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Sagittal parameters after primary TKA affecting knee joint function: a correlative analysis and predictive model

Wenqian Xu1, Xiaotao Huang2, Jinsong Liu1

  • 1Department of Orthopaedics, First Affiliated Hospital of Kunming Medical University, Kunming, 650032, Yunnan, China.

Journal of Orthopaedic Surgery and Research
|February 8, 2026
PubMed
Summary

Accurate sagittal knee prosthesis placement, specifically posterior tibial slope (PTS), posterior condylar offset (PCO), and patellar thickness, significantly impacts total knee arthroplasty (TKA) outcomes. These parameters are crucial for achieving satisfactory patient function and joint feeling post-surgery.

Keywords:
Clinical prediction modelCorrelation analysisRetrospective studySagittal parametersTotal knee arthroplasty

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Area of Science:

  • Orthopedic Surgery
  • Biomedical Engineering
  • Radiology

Background:

  • Accurate prosthesis placement is vital for the clinical efficacy of total knee arthroplasty (TKA).
  • While coronal and patellar axial parameters are often within normal limits, some TKA patients experience suboptimal outcomes, potentially due to abnormal sagittal parameters.
  • This study investigates the relationship between sagittal parameters and clinical efficacy following TKA.

Purpose of the Study:

  • To analyze the impact of sagittal knee prosthesis placement parameters on clinical outcomes after primary TKA.
  • To identify key sagittal parameters influencing patient prognosis.
  • To develop a clinical prediction model for satisfactory postoperative status in TKA patients.

Main Methods:

  • Retrospective analysis of 188 patients undergoing primary TKA.
  • Collection of coronal, patellar axial, and sagittal radiographic parameters.
  • Correlation analysis (Spearman) and logistic regression were used to assess the association between sagittal parameters and clinical scores (HSS, KPS, FJS-12), followed by predictive model development.

Main Results:

  • Posterior tibial slope (PTS), posterior condylar offset (PCO), and posterior condylar offset ratio (PCOR) positively correlated with the Hospital for Special Surgery Knee Score (HSS).
  • Patellar thickness and Blackburne-Peel index (B-P index) showed negative correlations with HSS and KPS.
  • PTS, PCO, PCOR, B-P index, and patellar thickness were independently associated with the Forgotten Joint Score (FJS-12). Optimal parameters for satisfactory outcomes included PTS ≥ 5.5°, PCO ≥ 31.2 mm, B-P index < 1, and patella thickness < 16.6 mm.

Conclusions:

  • Sagittal parameters, including PCO, PCOR, PTS, B-P index, and patellar thickness, significantly influence patient prognosis after TKA.
  • Clinicians should pay close attention to these sagittal parameters during prosthesis implantation.
  • The developed prediction model provides optimal parameter ranges for improved TKA outcomes.