Hunt Anastasia A, Hollyer Ian, Pham Nicole S, Maloney William J, Huddleston James I
Department of Orthopaedic Surgery, Stanford University School of Medicine, Redwood City, CA, USA.
Arthroplast Today. 2025 Mar 13;32:101660. doi: 10.1016/j.artd.2025.101660. eCollection 2025 Apr.
The optimal postoperative coronal alignment after total knee arthroplasty (TKA) for preoperative valgus deformity is unknown. This study aims to evaluate the impact of postoperative coronal alignment on clinical outcomes following TKA for valgus deformities.
Patients in preoperative valgus undergoing primary TKA between 2010 and 2020 with at least 1 year of follow-up were retrospectively reviewed. Preoperative and postoperative mechanical alignment was assessed on long-leg radiographs via the hip-knee-ankle angle. Postoperative alignment was categorized into valgus (>2° valgus), neutral (within 2° of the mechanical axis), or varus (>2° varus). Patient demographics, preoperative and postoperative outcome scores, and complications were collected.
106 patients met inclusion criteria, with a mean preoperative valgus deformity of 11° (standard deviation ± 6.1). Postoperatively, 18 patients were in varus alignment, 58 were neutral, and 30 remained in valgus. At 2-year follow-up, multivariate analyses showed that patients in neutral or varus alignment postoperatively had superior Veterans RAND 12-Item Health Survey Physical and Knee injury and Osteoarthritis Outcome Score Pain scores compared to those in residual valgus. Varus knees showed significantly greater improvement in Knee Society Score Function scores compared to valgus knees. At final follow-up, Knee injury and Osteoarthritis Outcome Score Pain scores were significantly better in varus knees. Patients in varus were 7.79 times more likely to achieve the minimal clinically important difference VR-12 Physical score, while patients in neutral were 3.26 times more likely to achieve the minimal clinically important difference for Knee Society Score Function when compared to valgus knees.
Correcting preoperative valgus coronal alignment to neutral or varus yields improved patient-reported outcomes when compared to residual valgus.
全膝关节置换术（TKA）治疗术前外翻畸形后的最佳术后冠状面排列尚不清楚。本研究旨在评估术后冠状面排列对外翻畸形TKA术后临床结果的影响。
回顾性分析2010年至2020年间接受初次TKA且术前为外翻畸形、随访至少1年的患者。通过髋-膝-踝角在长腿X线片上评估术前和术后的机械对线。术后对线分为外翻（外翻>2°）、中立（在机械轴的2°范围内）或内翻（内翻>2°）。收集患者人口统计学资料、术前和术后结果评分以及并发症。
106例患者符合纳入标准，术前平均外翻畸形为11°（标准差±6.1）。术后，18例患者为内翻对线，58例为中立对线，30例仍为外翻对线。在2年随访时，多变量分析显示，术后中立或内翻对线的患者与残留外翻患者相比，在退伍军人兰德12项健康调查身体和膝关节损伤及骨关节炎结果评分疼痛评分方面更优。与外翻膝相比，内翻膝在膝关节协会评分功能评分方面有显著更大的改善。在末次随访时，内翻膝的膝关节损伤及骨关节炎结果评分疼痛评分明显更好。与外翻膝相比，内翻患者达到最小临床重要差异VR-12身体评分的可能性高7.79倍，而中立患者达到膝关节协会评分功能最小临床重要差异的可能性高3.26倍。
与残留外翻相比，将术前外翻冠状面排列纠正至中立或内翻可改善患者报告的结果。
