ArticleKnee surgery, sports traumatology, arthroscopy : official journal of the ESSKA2018
Neutral alignment leads to higher knee society scores after total knee arthroplasty in preoperatively non-varus patients: a prospective clinical study using 3D-CT.
Article in Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA, 2018. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 49 papers, 7 of them syntheses that pooled it.
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Who cites it
49 citing papers in PubMed, 7 syntheses or guidelines pooled it, 84 citations in OpenAlex.
- Verasense sensor-assisted total knee arthroplasty showed no difference in range of motion, reoperation rate or functional outcomes when compared to manually balanced total knee arthroplasty: a systematic review.Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA · 2023Pooled it
- Kinematic alignment versus mechanical alignment in primary total knee arthroplasty: an updated meta-analysis of randomized controlled trials.Journal of orthopaedic surgery and research · 2022Pooled it
- Comparison of Outcomes After Total Knee Arthroplasty Involving Postoperative Neutral or Residual Mild Varus Alignment: A Systematic Review and Meta-analysis.Orthopaedic surgery · 2022Pooled it
- Intra- and postoperative assessment of femoral component rotation in total knee arthroplasty: an EKA knee expert group clinical review.Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA · 2021Pooled it
- Similar results with kinematic and mechanical alignment applied in total knee arthroplasty.Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA · 2020Pooled it
- Highly variable coronal tibial and femoral alignment in osteoarthritic knees: a systematic review.Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA · 2019Pooled it
- Native non-osteoarthritic knees have a highly variable coronal alignment: a systematic review.Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA · 2019Pooled it
- Accelerometer-based portable navigation, a faster guide compared to computer-assisted navigation in bilateral total knee arthroplasty-a randomized controlled study.Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA · 2023Trial
- Predictive pre-resection robotic ligament balancing in total knee arthroplasty is accurate across surgeons and patient factors.Journal of robotic surgery · 2026Article
- Analysis of CPAK change in robotic functional alignment TKA: a new simplified classification.Archives of orthopaedic and trauma surgery · 2026Article
- A new parameter in the era of robotic total knee arthroplasty: Coronal alignment at 90° of flexion impacts clinical outcomes.Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA · 2025Article
- Is limb overcorrection following total knee arthroplasty compromising functional outcome?Journal of orthopaedics · 2025Article
- Residual Postoperative Valgus After Total Knee Arthroplasty for Preoperative Valgus Deformity Results in Inferior Patient-Reported Outcomes.Arthroplasty today · 2025Article
- Predictors of Lower Limb Coronal Malalignment after Conventional Total Knee Arthroplasty Using a Mechanical Alignment Strategy.The archives of bone and joint surgery · 2025Article
- Phenotyping of the Turkish population according to Coronal Plane Alignment of the Knee classification: A retrospective cross-sectional study.Joint diseases and related surgery · 2024Article
- Staged Extra-Articular Deformity Correction in the Setting of Total Knee Arthroplasty.Arthroplasty today · 2023Article
- How Do the Morphological Abnormalities of Femoral Head and Neck, Femoral Shaft and Femoral Condyle Affect the Occurrence and Development of Medial Knee Osteoarthritis.Orthopaedic surgery · 2023Article
- Excessive femoral torsion is not associated with patellofemoral pain or instability if TKA is functionally aligned and the patella denervated.Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA · 2023Article
- The impact of different alignment strategies on bone cuts in total knee arthroplasty for varus knee phenotypes.Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA · 2023Article
- Mechanically aligned total knee arthroplasty with the extension-first technique does not equally restore neutral knee alignment in all preoperative knee phenotypes.Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA · 2023Article
Corrections and comments
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Authors and funding
6 authors at 4 institutions in 2 countries.
Funding
No grant is acknowledged in the PubMed record.
Abstract
purposeThe optimal coronal alignment is still under debate. However, in most of the studies, alignment was only assessed using radiographs, which are not accurate enough for assessment of tibial and femoral TKA position. The primary purpose of this study was to assess the relationship between coronal TKA alignment using 3D-reconstructed CTs and clinical outcome in patients with preoperative varus in comparison with patients with natural or valgus deformity. It was the hypothesis that neutral limb alignment shows a better outcome after TKA.
methodsProspectively collected data of 38 patients were included. The clinical and radiological follow-up was 24 months. The patients were grouped into two groups with regard to their preoperative limb alignment. Group A (varus) consisted of 21 patients with preoperative varus of 3° or more, while group B (non-varus) consisted of 17 patients with neutral (- 3 < 0 > + 3) or valgus alignment (> + 3). For assessment of TKA component position and orientation, 3D-reconstructed CT was used. The measurements of the deviation from the whole limb mechanical axis (HKA angle) and the joint line alignment in the femoral (mLDFA) and the tibial side (MPTA) were assessed in the preoperative leg as well as during follow-up after TKA. For clinical outcome assessment, the Knee Society Score (KSS) was used at 1 and 2 years postoperatively. Correlation between KSS score and each variable was done using a linear and quadratic regression model (p < 0.05).
resultsThe mean postoperative HKA angle was - 1.3 (varus) in the varus group and + 1.4 (valgus) in the non-varus group. Overall, significant correlations between the preoperative and postoperative alignments were found. In the preoperatively non-varus group, a highly significant correlation was found between neutral limb alignment (HKA = 0° ± 3°) and higher KSS (r
conclusionA significant correlation was found between neutral limb alignment and higher KSS only in patients with preoperative non-varus alignment. The concept of constitutional varus alignment is still under debate. Moreover, it appears that one should aim for a more individualized, alignment target based on the individual knee morphotype. LEVEL OF EVIDENCE: Diagnostic study, Level II.
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