Alignment in Total Knee Arthroplasty: Avoid Crossing Over From Varus to Valgus

Pradyumna Gurusamy, Jennifer W. Liu, Thomas C. Sullivan, Terry A. Clyburn, Bradley Lambert, Stephen J. Incavo

Research output: Contribution to journalArticlepeer-review

Abstract

Background: Ideal target limb alignment remains a debated topic in total knee arthroplasty (TKA). We aimed to determine the effect of limb alignment correction on patient-reported outcomes and knee range of motion (ROM) following TKA. Methods: In this retrospective analysis, patients (N = 409) undergoing primary TKA at a single institution were studied. Using full leg-length radiographs, limb alignment was measured preoperatively and postoperatively. Patients were categorized by preoperative (Preop) alignment (varus > 0°; valgus < 0°). Preop varus patients were then divided as follows based on postoperative alignment: neutral (VAR-NEUT, 0°± 2), remaining in varus (VAR-rVAR, ≥3°), and cross-over to valgus (VAR-CO, ≤−3°). Similarly, Preop valgus patients were divided as follows for postoperative alignment: neutral (VAL-NEUT, 0°± 2), remaining in valgus (VAL-rVAL, ≤−3°), and cross-over to varus (VAL-CO, ≥3°). The Knee Injury and Osteoarthritis Outcome Score for Joint Replacement survey scores were collected at preoperatively as well as at 6 weeks, 3, 6, and 12 months postoperatively. Knee ROM was collected at 2 weeks, 6 to 12 weeks, and >6 months postoperatively. An analysis of variance repeated on time followed by a Bonferroni post hoc test was used to compare outcomes for the postoperative alignment subgroups. Results: Preop Varus patients: Those in the VAR-CO group (overcorrected to −4.03° ± 1.95valgus) were observed to have lower Knee Injury and Osteoarthritis Outcome Score for Joint Replacement scores at 3, 6, and 12 months postoperatively compared to those in the NEUT group (P <.05). This finding was paired with reduced ROM at 6 to 12 weeks postoperatively in the VAR-CO group compared to VAR-NEUT and VAR-rVAR (P <.05). Preop Valgus patients: Those in the VAL-rVal group (left in −4.39° ± 1.39valgus) were observed to have reduced knee flexion at 6 to 12 weeks postoperatively compared to VAL-NEUT and VAL-CO. Conclusions: These findings indicate that postoperative valgus alignment via either crossing over to valgus (VAR-CO) or remaining in valgus (VAL-rVAL) alignment may result in less preferable outcomes than correction to neutral or slightly varus alignment.

Original languageEnglish (US)
JournalJournal of Arthroplasty
DOIs
StateAccepted/In press - 2024

Keywords

  • coronal alignment
  • crossover
  • kinematic alignment
  • mechanical alignment
  • patient reported outcome measures
  • total knee arthroplasty

ASJC Scopus subject areas

  • Orthopedics and Sports Medicine

Fingerprint

Dive into the research topics of 'Alignment in Total Knee Arthroplasty: Avoid Crossing Over From Varus to Valgus'. Together they form a unique fingerprint.

Cite this