The impact of residual varus alignment following total knee arthroplasty on patient outcome scores in a constitutional varus population
Following a total knee arthroplasty (TKA), restoration of the mechanical axis of the lower limb to a neutral position of 0° ± 3° is generally considered the standard of care. Little is known, however, regarding the impact of realignment defined according to the patient's physiologic anatomy on...
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| Veröffentlicht in: | The knee Jg. 25; H. 6; S. 1278 - 1282 |
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Elsevier B.V
01.12.2018
Elsevier Limited |
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| Abstract | Following a total knee arthroplasty (TKA), restoration of the mechanical axis of the lower limb to a neutral position of 0° ± 3° is generally considered the standard of care. Little is known, however, regarding the impact of realignment defined according to the patient's physiologic anatomy on clinical outcome scores.
The study included 67 knees with a mean age of 65.9 ± 8.3 years with unilateral osteoarthritis (OA) who underwent a primary unilateral TKA for medial end-stage OA. Patients were categorized based on post-operative limb alignment in one of two ways, either based on alignment relative to their contralateral, physiologic side (physiologic), or alignment relative to a neutral axis (neutral). Knee Society Score (KSS), Western Ontario & McMaster Universities Osteoarthritis Index (WOMAC), and the 12-Item Short Form Survey (SF-12) were compared between the two groups.
WOMAC Total and subscale scores improved for both groups between the pre- and post-operative time points. SF-12 scores were comparable post-operatively between the groups. WOMAC and KSS total and subscale scores were slightly greater post-operatively in the group not aligned according to their physiologic anatomy (neutral). However, none of these differences reached a level of significance.
Post-operatively, residual varus and neutral limb alignment lead to comparable clinical outcome scores. In a constitutional varus population with medial end-stage OA, aligning the lower limb during a TKA to a neutral position rather than the patient's native anatomy does not negatively impact self-reported patient outcome scores at the one and two-year time points. |
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| AbstractList | Following a total knee arthroplasty (TKA), restoration of the mechanical axis of the lower limb to a neutral position of 0° ± 3° is generally considered the standard of care. Little is known, however, regarding the impact of realignment defined according to the patient's physiologic anatomy on clinical outcome scores.
The study included 67 knees with a mean age of 65.9 ± 8.3 years with unilateral osteoarthritis (OA) who underwent a primary unilateral TKA for medial end-stage OA. Patients were categorized based on post-operative limb alignment in one of two ways, either based on alignment relative to their contralateral, physiologic side (physiologic), or alignment relative to a neutral axis (neutral). Knee Society Score (KSS), Western Ontario & McMaster Universities Osteoarthritis Index (WOMAC), and the 12-Item Short Form Survey (SF-12) were compared between the two groups.
WOMAC Total and subscale scores improved for both groups between the pre- and post-operative time points. SF-12 scores were comparable post-operatively between the groups. WOMAC and KSS total and subscale scores were slightly greater post-operatively in the group not aligned according to their physiologic anatomy (neutral). However, none of these differences reached a level of significance.
Post-operatively, residual varus and neutral limb alignment lead to comparable clinical outcome scores. In a constitutional varus population with medial end-stage OA, aligning the lower limb during a TKA to a neutral position rather than the patient's native anatomy does not negatively impact self-reported patient outcome scores at the one and two-year time points. BackgroundFollowing a total knee arthroplasty (TKA), restoration of the mechanical axis of the lower limb to a neutral position of 0° ± 3° is generally considered the standard of care. Little is known, however, regarding the impact of realignment defined according to the patient's physiologic anatomy on clinical outcome scores.MethodsThe study included 67 knees with a mean age of 65.9 ± 8.3 years with unilateral osteoarthritis (OA) who underwent a primary unilateral TKA for medial end-stage OA. Patients were categorized based on post-operative limb alignment in one of two ways, either based on alignment relative to their contralateral, physiologic side (physiologic), or alignment relative to a neutral axis (neutral). Knee Society Score (KSS), Western Ontario & McMaster Universities Osteoarthritis Index (WOMAC), and the 12-Item Short Form Survey (SF-12) were compared between