SynthesisKnee surgery, sports traumatology, arthroscopy : official journal of the ESSKA2019
Highly variable coronal tibial and femoral alignment in osteoarthritic knees: a systematic review.
Synthesis in Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA, 2019. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 77 papers, 2 of them syntheses that pooled it.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
77 citing papers in PubMed, 2 syntheses or guidelines pooled it, 130 citations in OpenAlex.
- Sexual dimorphism and racial diversity render bone-implant mismatch inevitable after off-the-shelf total knee arthroplasty: a systematic review and meta-analysis.Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA · 2022Pooled it
- Kinematic alignment of medial UKA is safe: a systematic review.Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA · 2022Pooled it
- Similar postoperative outcomes after total knee arthroplasty with measured resection and gap balancing techniques using a contemporary knee system: a randomized controlled trial.Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA · 2021Trial
- Article
- Coronal Plane Alignment of the Knee Classification and Its Correlation with Post-operative Functional Outcomes in Total Knee Arthroplasty: A Prospective Cohort Study.Journal of orthopaedic case reports · 2026Article
- Reliability of the CPAK classification assessed on long-leg X-rays in patients undergoing total knee arthroplasty.Arthroplasty (London, England) · 2026Article
- Speaking the same language? A direct cartography between functional knee phenotypes and CPAK.Journal of experimental orthopaedics · 2026Article
- Alignment and/or ligament balancing? Towards truly personalized total knee arthroplasty-A narrative review.Journal of experimental orthopaedics · 2026Review
- Medial femoral condyle restoration technique in total knee arthroplasty.Arthroplasty (London, England) · 2026Article
- Precision medicine in orthopaedics: A review of current technologies and future directions.Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA · 2026Review
- Clinical outcomes following mobile-bearing unicompartmental knee arthroplasty in patients with varying degrees of perioperative alignment change.Arthroplasty (London, England) · 2026Article
- Computed tomography versus long-leg radiography for CPAK-based coronal alignment assessment in total knee arthroplasty: a prospective evaluation.Journal of robotic surgery · 2025Article
- Personalized Robotic-Assisted Total Knee Arthroplasty with Anatomo-Functional Implant Positioning for Varus Knees: A Minimum Follow-Up of 5 Years.Journal of personalized medicine · 2025Article
- Total Knee Arthroplasty and the Evolution of Coronal Alignment: From Mechanical to Personalized Strategies.Journal of personalized medicine · 2025Review
- Biplanar radiographic analysis of knee alignment: a stepwise approach for phenotype classification and knee arthroplasty planning.EFORT open reviews · 2025Review
- Effects of a novel externally rotated trochlear design on patellofemoral kinematics in total knee arthroplasty: A cadaveric study.Journal of experimental orthopaedics · 2025Article
- Robotic-assisted "physiological alignment" TKA with a 3-degree varus inclination does not affect gait ability, regardless of pre-arthritic CPAK classification matching.Journal of orthopaedics · 2025Article
- Rotational Projection Errors in Coronal Knee Alignment on Weight-Bearing Whole-Leg Radiographs: A 3D CT Reference Across CPAK Morphotypes.Bioengineering (Basel, Switzerland) · 2025Article
- Isolated tibial deformity is the most prevalent varus pattern in North American patients undergoing medial opening wedge high tibial osteotomy.Journal of experimental orthopaedics · 2025Article
- Differential effects of tibia varus deformity on clinical outcomes following high tibial osteotomy and unicompartmental knee arthroplasty for moderate medial compartment osteoarthritis with moderate varus alignment.Archives of orthopaedic and trauma surgery · 2025Article
17 more citing papers are in PubMed but not listed here.
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
5 authors at 4 institutions in 2 countries.
Funding
No grant is acknowledged in the PubMed record.
Abstract
purposeThere is a lack of knowledge about coronal alignment variability in osteoarthritic knees. Therefore, the purpose of this article was to systematically review the literature and collect data about the lower limb alignment including hip-knee-ankle angle (HKA), femoral mechanical angle (FMA), tibial mechanical angle (TMA) and the joint line convergence angle (JLCA) in osteoarthritic knees.
methodsA systematic review was performed using the electronic databases MEDLINE (PubMed), EMBASE and Google Scholar. The following keywords were used: (morphology OR geometr* OR anatomy OR alignment OR phenotypes), (coronal OR neutral OR varus OR valgus), (knee OR lower limb OR femur OR tibia) and (osteoarthritis OR arthritis). Out of 110 full-text articles retrieved, 15 studies were included. Demographic information included author's names, year of publication, imaging modality, sample size and patient demographics (i.e. sex, age, etc.). Descriptive statistics, such as means, ranges, and measures of variance [e.g. standard deviations, 95% confidence intervals (CI)] for all angles (HKA, FMA, TMA, JLCA) are presented.
resultsThirteen studies reported mean overall HKA angles ranging from 163.5° ± 2.3° to 179.9° ± 4.8°. The mean HKA angles in females were between 164.1° ± 7.2° and 178.8° ± 4.8°, and in males between 163.4° ± 5.5° and 177.4° ± 3.9°. The lowest and highest reported HKA angles were - 27.7° and + 22.0°, respectively. Seven studies reported mean FMA angles. Mean values ranged from 92.7° ± 2.7° valgus to 88.6° ± 2° varus. The reported mean FMAs for male were 87.9° ± 0.5° to 90.7° ± 3° and for female 89.91° ± 2.8° to 92.9° ± 3.1°. Six studies reported mean TMA values. TMA ranged from 81.7° ± 3.9° varus to 87.7° ± 4.1° varus. Only three studies reported mean JLCA angles, which ranged from - 4.3° to - 6.4° ± 3.8°.
conclusionOsteoarthritic knees showed a huge variation in overall coronal limb alignment as well as in femoral and tibial coronal alignment. Current total knee arthroplasty (TKA) alignment philosophies and preoperative planning do not sufficiently consider these variation, which might be one reason for unhappy knees after TKA. LEVEL OF EVIDENCE: IV, systematic review.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.