Abstract
BackgroundWhether neutral alignment brings better clinical outcomes is controversial. Consideration of the preoperative knee condition of patients and some limitations of previous studies, we suggested that other index may be more important than a generic target of 0° ± 3° of a neutral axis to reflect changes in coronal alignment after total knee replacement (TKR). The purpose of this study was to explore the relationship between alignment and functional outcome with a new grouping method and the concept of correction rate.MethodsThe study included 358 knees, the mean follow-up period was 3.62 years. A new grouping method was adopted to divide patients into three groups based on the degree of correction of mechanical femoral—tibial angle (MFTA): under-correction (n = 128), neutral (n = 209) and over-correction (n = 21). Hospital for Special Surgery (HSS) score were compared among the 3 groups (ANOVA with or without LSD t-test). In addition, we also attempt to further explore whether the concept of correction rate can predict postoperative functional score (Simple linear correlation analysis).ResultsHSS score showed significant improvement in all groups. There was no difference in HSS score (88.27 vs 88 vs 85.62) (p = 0.88) or incremental scores (26.23 vs 25.22 vs 22.88) (p = 0.25) based on the postoperative alignment category for the degree of correction of MFTA at the last follow-up. The correlational analyses also didn’t show any positive results (r = -0.01 p = 0.95, r = -0.01 p = 0.97, r = 0.11 p = 0.15, r = 0.01 p = 0.90).ConclusionCategorization of optimal coronal alignment after TKR may be impractical. But we still believe that the concept of correction rate and new grouping method are worthy of research which can reflects the preoperative knee condition and the change of coronal alignment. Perhaps it can be better used in TKR in the future.Level of evidence: III.
Highlights
The traditional opinion is that the postoperative limb alignment should be neutral, which is considered the prerequisite for successful total knee replacement (TKR) [1,2,3]
Bold indicates statistically significant The values are given as the mean and the standard deviation; mechanical femoral—tibial angle (MFTA) mechanical femoral-tibial angle, HSS score Hospital for Special Surgery score A Under-correction group, B Neutral alignment group, C Over-correction group a chi-square test; bANOVA; cLSD-t test; *There was a statistically difference compared with the A group, no statistically difference in other two groups
TKR is a soft tissue procedure and clinical outcome depends on many factors
Summary
The traditional opinion is that the postoperative limb alignment should be neutral, which is considered the prerequisite for successful total knee replacement (TKR) [1,2,3]. Based on the inconsistency of these findings and some limitations of the above studies (see discussion for limitations), a new method was adopt to explore the relationship between alignment and clinical outcomes, that is, grouping the patients according to the degree of correction of the limb alignment (under-correction, neutral and over-correction). Consideration of the preoperative knee condition of patients and some limitations of previous studies, we suggested that other index may be more important than a generic target of 0° ± 3° of a neutral axis to reflect changes in coronal alignment after total knee replacement (TKR). The purpose of this study was to explore the relationship between alignment and functional outcome with a new grouping method and the concept of correction rate
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