Rajani Amyn M, Desouza Clevio, Kulkarni Vishal, Mittal Anmol R S
OAKS Clinic, 707, Panchsheel Plaza, N S Patkar Marg, next to Dharam Palace, Gamdevi, Mumbai, Maharashtra 400007, Mumbai, India.
Eur J Orthop Surg Traumatol. 2025 Jul 26;35(1):327. doi: 10.1007/s00590-025-04453-8.
While total knee arthroplasty (TKA) is effective for managing end-stage tricompartmental osteoarthritis, up to 30% of patients report dissatisfaction due to functional limitations. There is increasing interest in whether maintaining slight residual varus alignment may better replicate native knee kinematics and improve outcomes.
This retrospective, single-center study evaluated 123 knees in 77 patients who underwent primary TKA between 2008 and 2010. The surgical aim was mild under-correction of varus deformity. Postoperative limb alignment was classified as residual varus (1°-3°), neutral (0°), or mild valgus (1°-2°). Clinical and radiological evaluations were performed at a mean follow-up of 15.5 years. Outcome measures included KOOS, KSS, FJS-12, VAS for pain/satisfaction, range of motion, and the ability to kneel or sit cross-legged. Radiographs assessed mechanical alignment and implant integrity.
Residual varus alignment (1°-3°) was achieved in 78.9% of knees. KOOS, KSS, and FJS-12 scores improved across all groups, with the varus group showing slightly higher final scores (KOOS: 92.8 ± 2.8) compared to neutral (92.0 ± 2.6) and valgus (91.4 ± 3.1), though not statistically significant. Radiographs showed no loosening or failure. Activities such as kneeling and cross-legged sitting were better preserved in the varus group.
At 15-year follow-up, patients with mild residual varus alignment demonstrated excellent functional outcomes and implant survival, with trends toward better satisfaction and cultural functionality. Mild under-correction in varus knees appears safe and may support more personalized alignment strategies.
虽然全膝关节置换术（TKA）在治疗终末期三关节骨关节炎方面有效，但高达30%的患者因功能受限而表示不满意。对于维持轻微残余内翻对线是否能更好地复制天然膝关节运动学并改善预后，人们的兴趣与日俱增。
这项回顾性单中心研究评估了2008年至2010年间接受初次TKA的77例患者的123个膝关节。手术目标是对内翻畸形进行轻度欠矫正。术后肢体对线分为残余内翻（1°-3°）、中立（0°）或轻度外翻（1°-2°）。平均随访15.5年时进行临床和影像学评估。结果指标包括膝关节损伤和骨关节炎疗效评分（KOOS）、膝关节协会评分（KSS）、12项功能膝关节评分（FJS-12）、疼痛/满意度视觉模拟评分（VAS）、活动范围以及跪或盘腿坐的能力。X线片评估机械对线和植入物完整性。
78.9%的膝关节实现了残余内翻对线（1°-3°）。所有组的KOOS、KSS和FJS-12评分均有所改善，内翻组的最终评分略高于中立组（92.0±2.6）和外翻组（91.4±3.1）（KOOS：92.8±2.8），但无统计学意义。X线片显示无松动或失败。内翻组在跪和盘腿坐等活动方面保留得更好。
在15年的随访中，轻度残余内翻对线的患者表现出优异的功能预后和植入物存活率，在满意度和文化功能方面有更好的趋势。内翻膝关节的轻度欠矫正似乎是安全的，可能支持更个性化的对线策略。
