Abstract
Background:There is an ongoing debate whether patients with constitutional varus should be restored to neutral mechanical alignment following total knee arthroplasty (TKA).Objective:The aim of this retrospective cohort study is to determine whether mild unintentional postoperative varus alignment (3°–6°) influences TKA outcome in patients with and without preoperative varus alignment due to medial osteoarthritis of the knee.Methods:We analyzed 172 consecutive TKA cases between April 2011 and May 2014. Patients were divided into four groups based on their preoperative and postoperative hip-knee-ankle angles (HKA): preoperative varus ≤ 3° with postoperative varus position ≤ 3° (Group 1, n = 47); preoperative varus >3° with postoperative varus ≤ 3° (Group 2, n = 104); preoperative varus ≤ 3° with postoperative varus malalignment > 3° (Group 3, n = 3); and preoperative varus > 3° with postoperative varus malalignment > 3° (Group 4, n = 18). Patients were followed up until 2 years postoperatively.Results:Knee Society Score and Western Ontario and McMaster University Osteoarthritis Index scores for all study groups increased following TKA, with no postoperative differences at any time point. Group 4 performed significantly better on the Forgotten Joint Score than Group 2 (p = 0.019). Group 4 performed significantly better on the High Flexion Knee Score than Group 2 (p = 0.004) and Group 1 (p = 0.019). All other between-group differences were not statistically significant.Conclusion:Residual postoperative varus alignment of the lower limb does not appear to adversely affect clinical outcome following TKA for varus-type osteoarthritis.
Highlights
During the last few decades, there has been consensus that restoration of neutral limb alignment is necessary for successful total knee arthroplasty (TKA) outcome
There is an ongoing debate whether patients with constitutional varus should be restored to neutral mechanical alignment following total knee arthroplasty (TKA)
Group 4 performed significantly better on the High Flexion Knee Score than Group 2 (p = 0.004) and Group 1 (p = 0.019)
Summary
During the last few decades, there has been consensus that restoration of neutral limb alignment is necessary for successful total knee arthroplasty (TKA) outcome. Matziolis et al, who conducted a matched cohort study to compare patients with unintentional residual varus and patients with neutral mechanical alignment, found a Knee Society Score (KSS) of 158 points in the varus group and 142 points in neutral alignment group (p > 0.05). The researchers found that TKAs placed in mild varus scored significantly better at 7 years on the KSS (with 10 points difference on the KSS) and WOMAC (with 15 points difference), as compared with knees that were corrected to neutral alignment [8]. There is an ongoing debate whether patients with constitutional varus should be restored to neutral mechanical alignment following total knee arthroplasty (TKA)
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