the two groups.ResultsWOMAC Total and subscale scores improved for both groups between the pre- and post-operative time points. SF-12 scores were comparable post-operatively between the groups. WOMAC and KSS total and subscale scores were slightly greater post-operatively in the group not aligned according to their physiologic anatomy (neutral). However, none of these differences reached a level of significance.ConclusionPost-operatively, residual varus and neutral limb alignment lead to comparable clinical outcome scores. In a constitutional varus population with medial end-stage OA, aligning the lower limb during a TKA to a neutral position rather than the patient's native anatomy does not negatively impact self-reported patient outcome scores at the one and two-year time points. Following a total knee arthroplasty (TKA), restoration of the mechanical axis of the lower limb to a neutral position of 0° ± 3° is generally considered the standard of care. Little is known, however, regarding the impact of realignment defined according to the patient's physiologic anatomy on clinical outcome scores.BACKGROUNDFollowing a total knee arthroplasty (TKA), restoration of the mechanical axis of the lower limb to a neutral position of 0° ± 3° is generally considered the standard of care. Little is known, however, regarding the impact of realignment defined according to the patient's physiologic anatomy on clinical outcome scores.The study included 67 knees with a mean age of 65.9 ± 8.3 years with unilateral osteoarthritis (OA) who underwent a primary unilateral TKA for medial end-stage OA. Patients were categorized based on post-operative limb alignment in one of two ways, either based on alignment relative to their contralateral, physiologic side (physiologic), or alignment relative to a neutral axis (neutral). Knee Society Score (KSS), Western Ontario & McMaster Universities Osteoarthritis Index (WOMAC), and the 12-Item Short Form Survey (SF-12) were compared between the two groups.METHODSThe study included 67 knees with a mean age of 65.9 ± 8.3 years with unilateral osteoarthritis (OA) who underwent a primary unilateral TKA for medial end-stage OA. Patients were categorized based on post-operative limb alignment in one of two ways, either based on alignment relative to their contralateral, physiologic side (physiologic), or alignment relative to a neutral axis (neutral). Knee Society Score (KSS), Western Ontario & McMaster Universities Osteoarthritis Index (WOMAC), and the 12-Item Short Form Survey (SF-12) were compared between the two groups.WOMAC Total and subscale scores improved for both groups between the pre- and post-operative time points. SF-12 scores were comparable post-operatively between the groups. WOMAC and KSS total and subscale scores were slightly greater post-operatively in the group not aligned according to their physiologic anatomy (neutral). However, none of these differences reached a level of significance.RESULTSWOMAC Total and subscale scores improved for both groups between the pre- and post-operative time points. SF-12 scores were comparable post-operatively between the groups. WOMAC and KSS total and subscale scores were slightly greater post-operatively in the group not aligned according to their physiologic anatomy (neutral). However, none of these differences reached a level of significance.Post-operatively, residual varus and neutral limb alignment lead to comparable clinical outcome scores. In a constitutional varus population with medial end-stage OA, aligning the lower limb during a TKA to a neutral position rather than the patient's native anatomy does not negatively impact self-reported patient outcome scores at the one and two-year time points.CONCLUSIONPost-operatively, residual varus and neutral limb alignment lead to comparable clinical outcome scores. In a constitutional varus population with medial end-stage OA, aligning the lower limb during a TKA to a neutral position rather than the patient's native anatomy does not negatively impact self-reported patient outcome scores at the one and two-year time points. AbstractBackgroundFollowing a total knee arthroplasty (TKA), restoration of the mechanical axis of the lower limb to a neutral position of 0° ± 3° is generally considered the standard of care. Little is known, however, regarding the impact of realignment defined according to the patient's physiologic anatomy on clinical outcome scores. MethodsThe study included 67 knees with a mean age of 65.9 ± 8.3 years with unilateral osteoarthritis (OA) who underwent a primary unilateral TKA for medial end-stage OA. Patients were categorized based on post-operative limb alignment in one of two ways, either based on alignment relative to their contralateral, physiologic side (physiologic), or alignment relative to a neutral axis (neutral). Knee Society Score (KSS), Western Ontario & McMaster Universities Osteoarthritis Index (WOMAC), and the 12-Item