Different targets of mechanical alignment do not improve knee outcomes after TKA |
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Authors: | Yasser Khatib Andrew Xia Justine M Naylor Ian A Harris Rami M Sorial |
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Institution: | 1. Nepean Hospital, 2 Hope St, PO Box 949, Penrith, NSW 2750, Australia;2. Nepean Hospital, Derby St, Penrith, NSW 2750, Australia;3. Whitlam Orthopaedic Research Centre, Ingham Institute for Applied Medical Research, Australia;4. C/O Orthopaedic Department, Liverpool Hospital, Locked Bag 7103, Liverpool BC 1871, Sydney, NSW, Australia;5. Whitlam Orthopaedic Research Centre, Ingham Institute for Applied Medical Research, South Western Sydney Clinical School, UNSW Sydney, Australia;6. Sydney University, Nepean Hospital, Derby St, Penrith, NSW 2750, Australia;7. Nepean Hospital, 60A Derby St, Penrith, NSW 2750, Australia |
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Abstract: | BackgroundAccurate alignment is a basic principle of TKA surgery, but achieving alignment within this target may not translate into superior outcomes after surgery.PurposeTo assess if neutral TKA mechanical alignment was associated with superior knee outcomes and to examine the effect of various aspects of pre-operative and post-operative alignment on knee function.MethodsAnalysis of a database of 444 TKA patients between June 2009 and October 2016. Knee outcomes (WOMAC, AKSS and knee range of motion) were collected before surgery and during follow-up at a minimum of six months.ResultsAnalysis included 444 TKA patients (62% female, mean age 66 years, mean follow-up 23 months). Deformity varied from 21° varus (mean = 7.9, SD = 2.8) to 17° valgus deformity (mean = 7.7, SD = 2.8). Pre-operatively, 101 (23%) knees were in native neutral mechanical alignment, while 278 (63%) were in varus and 65 (15%) were in valgus. Post-operatively, a group of 365 (82%) TKA were found to be in neutral mechanical alignment and a group of 79 (18%) TKA were noted to be ‘Outliers’ (17 4%] TKA > 3° varus and 62 14%] TKA > 3° valgus alignment). Restoration of the target of alignment of 0 ± 3° or 0 ± 1°, did not have better functional outcomes scores, range of motion or prosthesis longevity than those in the outlier range.ConclusionNeutral TKA alignment did not appear to be a significant contributing factor to the improvement in knee function in short-medium term follow-up. |
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Keywords: | Corresponding author at: 2 Hope St PO Box 949 Penrith NSW 2750 Australia Alignment Total knee arthroplasty Mechanical axis Function Patient satisfaction Prognosis |
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