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Functional Limb Length Preservation and Coronal Alignment Categories in Revision Total Knee Arthroplasty
Farouk Khury1, Mallory Ehlers2, Hadi H Aziz2
1Department of Orthopedic Surgery, NYU Langone Health, New York, New York, USA; Division of Orthopedic Surgery, Rambam Health Care Campus, The Ruth and Bruce Rappaport Faculty of Medicine, Haifa, Israel.
The Journal of Arthroplasty
|August 12, 2026
Summary
Revision total knee arthroplasty (rTKA) can preserve limb length and alignment, but outcomes vary. Early success was linked to limb lengthening over the contralateral limb and avoiding shortening compared to pre-surgery, with preserved alignment aiding long-term pain relief.
Area of Science:
- Orthopedic Surgery
- Biomechanical Engineering
- Reconstructive Surgery
Background:
- Revision total knee arthroplasty (rTKA) aims to restore function and alignment.
- Assessing functional limb-length (LL) and coronal alignment preservation is crucial for rTKA success.
- The association between LL/alignment and patient-reported outcome measures (PROMs) requires further investigation.
Purpose of the Study:
- To evaluate functional limb-length (LL) and coronal alignment preservation following rTKA.
- To compare LL and alignment outcomes against pre-rTKA and contralateral limb baselines.
- To examine the relationship between LL/alignment preservation and PROMs.
Main Methods:
- Retrospective review of 70 rTKA patients with pre- and post-operative radiographs.
- Functional LL preservation defined as within ±10 mm of target.
- Comparison of PROMs (KOOS, JR, PROMIS Pain) across LL and alignment categories relative to baselines.
Main Results:
- Functional LL preserved relative to contralateral limb in 68.6%, and pre-rTKA LL in 47.1%.
- Coronal alignment preserved in 64.3% of cases.
- Early achievement of minimal clinically important difference (MCID) in PROMs was associated with over-lengthening (vs. contralateral) and avoiding shortening (vs. pre-rTKA).
Conclusions:
- RTwo-thirds of rTKA cases achieved functional LL and coronal alignment preservation.
- While PROMs were comparable across LL categories, early MCID achievement varied based on limb length changes.
- Preserving pre-rTKA coronal alignment was linked to superior long-term pain interference relief.