Coronal Alignment in Total Knee Arthroplasty: Just How Important is it?
Section snippets
Materials and Methods
Between 1983 and 2006, six thousand seventy (6070) consecutive primary TKAs in 3992 patients were performed. Intraoperative alignment was achieved as previously described [8]. The femoral component was aligned to 5° of valgus using a intramedullary femoral guide. The proximal tibial cut was made perpendicular to the mechanical axis of the tibia using an extramedullary guide. Final intraoperative confirmation of overall tibial alignment was verified using a long rod through the center of the
Results
The average follow up was 6.6 ± 3.5 years (range, 2-22.5 years). During the study, 1118 (28.0%) patients died. The mean preoperative alignment was 0.1° varus (±7.7°) (range, 25° varus to 35° valgus); however, there was no difference in survival based on preoperative varus, valgus, or neutral alignment. The mean postoperative tibiofemoral angle was 4.8° (±2.5°) valgus. There were 4236 patients (69%) in the normal alignment group within 1 SD of the mean tibiofemoral angle (2.4°-7.2° valgus) (see
Discussion
The function and durability of total knee replacement is determined by a combination of patient-, implant-, and surgeon-related factors. One of the important variables controlled by the surgeon is proper positioning of the individual components and the resulting overall alignment of the lower extremity. Preoperative alignment did not have an impact on implant survival. Rather, postoperative alignment was the chief predictor of failure and revision surgery, regardless of the preoperative
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No benefits or funds were received in support of the study.
Investigation was performed at the Center for Hip and Knee Surgery, Mooresville, Ind.