Tuengler Tim Ludwig, Sterneder Christian Manuel, Haralambiev Lyubomir, Boettner Friedrich
Adult Reconstruction and Joint Replacement Service, Hospital for Special Surgery, New York, USA.
Department of Orthopedics, Greifswald University Hospital, Greifswald, Germany.
Arch Orthop Trauma Surg. 2025 Jan 25;145(1):145. doi: 10.1007/s00402-025-05765-4.
Knee alignment significantly impacts the outcome of total knee arthroplasty (TKA). Understanding patient perceptions of their knee alignment in relation to objective measurements is essential to ensure optimal surgical outcomes and to meet patients' expectations. This study reports patients' perception of pre- and postoperative knee alignment in relation to radiographic alignment measurements.
The study included 141 patients with primary osteoarthritis of the knee (mean age: 65.4 years, BMI: 30.8). Patients categorized their knee alignment before and after surgery using a picture-based rating scale: very bow-legged (> 10° varus), bow-legged (2.1-10° varus), straight (2° varus to 2° valgus), knock-kneed (2.1-10° valgus), and very knock-kneed (> 10° valgus). Hip-to-ankle films were performed to compared actual knee alignment with patients' assessments retrospectively.
Preoperatively, 15.1% of patients with severe varus, 55.6% with varus, and 86.7% with neutral alignment perceived their knees as straight. None of the patients with valgus or severe valgus alignment considered their knees as straight. Overall, 40.2% of patients with radiographic varus alignment classified their knees as straight, while nobody with valgus alignment did. Postoperatively patients with preoperative varus considered their knees as straight with an average of 1.8 ± 1.7 deg. mechanical varus alignment, while patients with preoperative valgus alignment considered their knees straight with an average of 0.4 ± 0.9 deg. mechanical valgus alignment.
Patients predominantly desire a straight knee postoperatively, however, most patients tend to perceive some varus alignment as straight. This is most common in patients with up to 5 degrees of varus deformity and suggests that a restricted or inverse kinematic alignment with up to 5 degrees of varus can meet the expectations of most patients. In contrast, patients with valgus deformity are sensitive to any remaining valgus deformity and leaving the knees in more than 2 deg. of valgus will unlikely satisfy the patients' overall desire for a straight knee after surgery.
膝关节对线显著影响全膝关节置换术（TKA）的结果。了解患者对其膝关节对线与客观测量结果之间关系的看法，对于确保最佳手术效果和满足患者期望至关重要。本研究报告了患者对术前和术后膝关节对线与影像学对线测量结果之间关系的看法。
该研究纳入了141例原发性膝关节骨关节炎患者（平均年龄：65.4岁，体重指数：30.8）。患者使用基于图片的评分量表对手术前后的膝关节对线进行分类：非常弓形腿（内翻>10°）、弓形腿（内翻2.1 - 10°）、直（内翻2°至外翻2°）、膝外翻（外翻2.1 - 10°）和非常膝外翻（外翻>10°）。回顾性地进行髋到踝部X线片检查，以比较实际膝关节对线与患者的评估结果。
术前，15.1%的重度内翻患者、55.6%的内翻患者和86.7%的中立对线患者认为他们的膝盖是直的。没有外翻或重度外翻对线的患者认为他们的膝盖是直的。总体而言，40.2%的影像学内翻对线患者将他们的膝盖分类为直，而没有外翻对线的患者这样做。术后，术前内翻的患者认为他们的膝盖是直的，平均机械内翻对线为1.8±1.7度，而术前外翻对线的患者认为他们的膝盖是直的，平均机械外翻对线为0.4±0.9度。
患者术后主要希望膝关节是直的，然而，大多数患者倾向于将一些内翻对线视为直。这在高达5度内翻畸形的患者中最为常见，表明高达5度内翻的受限或反向运动学对线可以满足大多数患者的期望。相比之下，外翻畸形患者对任何残留的外翻畸形都很敏感，术后膝关节外翻超过2度不太可能满足患者对直膝的总体期望。
