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Several technical factors, not just neutral alignment, may influence final outcome of TKA
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Researchers of this review noted coronal alignment may not be the most important factor to determine the result of total knee arthroplasty, but rather sagittal and rotational alignment, joint line restoration and soft-tissue balance all may influence the final outcome.
Researchers assessed the historical and contemporary evidence regarding the function and survivorship of total knee arthroplasty (TKA) as it relates to coronal plane alignment. Historically, neutral alignment has been a long-held notion for optimal function and survivorship.
Investigators of this review noted recent evidence has challenged the impact of neutral alignment. They noted that Morgan and colleagues reviewed the outcomes of 197 TKAs at 9 years postoperatively and found no difference in revision rate between those in neutral, varus or valgus alignment.
“With regard to function, two medium-term studies have suggested that functional outcome is not adversely affected by residual postoperative varus alignment. From a series of 218 primary TKAs, Matziolis and colleagues compared the results of the 30 knees with the greatest postoperative varus alignment, to neutrally aligned, matched controls. The varus group had a mean postoperative mechanical axis deviation of 6.3° (3.9° to 10.7°). There was no difference in functional results using multiple validated measures, and no revisions in either group at a minimum 5-year follow-up,” researchers wrote in their review.
According to the authors of this review, ideal alignments for patient function and prosthesis longevity may be different. If so, advances in material technology may allow for implant survival in a more functional, but non-optimal mechanical environment. – by Robert Linnehan
Disclosure: Researchers report no relevant financial disclosures.
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