Large angular correction of arithmetic coronal alignment is associated with residual lateral laxity after total knee arthroplasty in varus knees for Japanese patients

Abstract

Abstract Purpose One of the most common types of coronal plane alignment of the knee (CPAK) is type I, which is characterised by varus alignment and apex distal joint line obliquity. The purpose of this study was to evaluate the association of changes in arithmetic hip–knee–ankle angle (aHKA) with both postoperative joint laxity and patient‐reported outcome measures (PROMs) in patients with CPAK type I following mechanical alignment (MA) total knee arthroplasty (TKA). Methods Of 111 consecutive knees in 92 patients with osteoarthritis who underwent primary TKA, 80 knees (72.0%) with CPAK type I phenotype preoperatively were evaluated. All TKAs were performed to achieve neutral MA by a medial stabilising gap balancing technique. Pre‐ to postoperative change in aHKA was defined as ΔaHKA. The 80 CPAK type I knees were divided into a larger ΔaHKA group (>7°) and a smaller ΔaHKA group (≤7°). PROMs, including the Knee Society Score and Forgotten Joint Score‐12, were assessed before and 2 years after surgery. Pre‐ and postoperative joint laxity was assessed using a Telos arthrometer. Results Twenty‐two knees showed a larger ΔaHKA, and postoperative lateral joint laxity in varus stress was significantly greater in these patients than in those with a smaller ΔaHKA (6.8° vs. 4.5°, p = 0.006). There were no significant differences between the groups in PROMs (p = n.s.). Conclusions Postoperative lateral laxity was associated with larger aHKA changes than smaller aHKA changes in CPAK type I knees after TKA. However, no statistically significant differences in PROMs were found according to the amount of change in aHKA. Level of Evidence Level III.

Keywords

• alignment
• coronal plane alignment of the knee
• patient‐reported outcome measures
• total knee arthroplasty
• varus