Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2025 May 9;35(1):184.
doi: 10.1007/s00590-025-04297-2.

Distribution of coronal plane alignment of the knee and functional knee phenotype classification in the Thai arthritic population and correlation with other Asian populations

Sirada Phongpetra  1 , Thun Osirichaivait  1 , Krish Danghorachai  1 , Nop Khongthon  2 , Krit Boontanapibul  3
Affiliations

Distribution of coronal plane alignment of the knee and functional knee phenotype classification in the Thai arthritic population and correlation with other Asian populations

Sirada Phongpetra et al. Eur J Orthop Surg Traumatol. .

Abstract

Purpose: The Coronal Plane Alignment of the Knee (CPAK) and Functional Knee Phenotype (FKP) classification system categorize knee phenotypes into subtypes. It has been proposed that maintaining constitutional knee alignment in knee arthroplasty may enhance outcomes. Therefore, this study aimed to examine the phenotypic distribution in a Thai population using the CPAK and FKP classifications and its correlation with other Asian populations.

Methods: This retrospective cohort study included 509 patients who underwent knee arthroplasty. Long-leg standing weight-bearing radiographs were used to categorize patients according to the CPAK (arithmetic hip-knee-ankle angle [aHKA], joint-line obliquity [JLO]) and FKP (hip-knee-ankle angle [HKA], femoral mechanical angle [FMA], and tibial mechanical angle [TMA]) classification system.

Results: The most common CPAK distribution was type I (49.3%), followed by type II (20.6%) and type IV (11.0%). In males, CPAK Types I and II were the most common, similar to females; however, males had a significantly higher rate of Type I than females (58.8% vs. 46.5%, p = 0.049). The most frequent FKP was VARHKA6°VARFMA3°VARTMA3° (10%), VARHKA3°VARFMA3°NEUTMA0° (7.7%), and NEUHKA0°NEUFMA0°NEUTMA0° (7.1%). Thai arthritic knees predominantly exhibited apex distal JLO with constitutional varus alignment, consistent with findings from other Asian populations. There were no significant differences in CPAK distribution between TKA and UKA patients; however, aHKA and lateral distal femoral angle were significantly different between groups.

Conclusion: The Thai arthritic population demonstrates a significant trend toward apex distal JLO and varus alignment, aligning with findings from other Asian populations, which aids in the personalization of knee arthroplasty approaches.

Keywords: Constitutional limb alignment; Coronal plane alignment of the knee; Functional knee phenotype; Knee arthroplasty; Knee phenotype; Osteoarthritis.

PubMed Disclaimer

Conflict of interest statement

Declarations. Conflict of interests: The authors declare no competing interests.

References

    1. Bourne RB, Chesworth BM, Davis AM, Mahomed NN, Charron KD (2010) Patient satisfaction after total knee arthroplasty: who is satisfied and who is not? Clin Orthop Relat Res 468(1):57–63 - DOI - PubMed
    1. Bellemans J, Colyn W, Vandenneucker H, Victor J (2012) The Chitranjan Ranawat award: is neutral mechanical alignment normal for all patients? The concept of constitutional varus. Clin Orthop Relat Res 470(1):45–53 - DOI - PubMed
    1. MacDessi SJ, Allom RJ, Griffiths-Jones W, Chen DB, Wood JA, Bellemans J (2022) The importance of joint line obliquity: a radiological analysis of restricted boundaries in normal knee phenotypes to inform surgical decision making in kinematically aligned total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 30(9):2931–2940 - DOI - PubMed
    1. MacDessi SJ, Griffiths-Jones W, Harris IA, Bellemans J, Chen DB (2021) Coronal plane alignment of the knee (CPAK) classification: a new system for describing knee phenotypes. Bone Joint J 103(2):329–37 - DOI - PubMed
    1. Clark GW, Steer RA, Khan RN, Collopy DM, Wood D (2023) Maintaining joint line obliquity optimizes outcomes of functional alignment in total knee arthroplasty in patients with constitutionally varus knees. J Arthroplasty 38(7):S239–S244 - DOI - PubMed

LinkOut - more resources