Varus malalignment has no influence on clinical outcome in midterm follow-up after total knee replacement

Matziolis, Georg; Adam, J; Perka, Carsten

doi:10.1007/s00402-010-1064-9

Cited by 140 publications

(134 citation statements)

References 23 publications

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“…The same applied for KSS and ROM, where the differences were small and hardly clinically relevant (Table 2, see supplementary data, and Table 4). This is in agreement with the results of Matziolis et al (2010), who reported that postoperative varus malalignment as compared to neutral knee alignment after TKA had no influence on clinical outcome (KSS, the WOMAC, and the SF36). Furthermore, Magnussen et al (2011) even found KSS to be better in patients with residual varus than in those with neutral alignment.…”

Section: Discussionsupporting

confidence: 92%

Moderate varus/valgus malalignment after total knee arthroplasty has little effect on knee function or muscle strength

Stučinskas¹,

Robertsson²,

Širka³

et al. 2015

Acta Orthopaedica

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Background and purpose — Postoperative muscle strength and component alignment are important factors affecting functional results after total knee arthroplasty (TKA). We are not aware of any studies that have investigated the relationship between them. We therefore investigated whether coronal malalignment of the mechanical axis and/or of individual implant components would affect knee muscle strength and function 1 year after TKA surgery.Patients and methods — We included 120 consecutive osteoarthritis (OA) patients admitted for TKA. Preoperative active range of motion (ROM) of the knee, patient age, sex, and BMI were recorded and the Knee Society score (KSS) and knee joint extensor/flexor muscle strength were assessed. At 1-year follow-up, the mechanical and coronal component alignment was measured from a postoperative long standing radiograph, and ROM, KSS, and muscle strength measurements were taken in 91 patients. Functional outcome and muscle strength measurements were compared between normally aligned and malaligned TKA groups.Results — 29 of 91 TKAs were malaligned, i.e. they deviated more than 3° from the neutral mechanical axis. 18 femoral components and 15 tibial components were malaligned. Before surgery, the malaligned and normally aligned groups were similar regarding sex distribution, BMI, ROM, KSS, and muscle strength. At the 1-year follow-up, the differences between the groups regarding knee joint function and muscle strength were small, not statistically significant, and barely clinically relevant.Interpretation — Moderate varus/valgus malalignment of the mechanical axis or of individual components has no relevant clinical effect on function or muscle strength 1 year after TKA surgery.

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Section: Discussionsupporting

confidence: 92%

Moderate varus/valgus malalignment after total knee arthroplasty has little effect on knee function or muscle strength

Stučinskas¹,

Robertsson²,

Širka³

et al. 2015

Acta Orthopaedica

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“…Our subgroup comparisons of the functional outcomes of aligned knees and outliers may provide some clues to resolving recent debate as to whether the restoration of neutral limb alignment is associated with better functional outcome [4,23,32]. Several authors have recently challenged the importance of the restoration of neutral limb alignment [4,23,32].…”

Section: Discussionmentioning

confidence: 89%

Section: Discussionmentioning

confidence: 99%

“…Several authors have recently challenged the importance of the restoration of neutral limb alignment [4,23,32]. A previous study that compared aligned and varus-malaligned knees found no differences between the two in terms of American Knee Society, WOMAC, or SF-36 scores [23]. In contrast, in our study, the mechanical tibiofemoral angle outlier had a lower American Knee Society knee score and SF-36 physical component summary score, and coronal tibial prosthesis alignment outlier had a low SF-36 physical component summary score.…”

Section: Discussionmentioning

confidence: 99%

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Femoral Lateral Bowing and Varus Condylar Orientation Are Prevalent and Affect Axial Alignment of TKA in Koreans

