Neutral and constitutional coronal alignment yield similar outcomes in total knee arthroplasty at mid-term follow-up using the coronal plane alignment of the knee classification

IF 5 2区医学 Q1 ORTHOPEDICS

Knee Surgery, Sports Traumatology, Arthroscopy Pub Date : 2025-07-07 DOI:10.1002/ksa.12742

Eran Keltz, Saud Almaslmani, Eugenie Ng, Oren Tirosh, Libby Spiers, Sara Vogrin, Phong Tran

{"title":"Neutral and constitutional coronal alignment yield similar outcomes in total knee arthroplasty at mid-term follow-up using the coronal plane alignment of the knee classification","authors":"Eran Keltz, Saud Almaslmani, Eugenie Ng, Oren Tirosh, Libby Spiers, Sara Vogrin, Phong Tran","doi":"10.1002/ksa.12742","DOIUrl":null,"url":null,"abstract":"<div>\n \n \n <section>\n \n <h3> Purpose</h3>\n \n <p>Achieving neutral coronal mechanical alignment in knee arthroplasty is traditionally considered crucial for implant longevity and function. However, recent studies suggest alternative alignment strategies. This study examines the correlation between preoperative and postoperative coronal alignment and patient-reported outcome measures (PROMs) at midterm follow-up. We hypothesised that preserving a patient's constitutional alignment would yield superior results, whereas overcorrection toward neutral alignment would lead to poorer outcomes.</p>\n </section>\n \n <section>\n \n <h3> Methods</h3>\n \n <p>Data from 369 knee arthroplasties in 335 patients at a tertiary hospital, all performed aiming for mechanical alignment, was analysed. Coronal alignment and joint line obliquity were measured pre- and postoperatively using long-leg radiographs. coronal plain alignment of the knee (CPAK) classification was determined. PROMs, including the Oxford knee score (OKS), pain visual analogue scale (VAS) and EuroCol 5-dimensions (EQ.5D) VAS scores, were collected with a mean (standard deviation) follow-up period of 5.7 (1.6) years. Logistic regression was used to assess the association between coronal radiological measurements, CPAK classification, and PROMs, adjusting for age, sex and body mass index (BMI).</p>\n </section>\n \n <section>\n \n <h3> Results</h3>\n \n <p>No significant association was observed between maintaining the same coronal CPAK phenotype at the mid-term follow-up and patient outcomes. Patients who achieved postoperative neutral coronal alignment had a comparable mean OKS yet demonstrated a higher likelihood of reporting an excellent OKS. In cases where coronal alignment was over-corrected and crossed over from valgus to varus or vice versa, the OKS was 5.3 points lower (−9.3, −1.2, 95% confidence interval [CI]: <i>p</i> = 0.011), with an odds ratio [OR] of 3.1 (1.5, 6.7, 95% CI: <i>p</i> = 0.003) for a poor OKS, comparing patients who did not cross over to the opposite coronal alignment.</p>\n </section>\n \n <section>\n \n <h3> Conclusion</h3>\n \n <p>At the mid-term follow-up, patients with postoperative neutral coronal alignment demonstrated similar outcomes to those who maintained their preoperative constitutional alignment. Patients who had crossover from varus to valgus or vice versa exhibited significantly poorer results.</p>\n </section>\n \n <section>\n \n <h3> Level of Evidence</h3>\n \n <p>Level II.</p>\n </section>\n </div>","PeriodicalId":17880,"journal":{"name":"Knee Surgery, Sports Traumatology, Arthroscopy","volume":"33 10","pages":"3629-3636"},"PeriodicalIF":5.0000,"publicationDate":"2025-07-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Knee Surgery, Sports Traumatology, Arthroscopy","FirstCategoryId":"3","ListUrlMain":"https://esskajournals.onlinelibrary.wiley.com/doi/10.1002/ksa.12742","RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"ORTHOPEDICS","Score":null,"Total":0}

引用次数: 0

Abstract

Purpose

Achieving neutral coronal mechanical alignment in knee arthroplasty is traditionally considered crucial for implant longevity and function. However, recent studies suggest alternative alignment strategies. This study examines the correlation between preoperative and postoperative coronal alignment and patient-reported outcome measures (PROMs) at midterm follow-up. We hypothesised that preserving a patient's constitutional alignment would yield superior results, whereas overcorrection toward neutral alignment would lead to poorer outcomes.