Short Form Survey (SF-12) were compared between the two groups. ResultsWOMAC Total and subscale scores improved for both groups between the pre- and post-operative time points. SF-12 scores were comparable post-operatively between the groups. WOMAC and KSS total and subscale scores were slightly greater post-operatively in the group not aligned according to their physiologic anatomy (neutral). However, none of these differences reached a level of significance. ConclusionPost-operatively, residual varus and neutral limb alignment lead to comparable clinical outcome scores. In a constitutional varus population with medial end-stage OA, aligning the lower limb during a TKA to a neutral position rather than the patient's native anatomy does not negatively impact self-reported patient outcome scores at the one and two-year time points. |
| Author | Vasarhelyi, Edward M. Lanting, Brent A. Teeter, Matthew G. Somerville, Lyndsay E. Vandekerckhove, Pieter-Jan Williams, Harley A. Matlovich, Nicholas F. Howard, James L. |
| Author_xml | – sequence: 1 givenname: Brent A. surname: Lanting fullname: Lanting, Brent A. organization: Department of Surgery, Division of Orthopaedic Surgery, Schulich School of Medicine & Dentistry, Western University & London Health Sciences Centre, University Campus, 339 Windermere Road, London, ON N6A 5A5, Canada – sequence: 2 givenname: Harley A. surname: Williams fullname: Williams, Harley A. email: harley.williams@lhsc.on.ca organization: Robarts Research Institute, Western University, 1151 Richmond Street, London, ON N6A 5B7, Canada – sequence: 3 givenname: Nicholas F. surname: Matlovich fullname: Matlovich, Nicholas F. organization: Department of Surgery, Division of Orthopaedic Surgery, Bluewater Health, 89 Norman Street, Sarnia, ON N7T 6S3, Canada – sequence: 4 givenname: Pieter-Jan surname: Vandekerckhove fullname: Vandekerckhove, Pieter-Jan organization: Department of Surgery, Division of Orthopaedic Surgery, AZ Sint-Jan Brugge, Ruddershove10, 8000 Bruges, Belgium – sequence: 5 givenname: Matthew G. surname: Teeter fullname: Teeter, Matthew G. organization: Department of Surgery, Division of Orthopaedic Surgery, Schulich School of Medicine & Dentistry, Western University & London Health Sciences Centre, University Campus, 339 Windermere Road, London, ON N6A 5A5, Canada – sequence: 6 givenname: Edward M. surname: Vasarhelyi fullname: Vasarhelyi, Edward M. organization: Department of Surgery, Division of Orthopaedic Surgery, Schulich School of Medicine & Dentistry, Western University & London Health Sciences Centre, University Campus, 339 Windermere Road, London, ON N6A 5A5, Canada – sequence: 7 givenname: James L. surname: Howard fullname: Howard, James L. organization: Department of Surgery, Division of Orthopaedic Surgery, Schulich School of Medicine & Dentistry, Western University & London Health Sciences Centre, University Campus, 339 Windermere Road, London, ON N6A 5A5, Canada – sequence: 8 givenname: Lyndsay E. surname: Somerville fullname: Somerville, Lyndsay E. organization: Department of Surgery, Division of Orthopaedic Surgery, Schulich School of Medicine & Dentistry, Western University & London Health Sciences Centre, University Campus, 339 Windermere Road, London, ON N6A 5A5, Canada |
| BackLink | https://www.ncbi.nlm.nih.gov/pubmed/30314879$$D View this record in MEDLINE/PubMed |
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| Copyright | 2018 Elsevier B.V. Elsevier B.V. Copyright © 2018 Elsevier B.V. All rights reserved. Copyright Elsevier Limited Dec 2018 |
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| Keywords | Knee Constitutional varus Osteoarthritis Clinical outcomes |
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| Snippet | Following a total knee arthroplasty (TKA), restoration of the mechanical axis of the lower limb to a neutral position of 0° ± 3° is generally considered the... AbstractBackgroundFollowing a total knee arthroplasty (TKA), restoration of the mechanical axis of the lower limb to a neutral position of 0° ± 3° is generally... BackgroundFollowing a total knee arthroplasty (TKA), restoration of the mechanical axis of the lower limb to a neutral position of 0° ± 3° is generally... |
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| SubjectTerms | Aged Anatomy Arthritis Arthroplasty (knee) Arthroplasty, Replacement, Knee - adverse effects Arthroplasty, Replacement, Knee - methods Bias Biomechanics Clinical outcomes Constitutional varus Design Female Genu Varum - surgery Humans Joint surgery Knee Knee Joint - surgery Knee Prosthesis - adverse effects Male Middle Aged Orthopedics Osteoarthritis Osteoarthritis, Knee - surgery Patient Reported Outcome Measures Patients Polyethylene Studies Surgeons |
| Title | The impact of residual varus alignment following total knee arthroplasty on patient outcome scores in a constitutional varus population |
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