Alignment in Total Knee Arthroplasty: Avoid Crossing Over From Varus to Valgus

Area of Science:

• Orthopedic Surgery
• Biomechanical Engineering
• Reconstructive Surgery

Background:

• Limb alignment in total knee arthroplasty (TKA) is a critical factor influencing surgical success.
• Debate persists regarding the ideal target limb alignment for optimal patient outcomes post-TKA.

Purpose of the Study:

• To investigate the impact of postoperative limb alignment correction on patient-reported outcomes and knee range of motion (ROM) following TKA.
• To compare outcomes across different postoperative alignment subgroups in patients undergoing primary TKA.

Main Methods:

• Retrospective analysis of 409 primary TKA patients using full leg-length radiographs for alignment measurement.
• Categorization of patients based on preoperative and postoperative alignment (neutral, varus, valgus, crossover).
• Assessment of Knee Injury and Osteoarthritis Outcome Score for Joint Replacement (KOOSJR) and knee ROM at various postoperative intervals.

Main Results:

• Patients with postoperative valgus alignment (VAR-CO) showed significantly lower KOOSJR scores and reduced ROM compared to neutral alignment.
• Preoperative valgus patients remaining in valgus alignment (VAL-rVAL) exhibited decreased knee flexion.
• Overcorrection to valgus (VAR-CO) resulted in poorer outcomes than neutral or remaining varus alignment.

Conclusions:

• Postoperative valgus alignment, whether through overcorrection or failure to correct, is associated with less favorable patient outcomes and reduced knee ROM.
• Correction to neutral or slightly varus alignment appears to be a more beneficial strategy in TKA.