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. 2021 Oct;29(10):3170-3177.
doi: 10.1007/s00167-020-06097-z. Epub 2020 Jun 17.

Restoration of pre-operative joint line orientation and alignment does not affect KSS and KOOS 1 year after total knee arthroplasty

Michele D'Amato  1 , Nienke M Kosse  2 , Ate B Wymenga  3
Affiliations

Restoration of pre-operative joint line orientation and alignment does not affect KSS and KOOS 1 year after total knee arthroplasty

Michele D'Amato et al. Knee Surg Sports Traumatol Arthrosc. 2021 Oct.

Abstract

Purpose: The objectives of this study were to examine the relation between clinical outcomes 1 year postoperatively, in a cohort of mechanically aligned total knee arthroplasties (TKA), and (1) the degrees of alignment change of the tibial, femoral and the hip-knee-ankle (HKA) angle; (2) the change of phenotype; (3) the postoperative knee joint line orientation to the floor.

Methods: Pre-operative and postoperative long-leg X-rays of 90 patients were used to determine the coronal alignment. The absolute difference between the pre-operative and postoperative measurements was determined and the outcomes were categorized in whether or not a change in phenotype had occurred. Finally, the orientation of the knee joint line relative to the floor (tibial joint line angle-TJLA) was measured. Clinical outcomes were determined with the KOOS and KSS at 1-year follow-up.

Results: The clinical outcomes (1) did not correlate with the absolute difference of the alignment measured; (2) did not show a difference between patients with or without a change in phenotype; and (3) were higher (KOOS ADL, Sport and QoL) in patients with a medial open TJLA.

Conclusion: This study showed no correlation between clinical outcomes and joint line restoration of the femur, tibia or HKA in patients after TKA. Leaving the prosthesis with some degrees of under correction on the coronal plane maintaining the phenotype, was not associated to better clinical results compared to TKA overcorrection. Nevertheless, the results showed that patients with a medial open TJLA had better clinical outcomes than patients with a lateral open TJLA.

Level of evidence: III.

Keywords: Joint line orientation; Mechanical alignment; Phenotype; Total knee arthroplasty.

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