ArticleFrontiers in surgery2026
Restoration of pre-arthritic coronal alignment improves joint perception following fixed-bearing medial unicompartmental knee arthroplasty.
Article in Frontiers in surgery, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Background: The optimal postoperative alignment strategy in unicompartmental knee arthroplasty (UKA) remains a topic of debate. Although traditional mechanical alignment targets a neutral axis, restoring a patient's pre-arthritic, constitutional alignment may enhance clinical outcomes and joint perception. This study compares patient-reported outcomes (PROs) and joint awareness between patients who achieved pre-arthritic alignment and those who did not after medial fixed-bearing UKA. Methods: In this retrospective cohort study, 266 patients who underwent medial fixed-bearing UKA between January, 2022 and May, 2023 were included, with a mean follow-up of 3.5 years. Pre-arthritic coronal alignment was estimated using the arithmetic Hip-Knee-Ankle angle (aHKA). Preoperative and postoperative coronal alignment measurements were performed using weight-bearing long-leg radiographs. Patients were stratified into two groups: pre-arthritically aligned (postoperative mechanical Hip-Knee-Ankle angle [mHKA] within ±3° of aHKA) and nonpre-arthritically aligned (mHKA beyond ±3° of aHKA). PROs assessed at final follow-up included Oxford Knee Score (OKS), Forgotten Joint Score-12 (FJS-12), and Kujala Score. Results: Among the cohort, 212 knees (79.7%) were classified as pre-arthritically aligned and 54 (20.3%) as nonpre-arthritically Aligned. The groups were comparable in all baseline demographic and radiological parameters ( Conclusion: Restoring pre-arthritic coronal alignment following fixed-bearing medial UKA is associated with superior patient-reported outcomes, including significantly better joint perception and patellofemoral function compared to nonpre-arthritic alignment. Further long-term follow-up is required to confirm the durability of these findings.
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