Lasam

Lee

Chang

et al. 2013

Clinical Orthopaedics &Amp; Related Research

100

120

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Background Coronal alignment is considered key to the function and longevity of a TKA. However, most studies do not consider femoral and tibial anatomical features such as lateral femoral bowing and the effects of these features and subsequent alignment on function after TKA are unclear. Questions/purposes We therefore determined (1) the prevalence of lateral femoral bowing, varus femoral condylar orientation, and severe tibia plateau inclination in female Koreans undergoing TKA; (2) whether postoperative alignments are affected by these anatomical features and improved by the use of navigation; and (3) whether postoperative coronal alignments are associated with function.Methods We measured alignment in 367 knees that underwent TKA and 60 sex-and age-matched normal knees (control group). We determined patterns and degrees of femoral bowing angle, femoral condylar orientation, and tibial plateau inclination on preoperative full-limb radiographs. Postoperatively, coronal alignment of limbs and of femoral and tibial components was measured. We compared American Knee Society scores, WOMAC scores, and SF-36 scores in aligned knees and outliers (beyond ± 3°o r ± 2°) at 1 year. Results The prevalence of lateral femoral bowing was 88% in the TKA group and 77% in the control group. Mean femoral condylar orientation angle was varus 2.6°in the TKA group and valgus 1.1°in the control group, and mean tibial plateau inclination was varus 8.3°in the TKA group and varus 5.4°in the control group. Femoral lateral bowing and varus femoral condylar orientation were associated with postoperative alignments. Several clinical outcome scales were inferior in the outliers in mechanical tibiofemoral angle, anatomical tibiofemoral angle, and tibial coronal alignment but not in femoral coronal alignment outliers. Conclusions Lateral femoral bowing, varus condylar orientation, and severe varus inclination of the tibia plateau should be considered when performing TKA in Korean patients or patients with otherwise similar anatomical features.

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“…Parratte et al [67] found mechanical alignment in 292 TKAs did not confer a significant advantage compared to malalignment (± 3°) in 106 cases in terms of survival. In a smaller study, Matziolis et al [57] reported no difference in patient outcome between aligned TKA and a subset of varus outliers and no revisions in either group. Nevertheless, their findings implied not that coronal alignment was unimportant but rather that assessment of alignment as a dichotomous variable (aligned versus malaligned) was limited and could only serve as a general guideline.…”

Section: Discussionmentioning

confidence: 93%

Improved Accuracy of Alignment With Patient-specific Positioning Guides Compared With Manual Instrumentation in TKA

DeClaire

Berend

et al. 2012

Clinical Orthopaedics &Amp; Related Research

285

243

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Background Coronal malalignment occurs frequently in TKA and may affect implant durability and knee function. Designed to improve alignment accuracy and precision, the patient-specific positioning guide is predicated on restoration of the overall mechanical axis and is a multifaceted new tool in achieving traditional goals of TKA. Questions/purposes We compared the effectiveness of patient-specific positioning guides to manual instrumentation with intramedullary femoral and extramedullary tibial guides in restoring the mechanical axis of the extremity and achieving neutral coronal alignment of the femoral and tibial components. Methods We retrospectively reviewed 569 TKAs performed with patient-specific positioning guides and 155 with manual instrumentation by two surgeons using postoperative long-leg radiographs. For all patients, we assessed the zone in which the overall mechanical axis passed through the knee, and for one surgeon's cases (105 patient-specific positioning guide, 55 manual instrumentation), we also measured the hip-knee-ankle angle and the individual component angles with respect to their mechanical axes. Results The overall mechanical axis passed through the central third of the knee more often with patient-specific positioning guides (88%) than with manual instrumentation (78%). The overall mean hip-knee-ankle angle for patient-specific positioning guides (180.6°) was similar to manual instrumentation (181.1°), but there were fewer ± 3°hip-knee-ankle angle outliers with patient-specific positioning guides (9%) than with manual instrumentation (22%). The overall mean tibial (89.9°versus 90.4°) and femoral (90.7°versus 91.3°) component angles were closer to neutral with patient-specific positioning guides than with manual instrumentation, but the

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Varus malalignment has no influence on clinical outcome in midterm follow-up after total knee replacement

Cited by 140 publications

References 23 publications

Moderate varus/valgus malalignment after total knee arthroplasty has little effect on knee function or muscle strength

Moderate varus/valgus malalignment after total knee arthroplasty has little effect on knee function or muscle strength

Femoral Lateral Bowing and Varus Condylar Orientation Are Prevalent and Affect Axial Alignment of TKA in Koreans

Improved Accuracy of Alignment With Patient-specific Positioning Guides Compared With Manual Instrumentation in TKA

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