Methods

Data from 369 knee arthroplasties in 335 patients at a tertiary hospital, all performed aiming for mechanical alignment, was analysed. Coronal alignment and joint line obliquity were measured pre- and postoperatively using long-leg radiographs. coronal plain alignment of the knee (CPAK) classification was determined. PROMs, including the Oxford knee score (OKS), pain visual analogue scale (VAS) and EuroCol 5-dimensions (EQ.5D) VAS scores, were collected with a mean (standard deviation) follow-up period of 5.7 (1.6) years. Logistic regression was used to assess the association between coronal radiological measurements, CPAK classification, and PROMs, adjusting for age, sex and body mass index (BMI).

Results

No significant association was observed between maintaining the same coronal CPAK phenotype at the mid-term follow-up and patient outcomes. Patients who achieved postoperative neutral coronal alignment had a comparable mean OKS yet demonstrated a higher likelihood of reporting an excellent OKS. In cases where coronal alignment was over-corrected and crossed over from valgus to varus or vice versa, the OKS was 5.3 points lower (−9.3, −1.2, 95% confidence interval [CI]: p = 0.011), with an odds ratio [OR] of 3.1 (1.5, 6.7, 95% CI: p = 0.003) for a poor OKS, comparing patients who did not cross over to the opposite coronal alignment.

Conclusion

At the mid-term follow-up, patients with postoperative neutral coronal alignment demonstrated similar outcomes to those who maintained their preoperative constitutional alignment. Patients who had crossover from varus to valgus or vice versa exhibited significantly poorer results.

Level of Evidence

Level II.

Abstract Image

查看原文本刊更多论文

在全膝关节置换术的中期随访中，使用膝关节分类的冠状面对齐，中性冠状面对齐和宪政冠状面对齐产生相似的结果。

目的：在膝关节置换术中实现中性冠状位机械对齐传统上被认为对假体寿命和功能至关重要。然而，最近的研究提出了其他结盟策略。本研究探讨了术前和术后冠状位对齐与中期随访中患者报告的结果测量（PROMs）之间的相关性。我们假设保留患者的体质排列会产生更好的结果，而向中性排列过度矫正会导致较差的结果。方法：对某三级医院335例369例膝关节置换术患者的数据进行分析。术前和术后使用长腿x线片测量冠状位和关节线倾角。确定膝关节冠状平面排列（CPAK）分类。收集PROMs，包括牛津膝关节评分（OKS）、疼痛视觉模拟评分（VAS）和EuroCol 5维VAS评分（EQ.5D），平均（标准差）随访5.7（1.6）年。在调整年龄、性别和体重指数（BMI）后，采用Logistic回归评估冠状放射测量、CPAK分类和PROMs之间的关系。结果：在中期随访中维持相同冠状CPAK表型与患者预后无显著相关性。术后实现中性冠状位对准的患者有相当的平均OKS，但显示出更高的可能性报告良好的OKS。在冠状位对齐过度矫正并从外翻到内翻或相反的情况下，与未交叉到相反冠状位对齐的患者相比，较差的OKS较低5.3点（-9.3,-1.2,95%可信区间[CI]: p = 0.011），优势比[or]为3.1 （1.5,6.7,95% CI: p = 0.003）。结论：在中期随访中，术后中性冠状位对齐的患者与术前保持冠状位对齐的患者表现出相似的结果。从内翻到外翻或反之的患者表现出明显较差的结果。证据等级：二级。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

求助全文

约1分钟内获得全文求助全文

来源期刊

Knee Surgery, Sports Traumatology, Arthroscopy 医学-外科

CiteScore

8.10

自引率

18.40%

发文量

418

审稿时长

2 months

期刊介绍： Few other areas of orthopedic surgery and traumatology have undergone such a dramatic evolution in the last 10 years as knee surgery, arthroscopy and sports traumatology. Ranked among the top 33% of journals in both Orthopedics and Sports Sciences, the goal of this European journal is to publish papers about innovative knee surgery, sports trauma surgery and arthroscopy. Each issue features a series of peer-reviewed articles that deal with diagnosis and management and with basic research. Each issue also contains at least one review article about an important clinical problem. Case presentations or short notes about technical innovations are also accepted for publication. The articles cover all aspects of knee surgery and all types of sports trauma; in addition, epidemiology, diagnosis, treatment and prevention, and all types of arthroscopy (not only the knee but also the shoulder, elbow, wrist, hip, ankle, etc.) are addressed. Articles on new diagnostic techniques such as MRI and ultrasound and high-quality articles about the biomechanics of joints, muscles and tendons are included. Although this is largely a clinical journal, it is also open to basic research with clinical relevance. Because the journal is supported by a distinguished European Editorial Board, assisted by an international Advisory Board, you can be assured that the journal maintains the highest standards. Official Clinical Journal of the European Society of Sports Traumatology, Knee Surgery and Arthroscopy (ESSKA).