutral or Natural? Functional Impact of the Coronal Alignment in Total Knee Arthroplasty

Erik Schiffner
1   Department of Trauma and Hand Surgery, Universitätsklinikum Düsseldorf, Düsseldorf, Germany
,
Michael Wild
2   Department of Trauma and Orthopaedic Surgery, Klinikum Darmstadt, Darmstadt, Hessen, Germany
,
Bertram Regenbrecht
3   Department of Trauma and Orthopaedic Surgery, Klinik Lilienthal, Lilienthal, Germany
,
Alberto Schek
4   Department of Trauma, Hand and Orthopaedic Surgery, Vivantes Klinikum Am Urban, Berlin, Germany
,
Mohssen Hakimi
4   Department of Trauma, Hand and Orthopaedic Surgery, Vivantes Klinikum Am Urban, Berlin, Germany
,
Simon Thelen
1   Department of Trauma and Hand Surgery, Universitätsklinikum Düsseldorf, Düsseldorf, Germany
,
Pascal Jungbluth
1   Department of Trauma and Hand Surgery, Universitätsklinikum Düsseldorf, Düsseldorf, Germany
,
Johannes Schneppendahl
1   Department of Trauma and Hand Surgery, Universitätsklinikum Düsseldorf, Düsseldorf, Germany
› Author Affiliations
Further Information

Publication History

16 January 2018

23 July 2018

Publication Date:
07 September 2018 (online)

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Abstract

Total knee arthroplasty (TKA) is a very successful procedure. The alignment in TKA has been identified as being of importance to prevent early implant failure and patient dissatisfaction. Our hypothesis was that patients with a preoperative varus deformation remaining in a slight varus alignment as their natural alignment after TKA will have superior clinical results compared with patients who are restored in neutral alignment. A total of 115 patients were corrected from varus to neutral (varus–neutral) and in 33 patients a preoperative varus alignment was kept in varus (varus). Standardized preoperative and postoperative full-length hip–knee–ankle radiographs under full weight-bearing conditions were performed in all patients. The patients' knees were categorized preoperatively and postoperatively based on the angle between mechanical femoral axis and mechanical tibial axis. Knees with alignment between ± 3 degrees were categorized as neutrally aligned, whereas alignment within ≤ –3 degrees was categorized as varus. The Knee Injury Osteoarthritis Outcome Score (KOOS) and Oxford Knee Score were determined retrospectively. The varus group scored significantly better in total KOOS (p < 0.05) compared with the varus–neutral group. Also, a trend was visible in the Oxford Knee Score but this was not significant (p > 0.05). This trend was even more evident in varus knees which were slightly undercorrected. The results support the assumption that leaving a residual varus alignment after TKA leads to better functional outcomes in TKA for patients with preoperative varus osteoarthritis.

Keywords

total knee arthroplasty - neutral alignment - varus alignment - total knee replacement
 

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