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Intraoperative Coronal Alignment Safe Zones Influence Patient Outcomes Following Total Knee Arthroplasty: A
Isobel H Oon1, Joseph T Lynch2, Cody Lindsay3
1University of Canberra Research Institute for Sport and Exercise (UCRISE), Faculty of Health, University of Canberra, Canberra, Australia.
This study found the 6° varus to 3° valgus (6VR-3VL) alignment strategy superior for patient outcomes and pain relief in total knee arthroplasty. Unrestricted alignment also improved knee flexion, suggesting better restoration of prearthritic alignment.
Area of Science:
- Orthopedic Surgery
- Biomechanical Engineering
- Reconstructive Surgery
Background:
- Patient dissatisfaction after total knee arthroplasty (TKA) can reach 20%, with alignment strategy a key factor.
- Previous reviews faced limitations due to inconsistent definitions of safe zones for neutral and kinematic alignment.
- This systematic review investigates the impact of intraoperative coronal alignment safe zones on patient-reported and functional outcomes in TKA.
Purpose of the Study:
- To systematically review and compare patient-reported and functional outcomes across different intraoperative coronal alignment safe zones in TKA.
- To identify optimal coronal alignment strategies that enhance patient satisfaction and functional recovery post-TKA.
- To address inconsistencies in safe zone definitions and their influence on TKA outcomes.
Main Methods:
- A comprehensive literature search was conducted across six major databases (Medline, Scopus, PubMed, Web of Science, CINAHL, Cochrane) in November 2024.
- Included studies reported patient outcomes (≥12 months postoperatively) and defined coronal alignment safe zones.
- Random-effects network meta-analyses compared outcomes (Forgotten Joint Score, pain, knee flexion) across four identified safe zones: 0° (neutral), ±3°, 6° varus to 3° valgus (6VR-3VL), and unrestricted. Quality assessment used the Methodological Index for Non-Randomized Studies.
Main Results:
- Four coronal safe zones were identified: neutral (0°), ±3°, 6VR-3VL, and unrestricted.
- The 6VR-3VL zone demonstrated superior patient outcomes, including the Forgotten Joint Score, pain reduction, and knee flexion.
- Unrestricted alignment was associated with improved knee flexion, potentially by better restoring the patient's native knee alignment.
Conclusions:
- The 6VR-3VL alignment strategy appears to yield better patient-reported outcomes and pain relief compared to neutral alignment.
- Unrestricted alignment may offer advantages in functional outcomes, specifically knee flexion.
- Restoring the patient's prearthritic alignment through specific coronal alignment strategies may be crucial for optimizing TKA results.
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